Hello, I am Michelle and I'm here today to talk about the Maternity Community Hubs in Logan. So the Innovation Project also was concentrated around the project management quadruple aim of ensuring that we are strengthening and growing continuity of care and evaluating that. So the experiences of women, the clinical care outcomes, and the experiences of staff and, most importantly, going to our community and looking to see, you know, what our community want and how they would like us to grow care in the community, really having their voices around the table. And so at the end of the project, obviously, the main aim was to ensure that we had all of those voices in our evaluation and alongside looking at our clinical outcomes. So we were incredibly fortunate to be awarded two million and, give or take, around $58,000 to grow and strength midwifery continuity of care models at Logan Hospital. So we were really fortunate at Logan because we already had an established Midwifery Group Practise in the community. So the Community Maternity Hubs had been established in 2017 and was growing. There'd already been a preliminary evaluation that showed us that our outcomes were promising. So what we, the emergent and unmet need at Logan was around our priority populations. So the population at Logan of our diverse priority populations is growing, and growing faster than the state. We have a First Nations population in and around Logan that is also growing faster than the state, we have culturally and linguistically diverse families, we have Maori and Pacific Island families, and we have a large population of young parents. These are the people that were needing priority care in that they were disengaged with the health service. They didn't feel safe. They wanted to be cared for in a way that felt culturally appropriate. And so in 2017, we took care into the community with the Community Maternity Hubs. We wanted to improve our engagement and our clinical outcomes and we wanted to improve trust and engagement with our community. So there's only one way to do that and that is to ensure that community is around the table giving voice to how they want their care to be provided. And so the innovation around the Community Maternity Hubs is really around bringing community to the table and not just taking a healthcare service and putting it in the community. We wanted to have a service that was completely reflective of our community voice, our community organisations, and our consumers, and so we wanted that to be not just at the startup of the project but ongoing. And so what this gives us an opportunity to do is, throughout the years, as we grow this programme and this model of care, to continue to have our community around the table with us in a true co-designed project, which is the beauty of the Community Maternity Hubs. So with any growth that happens quickly, and change, there's obviously challenge. The beauty of this is we already had an established programme. So we didn't have a startup. We were established. We needed to grow and strengthen the model and that was the task that the project had. And so we did that. We had some unexpected delays with recruitment, and whilst recruitment can often have unexpected delays, I think COVID certainly, it was our lives from early 2020 onwards and we did experience challenges with not only providing the care but ensuring that we had the workforce to grow and sustain the model. And I think, you know, that's almost a given, really, when you are growing something really quickly, is that you have delays, but that's okay. And so, yeah, we pivoted and we do-si-doed like everyone did in 2020 but we managed to have the growth of our workforce, you know, in place by about April/May of that year and then we had our skates on growing the model. So the beauty of this project is, as I said, we already had a programme. We knew what we needed to stay true to, which was growing midwifery models of care, continuity of care in the community, and the Community Maternity Hubs, which is based around the Lancet framework, and it's about taking care to the community, for the community, with the community. So there's a term and it's called proportionate universalism and it's really just about ensuring that women get the care they need, where they need it, when they need it, and how they need it. So the challenge always with a health service is to ensure that the needs of the community and the women that you're caring for are a priority inside this institution that you are working for, which also has priorities and needs in how it delivers the care. So the challenge is, how do we ensure with the Community Maternity Hubs that we are putting the needs of our women and families first? So if we stay true to that, it's almost like having a true north. So you know that at the end of the day your goal is to engage your priority populations in care, ensure that they feel safe, that they want to show up for care, and that the care is exactly in the right way that they need to have it. So it must feel safe. It must be resourced. We must be able to pivot and react and change and deliver to the needs of the consumers that we are seeing on daily basis. And those are young women who don't have transport. Those are First Nations women who are disengaged with the service and just need to trust a friendly face, someone that they know in the community. And that is essentially what we are striving to do every day and that we're really finding the community is responding to. So there are many opportunities when you're doing something like this, growing a service, engaging with stakeholders both internal and external. What happened was we went about our business of growing a service, growing a workforce, essentially, and growing a service around the templated vision of what we already had. So that was the easy part. So then COVID happened and we were presented with some challenges around, how are we going to, in a meaningful way, engage our community in consumer consultation, in their voice, and how are we going to do this evaluation with the added problems and issues and challenges that we came up, you know, that COVID presented us? And I've heard it said, and it's true also of this project, that it presented us with opportunities that we may not have thought about originally. So when we went out, we sort of cast our net out wider, asking community, how can we deliver, you know, how can we do this in a COVID-safe way? How can we all get our voices around the table? How can we use digital? How can we use face-to-face? How can we gather ourselves together? And so it just got us thinking about not so much the clinical aspects because they were happening anyway. We had our workforce. Our workforce was growing. We were providing midwifery care in the community. We were engaging with our stakeholders. We were coming up with ways to improve, you know, the care we were giving into the first 1,000 days of life. But then how is it that, you know, that we can engage in a meaningful way around our evaluation? We did reach out to Logan together, our community partners, and we developed a consultation process for the evaluation that I don't think, you know, we perhaps would have otherwise. So it presented us with opportunities to think outside the square. That consumer consultation process was amazing. We reached out wide to our community groups and 50% of the women and families that were interviewed for that consultation process for the evaluation were First Nations women. We were able to engage our community, our First Nations women and families, our Elders, and just what we produced in the end to form part of the evaluation was, I'm sure, richer, more contextual, and multifaceted than we perhaps would have achieved had COVID not forced us into thinking outside the square a bit more than usual. Like I said, we already had a model of care and we had a philosophy and a way of delivering this care that we were absolutely certain that we wanted to achieve. So what we were able to extend on is, just because of the funding, was to increase our staffing to ensure that more women were achieving this care but also to concentrate on building a First Nations workforce and a identified workforce for our culturally and linguistically diverse communities. The project has given us an opportunity not just to upscale our continuity of care but to invest in ensuring that we are recognising we need First Nations workforce to care for First Nations women. We need Pacific Island community workforce to care for those women. We need to be investing in our young workforce. We need to be ensuring we've got new graduate positions and building our workforce from a identified perspective now. It's urgent and it will meet emergent healthcare needs for our priority populations. So the project has given us the opportunity to do that. So we now, before the project, we didn't have identified positions and new graduate positions. Now we have four, and we will continue to do that. Metro South Health has gotten behind the project, supplied recurrent funding. And so it was just the project pivoted us into a push of seeing what was possible and now we have this and we can say, I think, with a certain amount of confidence that we are growing an Indigenous First Nations workforce and a workforce that is completely in touch with the community needs and is able to bring the cultural capacity and safety to our community that is required. And this is exactly what we need to see for priority populations' life trajectory outcomes and for closing the gap. The evaluation, as I've said earlier, looked at women's experiences, staff experiences. It looked at, it looked at economic outcomes and it looked at clinical outcomes. So I'm very, very happy to say, and not surprisingly at all, that midwifery continuity of care is associated with improved maternal and infant outcomes, and this is something that we've known for a very long time. The jury returned quite a while ago and that's why we're getting funding for these models, because not only do they work for women, they show improved outcomes, and that helps with, you know, I think if you are thinking about improving a life trajectory for a priority population, start with women and babies. Put your money where things are improved for a mother and her family and her infant, and that's where it starts and that is where we will get to see the most sustained outcomes for, you know, the things that we're looking at long term, so into the first thousand and 2,000 days of life. So what did we see? Of course, we saw, around our maternity and neonatal outcomes, we saw improved, less caesarean section, less interventions. We saw higher breastfeeding rates. We saw a greater than 20% increase in smoking reduction and cessation for our First Nations women and for young women. And across the board, if you are in a midwifery community hub receiving that model of care, you can expect to have less special care nursery admissions for your baby. You can expect to have those social determinants of help improving because of the engagement and the wraparound services into the first 1 and 2,000 days. So the outcomes that we saw were increased antenatal attendance. Now, that was the big-ticket item for us at Logan because the women were disengaged with the service and at one point we had greater than 10% of our priority populations not attending for care. That's the whole reason the programme was started, engaging our priority populations. So earlier engagement, greater than 26 weeks, is something that we needed to improve upon and we've certainly done that. So women accessing our programme largely have booked in with us around 14 to 16 weeks. We have achieved less special care nursery admissions, pre-term birth, and low term birth weight babies. We have increased our smoking cessation and reduction targets. We have increased our engagement across the board with our consumers coming to the hubs and our referral rates after discharge from midwifery care. So that is, you know, referring women into services that will take them into the first 1,000 days of life in nurturing and caring for their family. If you're thinking about cost efficiency, which, of course, forms part of the quadruple aim when you're looking at your outcomes, we can certainly say that MGP, across the board, if you are in the Community Maternity Hubs model, you have less interventions. So what that means is that it's a cost saving for the facility. So on average, when you look at the reduced interventions with Midwifery Group Practise, it is around about a 5 to $800 saving per woman that we were able to evaluate in our evaluation at the end of the project. So that's significant when you're looking at achieving 30% of women having their model of care at Logan, you know, and perhaps even growing that into the future to 50%, which would be ideal. So you're looking at a significant cost saving for the service as well. So one of the highlights of this project has been the consumer consultation process, hearing from women in our community who have lived in the Logan community for a number of years, who have birthed at Logan, and also, recently, being able to hear from them the difference that this programme has made for them. One of the most compelling stories to hear is how they have felt about their experience before being able to access the Community Maternity Hubs and then after. So that is such a powerful story, how a woman felt having her baby with a certain model of care and then the difference that that made in her experience of that care. And not just in that care episode, but how she has felt about her life into the future with her family. So the amazing experience that she was able to tell us she had with the Community Maternity Hubs that has made such a difference in her life, that has helped her with her self-determination and her confidence, with improving health behaviours that she didn't have the motivation to improve before, to change the life trajectory for herself and her family. And that is why those of us working in these continuity models are so motivated to achieve more of them, to grow them, to sustain them into the future, to bring identified workforces to these models, because of those stories and those women and families, one at a time, that we have the gift of being able to hear these stories from, because we know and we understand that these outcomes and these stories that the women are telling us are going to make a difference for the health and wellbeing of their families into the future. That's why we get out of bed every morning. I hope that you've found this presentation from the Nursing and Midwifery Showcase informative. Please take some time to check out other projects that highlight nursing and midwifery excellence in Queensland Health.