Improving the Quality of Perinatal Mental Health: A Health Visitor-Led Protocol (Professional AND RESEARCH: PEER Reviewed) (Report‪)‬

Introduction Little is known about how health visitors contribute to the process of developing, adopting and sustaining protocol-based care (Ilott et al, 2010). This paper reports a case study about a health visitor-led protocol for perinatal mental health, particularly the lessons learned from sustaining a service improvement over a decade. The success factors include continuity of clinical leadership in driving and maintaining a service development against a backdrop of organisational change in primary health care. The case study shows that high quality effective care with measurable clinical outcomes can be achieved through local action, and that efficiency can be enhanced through a frontline clinically-led initiative. In addition, the paper reflects on the challenges faced in leading and sustaining quality through protocol development during a period of change. The application and embedding of the evidence base into practice takes time and effort. Some studies suggest that service improvements deteriorate and initiatives 'fizzle out' once champions leave an organisation (Madsen et al, 2006). The lessons from this case study may help healthcare organisations embark on the NHS Quality, Innovation, Productivity and Prevention Challenge (QIPP) (Department of Health/DH, 2010a), which involves identifying local solutions to improving productivity while maintaining quality services.