Mother knows best – a bizarre tale of variation…

As those of you who know me are already aware, I’m now just over 28 weeks pregnant! This is a brand new and exciting experience for me, and has exposed me to a whole raft of strange stories I can share with you all, primarily around the bizarre way I’ve seen management practices in the NHS seek to industrialise this very natural process.

In this blog, I’m going to look at due dates – how they’re calculated and managed…. For those of you not familiar, when a woman finds out she’s pregnant, the due date (the date we’d expect baby to arrive) is estimated using a calculation which is roughly along the lines of 40 weeks (280 days) after their last period.

It doesn’t take a world renowned obstetrician to explain that there are several factors that might influence the accuracy of this date which is known as the estimated date of delivery or EDD, for example, women’s menstrual cycles vary, dates may be inaccurate and also the length of gestation (the length of time it take an embryo to develop into a baby ready to be born).

So to get round this “problem”, a lot of women are sent for a dating scan when they think they are around 12 weeks pregnant to literally “date” the pregnancy. Now this ultrasound EDD, coupled with the original EDD, and monitoring at different stages during pregnancy does seem to give a good indication of timely development of the baby at any moment in time. However, this amateur medic has noticed that all children vary in their development, with growth spurts and plateaus, and understands this variation also applies in babies before they are born too.

This variation isn’t some wild phenomenon that just applies to pregnancy and childbirth… Imagine you catch the bus to work… the timetable says it leaves your stop at 8am. Even if it comes on time, you’re not pleased – because you’ve probably learned that although the 8 o’clock bus always gets you to work in time, it can arrive any time between ten to and ten past eight, so to guarantee you catch it, you need to be at the stop by 7.50am, meaning when it’s on time, you’ve still had to wait 10 minutes, and if it’s late, you’re getting pretty grumpy because you’ve been standing in all weathers for 20 minutes! But you know what to expect unless something out of the ordinary happens.

I drive to work – even if I set off at exactly the same time every day, it can take me between 45 minutes and 70 minutes to arrive at the car park at work. There are many things that influence the time it takes to vary so much – everything from if it’s sunny or raining (so if people walk, get the bus or drive), roadworks or accidents en route, whether I hit the many sets of traffic lights on red or green, through to the time other drivers set off that day. However, earlier this month it took me 3 ½ hours to get to work – not because of any of these “common causes”, but because of something very unusual – really bad snow and ice had closed many routes “over the tops” to Bradford, and the main roads were still pretty treacherous, resulting in a huge volume of traffic and massive delays for everyone – a “special cause”.

So going back to the birth of babies – this is precisely what is happening with due dates - only 5% of babies arrive on their due date, with typically 95% of babies being born between approximately 265 and 300 days, with the average roughly around the EDD or 280 days. So in reality, it may be smarter to suggest a baby might be expected in a particular month, rather than on a particular date, and only be concerned if a baby arrives before 265 days or after 300 days….

I wish someone would explain variation to some of the maternity service providers – then they might stop treating women whose pregnancies go "post term" (beyond their EDD) as special cases requiring medical intervention.

Once a mum gets to her EDD, the maternity services start paying attention to her – they want to get her monitored on a daily basis (often above and beyond government guidelines), and want to get her booked in for an induction whether or not there is any real medical reason. I’ve heard of a number of cases where mothers have been bullied and pressured by midwives and obstetricians using emotive language rather than evidence based information as they go beyond the EDD. I know of people that have been threatened with still born babies, have been offered mental health services and had implications that made them feel like social services might be involved further down the line because they’d prefer to adopt a “wait and see” approach, providing everything was ok with their baby.

Ironically, this whole exercise causes stress for the woman concerned, which in itself can delay labour! But more worryingly, the induction of a baby that’s simply not ready to be born would result in birthing an immature baby and can mean further medical intervention and an increased possibility of a caesarian being required. It’s obvious that this is no good for mum and baby. But there is also a real, adverse impact on the NHS in terms of the additional costs associated with premature baby care, surgery and after care for mum.

So why, you might ask, is the NHS doing something that on the face of it to the lay man seems so crazy! The straight answer is that I’m not sure – there seem to be a number of issues at play which might include a fear of litigation (so everyone is treated as a special case rather than those that need it, “just in case”); how the PCTs are funded for maternity services; or meeting the dreaded targets.

However, whatever the problem, something needs to be done to bring our maternity services back to basics - delivering their true purpose, not covering their backs and following policies and guidelines. But the NHS really needs to take steps to understand & accept the common causes of variation in arrival dates, and the difference between them and special situations that actually do require their help and intervention!

Unfortunately, this blogger knows that won’t happen before her baby arrives “some time in April”…

Orange cuts 300 call centre jobs in order to "improve, grow & evolve the company"

Yesterday, mobile phone giant Orange announced its plans to close its call centre in Bristol, resulting in the loss of 300 jobs. An anonymous spokesman for Orange commented “As part of our strategy to improve, grow and evolve the company, we are continually looking at ways to ensure we are operating in the most efficient way.”

OK – so let me translate – in order to cut costs (perhaps something to do with their impending merger with T Mobile who operate their call centres overseas??), Orange have sacked 300 customer facing staff.

But is that really the smartest thing to do…? Many of the internet sites that published this story had comments posted that not only sympathised with the displaced workers, but also were critical of Orange’s management and customer service. If the company is facing financial challenges, customer service isn’t good enough, then to simply slash jobs in customer service is downright foolish!

I’m not advocating that Orange simply soldier on regardless – that would be commercial suicide. However, I do think they must change the way they work so they are able to deliver better quality more efficiently.

As I’ve said before, this is possible – not through some magical, mystical approach, but through applying a bit of common sense! Instead of focusing on productivity, the management at Orange need to measure what matters to their customers: focus on quality, and trusting and empowering their staff to do what customers ask them to and taking the time to do it right first time, every time. Then their efficiency will be better as a direct consequence.

Delivering a better quality service means lower operating costs, lower prices, improved market share and company growth – which sounds a bit to me like what Orange said they wanted…

So come on Orange – be a bit smarter in your thinking and do something different from the norm in your industry so you can save money and offer a better service to your customers!!!