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Five Reasons Why Perinatal Care Can Lead the Way in Safety

By Frank Federico | Tuesday, July 23, 2013

The following is a guest post by Sue Gullo, Director

Sue Gullo

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:

Perinatal - Sue

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.

Perinatal - Sue 2


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?

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