All participating midwifery unit leads must attend the introductory meeting and training session on the Midwifery Unit Standards, self-assessment tool and MUSA Framework. The training sessions last 2 hours and provide an introduction to the Standards, background on the self-assessment tool and its development, summary of the MUSA Framework. This session also provides an opportunity to for your midwifery unit leads to review the online self-assessment tool space, ask questions about the MUSA Framework and network with other midwifery units. To register interest for a session, please contact us: musa@city.ac.uk.

The tool consists of 12 questions about your midwifery unit and 60 indicators connected to the Midwifery Unit Standards. Depending on the indicator, options of ‘No’, ‘Partly’, ‘Yes’ or ‘N/A’ (Not applicable) can be selected. Most indicators have sub-questions, with ‘Yes’ or ‘No’ responses. These will only appear if the answer to main indicator was ‘Yes’ or ‘Partly’. Once you have completed the self-assessment, your responses are collated and matched to a corresponding rating.

The self-assessment tool is currently hosted on Qualtrics and supported by City, University of London. You will be asked a series of questions about your midwifery unit, team structure, outcomes and model of care.

Next, you will be asked to respond to the indicator questions. An asterisk (*) means that there are notes or definitions connected to the standard or indicator that will help you complete the tool. There are comment sections, if you would like to add additional information about your responses as you go through the tool. You are not required to fill this in.

Once you have completed the tool, your responses will be saved, and you can download a copy of your responses from Qualtrics. A subsequent report will provide a summary of your responses, which are colour-coded for visual ease and understanding.

Improvement areas are those where your unit has scored either red or amber, indicating the need for at least some improvement. Impact actions are based on these improvement areas and are tailored to your midwifery unit’s specific context to ensure that any action that is taken is achievable within your setting and reflects your unit.

The MUSA Framework recognises that not all impact actions are the same for every unit or are achievable in the same timeframe. This is why impact actions are broken down by timeframe: short, medium and long term. Short-term impact actions should achievable in 1-3 months, medium-term actions in 3-6 months and long-term in 6-12 months.

The aim of the stakeholder event is to review the self-assessment results, share feedback about improvement areas, identify high impact actions and discuss the improvement plan (short-, medium- and long-term). We see this as a collaborative, multidisciplinary brainstorming session.

Stakeholders are people who are connected to or have an interest in your midwifery unit. They also have a ‘stake’ in you midwifery unit, meaning they are affected by the state of the unit's services and operation. Stakeholders include: midwifery unit staff, service users, hospital managers, linked midwives, obstetricians, neonatologists, Local community and health organizations, doulas and other maternity support workers. We recommend inviting at least three different stakeholders to your stakeholder event; however, who you invite, how many stakeholders you invite and how you host this meeting is up to your midwifery unit.

The event is organized by your midwifery unit with MUSA team support. We recommend that events last around 2 hours and be hosted face-to-face. Digital stakeholder events are also suitable. During stakeholder events, the MUSA team provides their feedback based on your MU’s self-assessment tool outcome and their expertise. However, you know your midwifery unit much better than we do, so we use the event as an opportunity to hear your thoughts and opinions on your improvement areas and impact actions.

After the stakeholder event, the MUSA team will develop a draft improvement plan document and send it back to you for review and approval. Your improvement plan will include 3-5 impact actions for the short-, medium- and long-terms and their linked indicator(s). Once the improvement plan has been finalised, you are ready to start implementing your impact actions. The MUSA team will provide ongoing support throughout the Implement phase.

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MUSA is a joint project between City, University of London and Midwifery Unit Network (MUNet). Our team provides ongoing support and troubleshooting to your midwifery unit throughout the MUSA process. We will organise meetings around Weeks 20, 35 and 50, as needed, to support your midwifery unit during the Implement phase. Please contact us at musa@city.ac.uk to organise any ongoing support.

Re-assess your midwifery unit’s progress by completing self-assessment tool a second time. Again, you will be asked a series of questions about your midwifery unit and be asked to respond to the indicator questions. You can revisit your midwifery unit’s previous self-assessments and keep track of your progress.

Once you have completed the tool, your responses will be saved, and you will receive a new report, providing a summary of your responses, which are colour-coded for visual ease and understanding.

Your unit’s improvement plan should be updated to reflect your reassessment outcomes. This includes updating the short-, medium- and long-term impact actions.

Midwifery units (also known as birth centres) offer maternity care to women and people with straightforward pregnancies, supporting physiological birth through a social model of care and providing a birthing environment that is calm, welcoming, comfortable and relaxing.

In midwifery units, midwives take primary professional responsibility and carry out most of the care, alongside maternity support workers, whom they manage. Interdisciplinary working with medical colleagues, ambulance service, community colleagues and service users is based on mutual respect to provide high quality, evidence-based care and smooth transfer to obstetric units, as required.

Alongside midwifery units (AMUs) are located in a hospital that provides obstetric care, close to the labour ward or on the same site in a different building. AMUs are close to medical facilities and personnel should a woman or birthing person need them. This may include access to interventions that can be carried out by midwives, for example electronic fetal heart monitoring. To access such services, women and birthing people will need to transfer to the obstetric unit, which will normally be by walking, trolley, bed or wheelchair.

Freestanding midwifery units (FMUs) are on a separate site from obstetric services, in an independent building or on the site of a community hospital. If a woman or birthing person transfers to the obstetric unit during labour they will usually travel by car or ambulance.

The Midwifery Unit Self-Assessment (MUSA) provides a structured framework to guide the self-assessment and improvement of midwifery units (MUs).

The implementation of the MUSA Framework includes the principle of co-production with stakeholders in the creation of an advisory group which contributes to the identification of strengths and area for improvement for the midwifery unit, based on the results of the completion of a self-assessment tool.

The framework provides a step-by-step guide supporting service improvement, emphasising co-production, stakeholder engagement and interdisciplinarity, particularly through strong service user input.

The MUSA Framework involves establishing a synergic partnership between midwifery units, key stakeholders and Midwifery Unit Network. This type of stakeholder engagement is highly effective because it combines insider knowledge with the benefit of gaining the fresh eye of an external facilitator.

The MUSA Framework was developed from the Midwifery Unit Standards, in collaboration with City, University of London, Midwifery Unit Network and international expert stakeholders, between 2019 and 2021.

In 2020, we conducted a rapid appraisal with four midwifery units in the UK and Europe. We gathered the views of service providers and users on the self-assessment tool and the stakeholder engagement process to identify the degree of support needed by services in the process of self-evaluation and co-creation of an improvement plan.

In 2021, we conducted a six case studies with midwifery units located in the UK and Europe to evaluate the self-assessment tool in practice, to identify barriers and facilitators for midwifery unit implementation and improvement within maternity services across Europe and to inform the development of the framework for this self-assessment process.

Through this time period, we have worked with an advisory group of healthcare professionals, service users, policymakers and academics, who have reviewed and supported us to refine the framework.

The MUSA Framework can be used by midwifery unit teams working in the UK and Europe. We recommend one or two midwives lead on using the framework. The framework is used alongside a self-assessment tool and with bespoke support from our MUSA team. There are three different phases to the framework: Prepare, Implement and Re-assess, with different steps are completed over 52 weeks.

During Prepare, your leads will attend an introductory meeting and training sessions, conduct a situation analysis using the self-assessment tool and organise wider stakeholder engagement in order to generate an improvement plan of impact actions for the midwifery unit.

The Implement phase involves implementing these  impact actions and receiving ongoing support from the MUSA team.

Finally, during Reassess, your midwifery unit will be asked to conduct a re-evaluation using the self-assessment tool and to revise your improvement plan based on the outcomes.