Managing Risk, Clinical Error and Quality of Care in the Maternal newborn Program

At The Scarborough Hospital (TSH), we are achieving our patient safety goals through an innovative program called MORE OB (Managing Obstetrical Risk Efficiently).  The Society of Obstetricians and Gynecologists of Canada (SOGC), to improve patient safety and quality of care, created MORE OB.  TSH was one of the first hospitals to launch MORE OB in 2003 as senior leadership recognized its value and allocated the resources.  Since 2003, the MORE OB program has been implemented in over 130 Canadian Hospitals.   

The philosophy of MORE OB is to make patient safety everyone’s priority and responsibility.  To achieve this, the team members, including obstetricians, midwives, registered nurses and family physicians providing intrapartum care, treat each other respectfully.  Communication amongst the team is highly valued and in times of emergency or crisis, hierarchy disappears with decisions on safety issues being made by any member of the team. 

More OB helps doctors, nurses, and midwives to advance and enhance their obstetrics knowledge and skills by learning together. Team members develop skills, which allow them to work towards one goal, Patient Safety.  The team becomes more effective together and begins to effect change in culture facilitating continuous patient safety.  This is achieved by integrating the principles of High Reliability Organizations (HRO’s) with evidenced based professional practice and patient safety concepts.   

Principles of High Reliability Organizations are:

1. Safety is the priority and is everyone’s responsibility
2. Operations are a team effort
3. Hierarchy disappears in an emergency
4. Communication is highly valued
5. Emergencies are rehearsed

 

There is a multidisciplinary review of routine practices and no harm and harm events under the QCIPA legislation.  Recommendations from reviews are used to propose and implement changes in practice to improve patient safety.  The key to the success of these reviews is a shift away from a culture of blame to an environment that supports candid discussions from the multidisciplinary team. 

MORE OB participants attend multidisciplinary workshops where learning and the transfer of knowledge are shared.  Emergency drills have been incorporated in to the Quality of Care Rounds (former Morbidity and Mortality Rounds).  Skills drills occur frequently on the unit where pelvic models are used to demonstrate assisted vaginal deliveries. 

At TSH, we have had fewer cases with severe outcomes since we started MORE OB!

MORE OB has effected change in the culture at TSH where patient safety is everyone’s priority.  Improvements in patient care practices, revision of policies and procedures that reflect MORE OB content and philosophy have been implemented.  Routine audits by any member of the team occur and are evaluated to improve patient safety and outcomes. 
Patient Safety is everyone’s priority and responsibility.  At TSH, MORE OB has assisted us in achieving this goal!