This case study summarises the Post Partum Haemorrhage (PPH) initiative at Lancashire Teaching Hospital, which aimed to reduce health inequalities in PPH incidence, particularly among women and birthing people from Black and ethnic minority backgrounds.
Context and Background
Lancashire Teaching Hospital focused on addressing health inequalities in the incidence of post-partum haemorrhage (PPH), particularly among women and birthing people from Black and ethnic minority backgrounds. Baseline data revealed a significant disparity: 12% of individuals from these groups experienced PPH of 1000mL or more per week, compared to just 5% of white individuals. The hospital set a clear aim to reduce the rate of PPH in Black and ethnic minority women and birthing people by 50%, targeting a reduction from 12% to 6% by March 2025. The population of focus, based on electronic patient records, included just over two women per week from these backgrounds experiencing significant PPH. This relatively small group size allowed for close monitoring and timely evaluation of interventions using weekly time series data.4
Addressing the issues
To tackle the issue of post-partum haemorrhage disparities, the team at Lancashire Teaching Hospital began by collaborating closely with data analysts to gain a clearer understanding of the trends and patterns within their service user population. This data-driven approach informed their strategy and was shared with staff to build awareness and engagement across the organisation. The completion of a three-part data review enabled deeper understanding of the opportunity through the facilitation of 9 service user interviews and 3 colleague focus groups. The team sought appropriate support from colleagues across the wider Trust to facilitate the interviews and focus groups, recognising the value and importance of the interviewer ethnicity being representative of the population group of focus.
A key component of their intervention was antenatal education. They introduced “early bird sessions” that individuals were invited to attend prior to their antenatal booking appointment. This meant that most individuals attended an “early bird session” between 6 and 8 weeks of pregnancy. These sessions offered practical health promotion activities, such as guidance on prevention of anaemia. To ensure accessibility and continuity, the sessions were recorded and condensed into bitesize videos, which were made available through the hospital’s website and electronic patient records, allowing service users to revisit the material at their convenience.
Recognising the importance of language accessibility, the team identified the ten most common spoken languages that required interpretation in their service area. They successfully sourced for nine of these languages from Healthcare Professionals working across the organisation. The trust is now looking at integrating artificial intelligence tools to provide real-time subtitles, speech interpretation for 1:1 and multi-lingual group sessions.
Colleague education was another cornerstone of the initiative. Informing colleagues about the project was promoted through a variety of formats, including team huddles, formal meetings, informal discussions, newsletters, visual prompts placed in staff areas and walking the floor to enable discussion to take place within the clinical environments. Essential training sessions on topics such as PPH and obstetric emergencies, incorporated tools such as diverse skin tone manikins to improve clinical recognition across diverse populations. The initiative adopted a “floor to board” approach, ensuring that engagement and support extended from frontline staff to senior leadership.
The team implemented the use of clear surgical drapes at assisted birth, which allowed clinicians to more accurately visually assess and measure blood loss following childbirth. They also reinforced the practice of weighing all materials used during and after delivery to determine blood loss with greater precision. This shift from estimation to measurement was embedded into routine practice through staff education and training such as “why we weigh”. While this approach may initially result in an apparent increase in reported PPH rates, it reflects a more accurate and reliable method of assessment, ultimately supporting better clinical decision-making and patient outcomes.
In addition to these efforts, the team developed culturally tailored resources, such as anaemia leaflets that included dietary advice relevant to different cultural backgrounds. Group education emerged as a promising area for future development. At the system level, the initiative sparked significant interest in data collection and led to the creation of a hospital-wide dashboard designed to track outcomes by ethnicity, marking a meaningful step toward sustained, equitable improvement.
Outcomes
The initiative led to a sustained 3% reduction in PPH among Black and ethnic minority women, decreasing from 12% to 9%. The most influential factor in achieving this reduction was raising awareness among staff, particularly through direct engagement and open discussions about anti-racism. New resources were created, including anaemia leaflets and improved PPH risk assessments. The use of skin tone manikins helped raise awareness of clinical differences, and efforts to improve communication through translation and digital tools continued.
The practice of weighing blood loss post-birth was reinforced, supported using clear drapes at assisted births to better estimate blood loss. Colleagues were educated on the importance of weighing all materials to ensure accurate measurement, which may initially increase reported PPH rates due to improved accuracy.
The impact was felt across multiple levels. Among colleagues, there was increased awareness of health inequalities and improved clinical care through better estimation of blood loss. Service users benefited from a sustained reduction in PPH, improved access to information, and early interventions. At the system level, the application of anti-racism principles gained interest, and the hospital demonstrated increased effectiveness in using data for improvement. Ethnicity-specific data aggregation, time series analysis using Statistical Process Control charts, and shared learning all contributed to sustained improvements. The hospital also developed a public health education approach and aimed to develop its Electronic Data Interchange (EDI) dashboard to other clinical areas within maternity.
Key learnings and recommendations
The team reflected on the impact and interest generated by the project, noting the importance of maintaining positive energy and using a continuous improvement framework. They embraced vulnerability and remained open to having uncomfortable conversations about representation, equity, and the limitations within their own structures. They recognised the value of time and the need for focused efforts on information and education, particularly through translation.
Key learnings included the importance of continuing to address inequalities in maternal and neonatal outcomes for Black, Asian, and other ethnic minority populations. The application of anti-racism principles was seen as essential to continuous improvement and should be embedded in clinical practice.
The team recommended that healthcare providers continue to embed anti-racism principles throughout clinical care. They also suggested exploring ways to improve resource accessibility for all population groups, including the use of AI and social media. More time was needed to fully analyse the data, and the team acknowledged that further work was required beyond the initial interventions. They expressed a commitment to expanding the EDI dashboard across all services within maternity.
Additional information
Key labels for HARP: PPH, education resources for patient, dashboard, maternity, Language/translation
Relevant links
This is a link to a video on reducing racial inequalities in Maternal and Neonatal care