Implementing recommendations arising from confidential enquiries into maternal deaths.

Implementing recommendations is a complex process involving all levels of health care. Effecting change in the health system can be broadly divided into four areas: policy, administration, clinical practice and training. Changes at the policy level require advocacy by lobby groups, as these changes are mainly political in nature. Changes at administrative level require a diversion of resources, and a clear policy framework must be in place within which the health administrator can work. Changes to clinical practice refer mainly changes in protocols of managing patients. The essential elements to change clinical practice include on-site, face-to-face teaching by a senior clinician; ineffective methods are lectures and memorandums on guidelines for practice posted to clinicians. Training refers to ensuring there are appropriate curricula for healthcare workers. Recommendations should also be phrased in such a way that targets can be established. These targets should be measurable and then be measured.