Learning and Action Network (LAN)

What?

The NHS Race and Health Observatory, in partnership with the Institute for Healthcare Improvement and supported by the Health Foundation, has established an innovative peer-to-peer Learning and Action Network (LAN). The LAN aims to address the inequalities seen in severe maternal morbidity, perinatal mortality and neonatal morbidity for people from Black, Asian and other ethnic minority backgrounds.

Ten teams, from eight Integrated Care Systems, in four regions are participating in an anti-racism focused quality improvement programme. The teams are focusing on four conditions where evidence highlights significant ethnic inequalities in health outcomes: post-partum haemorrhage; preterm birth; maternal mental health; and gestational diabetes.

Why?

Ethnic health inequalities are a long-standing challenge; Black women remain three times more likely to die during or soon after pregnancy compared to White women and the maternal death rate for women from Asian ethnic backgrounds remains two times higher than that of White women.  Babies from the Black ethnic group have the highest rates of stillbirths and infant deaths, with babies from the Asian ethnic group consistently the second highest.

In England, there are few large-scale maternal and neonatal health improvement initiatives aimed specifically at addressing ethnic health inequalities. There are also evidence gaps around organisation-level interventions targeting structural and institutional processes which perpetuate racism and ethnic health inequalities.

The RHO LAN pilot is based on the assumption that racism is one of the factors responsible for the persistence of ethnic health inequalities. Through this pilot, which views racism and racial bias as determinants of health, we aim to understand whether it is feasible, acceptable and possible to improve maternal and neonatal health outcomes for people from Black, Asian and other ethnic minority backgrounds through an anti-racism focused quality improvement approach.

How?

We are working with colleagues from the Institute for Healthcare Improvement and a group of experts drawn from the NHS RHO Maternal and Neonatal Health Advisory Group to develop and deliver an anti-racism focused Quality Improvement programme. By embedding the RHO Anti-Racism Principles in the programme, we aim to support teams to identify and address racism and racial bias in maternity services.

The RHO Anti-Racism Principles

1. Demonstrate leadership by naming racism, engaging seriously and continuously with the ways in which racism impacts the lives of the patients and the public, and actively working to dismantle it.

2. Understand and acknowledge that structural, institutional and interpersonal racism all impact on health and be clear about where accountability lies for improvement and progress. Create transparent pathways for raising concerns and tangible steps for addressing them.

3. Meaningfully involve racially minoritised individuals and communities in in every stage of developing a service or intervention, including ensuring that teams and decision-making structures themselves are racially diverse and fundamentally inclusive.

4. Collect and publish data on race inequity in its entirety, ensuring it directly informs policy, strategy, and improvement. Where data is not available, change policies to ensure that data is collected.
5. Identify racist bias in policies, decision making processes, and other areas within your organisation.

6. Apply a race-critical lens to the adoption of any interventions or improvements to be tested, and to the design and delivery of services.

7. Evaluate and reflect on interventions using metrics that recognise the role of racism as determinant of health. These evaluations should seek to understand the extent to which interventions mitigate the impacts of racism.

Find out more:

We are looking for an evaluation partner to explore the feasibility and acceptability of an anti-racism focused improvement approach to address ethnic inequalities in maternal and neonatal health. Please see our Invitation to Tender for more information.

Teams participating in the first phase of the RHO LAN include:

The LAN programme includes: improvement coaching, anti-racism webinars, clinical webinars, online and in-person sessions during which teams share and develop their learning around quality improvement methodologies and implementing anti-racism improvement at System level.

What next?

Through the initial phases of this pilot, we aim to assess feasibility, acceptability and effectiveness of applying an anti-racism focused Quality Improvement interventions and understand contextual and implementation factors important for scaling this approach. We are commissioning an evaluation to help us to understand these points and to design a strategy to scale and spread interventions of value for reducing maternal and neonatal ethnic health inequalities.

In later phases of this work, we will also seek to understand the applicability of this approach to other conditions and areas.

For further information, please contact: implementation@nhsrho.org