Case study: Improving Safety Culture in North West London one conversation at a time

Background

Perinatal care sits at the intersection of clinical excellence and profound human vulnerability. Every interaction — between staff, between teams, between families and the system — shapes outcomes. Culture is not a backdrop to safety; it is the mechanism through which safety is created.  

In North West London, where diversity, complexity, and demand converge, the quality of perinatal culture is not just a leadership concern — it is a determinant of equity, safety, and trust.  

The Perinatal Culture and Leadership Programme (PCLP) supports maternity and neonatal services across North West London (NWL) to strengthen safety culture, leadership behaviours and escalation practices as part of the National Patient Safety Improvement Programme. Commissioned by NHS England as part of the National HINS Specification 2025-56 ICHP works in collaboration with the NWL Local Maternity Neonatal Services  and is embedded within the ICS ecosystem. The Perinatal Culture and Leadership Programme (PCLP)  responded to growing evidence that culture and leadership are critical enablers of safe, equitable care in maternity and neonatal services. 

Project aims

The project aimed to support teams to move from understanding culture to actively improving it, enabling safer escalation, better multidisciplinary working and a more supportive environment for staff and families. Ultimately, the goal is to strengthen patient safety and staff wellbeing across maternity and neonatal pathways, contributing to healthier outcomes for women, babies and families in NWL. 

Partners

As the health innovation network for NWL, ICHP worked collaboratively with: 

• NWL maternity and neonatal provider trusts operational and clinical leads-.NWL Trusts include Imperial NHS Trust (ICHT) , The Hillingdon hospitals NHS Trust (THHT), London North West University Trust (LNWH) and Chelsea and Westminster NHS Trust.   

• Perinatal leadership teams (PLTs) 

• NWL local maternity and neonatal system (LMNS) 

• NWL Integrated Care Board (ICB) (before their merger to the West and North London ICB) 

• Culture coaches, cultural safety Midwives and quality improvement leads 

Trust leaders brought deep frontline insight, leadership sponsorship, while ICHP led on  programme design, facilitation, quality improvement methods, evaluation support and system connectivity. In addition connecting with National HINs allows cross sector collaboration, including implementation of innovative methods for supporting Safety Culture to enable safer escalation.  

Method

ICHP designed and implemented a unique support offer, using National evidence based interventions combined with ICHP expertise in Human Factors and use of Liberating Structures methodology. This offer  embedded Culture and Leadership directly into patient safety and deterioration workstreams, rather than treating culture as a standalone activity. Key approaches included: 

• Use of MOMENTs to surface everyday safety concerns and patterns in escalation 

• Conversation Cafés to create protected, multidisciplinary spaces for reflection and learning 

• Support to PLTs to translate insight into quality improvement actions 

• Development of communities of practice for culture coaches and safety leads 

• Routine sharing of learning across LMNS, ICS and national HIN forums 

• Evaluation using qualitative feedback, mentimeter outputs and local data 

Impact

The programme strengthened the conditions that support safe care, including psychological safety, inclusive leadership and confident escalation. 

Key impacts include: 

• Increased multidisciplinary engagement in reflective safety conversations in NWL trusts 

• Clear links made between culture insights and practical system improvements, including escalation pathways, communication tools and QI sprints 

• Development and spread of Conversation Cafés methodology directly informing local action at trust level 

• Collaboration with NWL ICB in evaluation of the Cultural Safety Midwife role in NWL — the first of its kind — now embedded into business‑as‑usual 

• Particular mention to the attention and commitment to progressing culture work at The Hillingdon Hospital, where culture champions meet weekly, lead improvement activity and co‑developed bespoke active bystander training in addition to several culture initiatives for example work in equity and trainee support. 

• Production of a Return on Investment paper on Human Factors and Safety Culture to support local business cases and sustainability

The programme has positively impacted workforce experience, leadership capability and the system’s ability to learn and improve safely. 

Scalability and next steps

Maternity and neonatal teams are working in increasingly complex environments, and across NWL there is strong professional commitment to delivering safe, compassionate care. The PCLP has focused on enabling this commitment — supporting teams to embed strong leadership behaviours, inclusive cultures and psychological safety into everyday practice. 

Rather than adding burden, the programme builds on what staff are already doing well by creating structured opportunities for reflection, learning and collaboration. This approach supports confident escalation, shared ownership of risk and sustained improvement over time. 

The NWL model demonstrates how culture and leadership development can support staff wellbeing, strengthen safety behaviours and contribute to more joined‑up, equitable care. Learning from the programme is being shared across systems, offering a scalable approach that can be adapted locally and spread more widely.