The following is a guest post by Sue Gullo, Director
Would you want your mother, sister, or daughter to
deliver a baby in an unsafe place? I have a feeling the resounding answer to
that question is “NO.” For the past seven years, I’ve been working with perinatal
teams across the world to ensure that the care we provide for moms and babies
is evidence-based and the best for perinatal health, each and every time. What
I’ve seen and learned from these teams dedicated to improvement are some
strategies that all health care teams could use. They are:
1. Develop reliable processes, and apply
them every time
The Labor and Delivery Units with the
fewest adverse events have reliable processes that, when followed properly,
lead to the best outcomes. These teams know that if we get our structure and
process right, the outcomes improve. In the perinatal world, we have various Care Bundles (a group of clinical events that should happen for
each time and every patient) to help with this.
2. Measure what matters
The most successful teams measure processes
linked to the outcome — at the beginning, in the middle, and at the end to ensure
that they are moving towards their goals. Here’s a snapshot of the IHI
Perinatal Improvement Community’s Measurement Strategy:
3. Use Data for Improvement, Not Judgment
I recently heard a statistic that 70
percent of perinatal sentinel events happen due to a miscommunication. We could
focus on the negative aspect of this stat, but instead, the best perinatal
teams turn this around. They say, knowing this, we can make big improvements in
our care by making minor adjustments in our communication. When data show
errors, mistakes, adverse events, we don’t focus on the who, but on the why.
The most successful teams also make a point to focus on what’s going right and
doing more of that rather than emphasizing only what’s gone wrong.
4. Revise and Revisit Your Processes — Even
if They’ve Worked for a Long Time
For years, the IHI Perinatal Faculty
and I taught our teams about the Oxytocin Bundles, which instructed safe
administration of oxytocin (Pitocin). This past spring, we realized that the
time had come and gone for these bundles and so we retired them in favor of new
advanced bundles, with the overall aim of improving the likelihood of vaginal
delivery for those women who present with a low risk for Cesarean delivery. At the
same time, we’ve begun work on new processes (e.g. the Neonatal Advantage
bundle) to improve our learning.
5. Don’t Wait for the Federal Requirement
— Move Ahead of National Imperatives
In the coming year, there will be
increased national attention on elective inductions, adherence to the perinatal
core measure set, and reducing the trend of rising Caesarean rates. Instead of
scrambling, I’ve worked with teams in our Perinatal Community who have been
working on these areas for years. While the government focuses on these areas,
top-functioning teams can focus on the next step to make care even better — ahead
of national OB imperatives. For example, in a recent Perinatal Community
meeting, Executive Director of the Childbirth Connection,
Maureen Cory, presented the Listening to Mothers Survey III and we discussed respectful patient partnerships.
The phrase “Are you doing things to, for, or WITH your patients?” became the
driver. One of the teams even brought their patient representative to the
meeting! I can see national imperatives moving this way soon.
What processes have you seen work in your teams that
could be applied to others?