Marathon runners know how difficult the last mile is – even though they’ve already run 25.2 miles, persevering through the final mile can be the most challenging of all. Reaching second stage labor can feel like the last marathon mile – a time when focus on and surveillance of Mom and Baby is crucial, yet often underestimated. Participating organizations in IHI’s Perinatal Improvement Community have worked together with faculty for the past two years to develop a Labor Deep Dive Tool. This tool provides a system perspective to identify opportunities to ensure optimal care during this final stage of labor, and to understand what system-level changes are needed. Now, the Perinatal Community teams are working to continuously improve the safety and reliability of the care they provide.
Watch a brief clip of a current Perinatal Improvement Community member describing her team's experience:
Program Design
The Perinatal Improvement Community provides results-focused improvement opportunities to teams with a wide range of content and improvement experience. Participants start with in-depth diagnostic and goal-setting processes and identify initial areas of focus based on their expertise in the topic and in improvement. Teams engage in rapid testing of changes that have been shown to improve care, adapting them to their own settings, and constantly measuring the outcomes.
Learning takes place in a variety of settings:
- Virtual learning sessions on WebEx several times per year to gather expert knowledge, share information with colleagues, and plan action with your team
- Structured teleconferences at least monthly to get additional information and share progress
- Self-paced online resources to bolster your team’s learning
- Access to the Extranet, IHI’s private web-based work space, for sharing data and documents
- Listserv communication that is available all the time to all team members and faculty
- Two face-to-face meetings as a major opportunity for accelerated learning
Improvements made by participating organizations
The Challenge
Momentum is building across the country in the perinatal field - there is no tolerance for elective delivery prior to 39 weeks gestation, unreliable care, and preventable events. Do your patients receive the care that your family member would - every day, every time?
Adverse events during labor and delivery can impose a heavy physical, psychological, and financial toll on the baby, family, care providers, and the community. Sound science that would allow us to deliver the best perinatal care is often known, yet is applied unreliably. Evidence-based guidelines for safe practices exist. The challenge is to ensure that these guidelines are applied to every patient, every time. Evidence-based care also relies on an effective, high functioning team, complemented by complete and accurate documentation of care provided. This Community seeks to move to a model of shared multidisciplinary training and understanding in which all team members function together and are not afraid to speak up. When this happens reliably, adverse events have been shown to decrease as the system is now a learning system.
Areas of Focus
- Structured according to the IOM aims for improvement to provide care that is safe, effective, patient-centered, timely, efficient, and equitable [Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.]
- Organized in four improvement areas: Leadership, reliable design, effective teamwork, and patient- and family-centered care.