Photo by suraj kardile | Unsplash
Recently released data shows that the US maternal mortality rate continues to increase, with consistently higher rates among American Indian, Alaska Native, and Black Women. Nationally, Black women have a maternal mortality rate nearly three times that of White women.
Based in Mobile, Alabama, where the population is 50 percent Black, and the state mortality rate is 36.2 maternal deaths for every 100,000 live births (compared to the US rate of 20.4 for every 100,000), the team at USA Health Children’s & Women’s Hospital knew they had a role to play in addressing health equity. Their Director of Women’s Services, Vicki Curtis, MSN, RN, RNC-OB, said these staggering statistics drove them to “fully embrace” efforts to improve maternal outcomes.
While they had the will to do the work, however, they recognized that they did not have all the tools they would need. Much of their team was new to quality improvement (QI) work, and for many, this was the first time they were explicitly addressing health equity. According to Carmen Morehead, MSN, RN, Quality and Performance Improvement Coordinator, “We are early on in our health equity journey. In our community, there is not as much awareness as there needs to be around these issues.” She added, “We have an opportunity to identify inequities and disparities in our population, but we don’t have a good handle on what [those are] because we don’t have a good handle on the data.”
In the fall of 2022, the team at Children’s & Women’s Hospital were accepted into the Institute for Healthcare Improvement (IHI) Eliminating Inequities and Reducing Postpartum Morbidity and Mortality Learning Community, which ran from January through June 2023. The Learning Community brought together five hospitals from across the country to support changes to clinical and administrative processes that will lead to safer and more equitable postpartum care and support for Black mothers and birthing persons.
For Children’s & Women’s Hospital, the Learning Community was an opportunity to learn from other health systems who were further along in their health equity and QI journeys and get coaching from IHI staff and faculty. Participating in a formal initiative pushed them to form a cohesive team, formalize their improvement work, and set clear goals. It also sparked important conversations across their hospital. “I feel like our community has been behind in having honest and open discussions about disparities, implicit bias, and structural racism,” shared Claudia Reed, DNP, Nurse Manager for Labor and Delivery. “The issues are complex and can be overwhelming and daunting.” She added, “We know we can make an impact in our lane, and we hope that will spill over into the community as well.”
Testing New Processes
The Children’s & Women’s Hospital team has developed and tested several key interventions focused on improving outcomes for their postpartum patients, including:
- Enhanced data collection — The team wanted to identify disparities in pain treatment by comparing pain scores for postpartum patients. They quickly realized they lacked the data to see the disparities. Efforts to improve data collection across the hospital are now underway.
- Remote blood pressure monitoring — With help from IHI faculty and participants in the Learning Community who have set up remote blood pressure monitoring, the team learned what was needed to run this type of program to help detect and prevent postpartum hypertensive disorders and got suggestions for potential funding sources.
- Medical bracelet distribution — Postpartum patients receive a special medical bracelet upon discharge to wear for at least six weeks after delivery. The bracelets alert providers, particularly in the emergency department, that someone has recently given birth, and promote awareness of the potential risks of birth-related complications.
- Support for their own equity journey — The team is talking explicitly about inequities and setting up opportunities for their staff to continue to learn and grow. Later this year, for example, they will offer implicit bias training for their providers through the March of Dimes.
The team from Children’s & Women’s Hospital offered advice to others who are starting their health equity improvement efforts:
- Take opportunities to learn from others whenever possible. Joining programs like the IHI Learning Community or getting connected to state Perinatal Quality Collaborative can be instrumental for providing opportunities to learn and build connections with other hospitals across the country or in your region.
- Let the data be your guide. To take part in the Learning Community, the team worked with their data analysts to review what data they had. Prior to their participation, the team struggled to see where they needed to make changes. Understanding your data identifies where to focus improvement.
- Engage everyone in the conversation. Make sure staff throughout your organization — including those in registration, food services, and clinical roles — recognize their role in improving health equity. Create a diverse, multidisciplinary team, and start these conversations early to bring people on board.
- Do not be afraid to get started. “Don't be intimidated,” remarked Curtis. “Be inspired.” The team knew they had a lot to learn but were not afraid to tackle challenges head on. She added, “It can be hard and frustrating, but we have an amazing team, and we [know we] can do this. It’s worth it.”
Beginning this summer, Children’s & Women’s Hospital will partner with IHI and AdaptX to pilot a software tool that collects, synthesizes, and reports back routine data entered into the electronic medical record on processes of care, stratified by race and ethnicity, by provider, or unit. Through this pilot project, they will have the opportunity to look closely at real-time data and pinpoint areas to drive change and improve outcomes. “I am hopeful for the opportunity to see the data and identify where we can take action now as well as set some long-term goals,” said Morehead. Added Reed, “It will be great to have this data to see if the strategies we are testing are working.”
Deborah Bamel, MPH, is an IHI director.
You may also be interested in:
Better Maternal Outcomes Quality Improvement Workbooks — Contain examples and templates to guide QI work focused on improving maternal health outcomes and equity
Reducing Inequities in Postpartum Maternal Morbidity and Mortality