Inductions at OSF Saint Francis Medical Center were performed at 39 weeks or less in 2006 (many were 37 to 38 weeks).  There was an opportunity for improvement when we joined the Institute for Healthcare Improvement (IHI).  The goal for this program was to identify an opportunity for safety and quality improvement in perinatal care, identify and overcome the obstacles to become better patient advocates, implement strategies/policies for labor induction/augmentation and evaluate performance improvement for elective inductions prior to 39 weeks.
          6 Sigma methodology was used to develop a process map of the current status and identify gaps causing problems.  A measurement plan was developed to determine how to collect and analyze appropriate data.  Operational definitions were developed and clearly stated.  Thirty charts were randomly sampled for both induction and augmentation.  Analysis of the data demonstrated that the complete pelvic assessment component was missing 100% of the time for both induction and augmentation.  Estimated fetal weight documentation was missing 100% of the time on augmented patients, and elective inductions below 39 weeks were without maternal/fetal medical conditions.  Following root cause analysis a Labor Form was designed and a new process map was developed to reflect how induction and augmentation bundle compliance could be achieved.  A new patient brochure was designed for patient education.  An implementation plan was launched and education on the new process was initiated.  All staff, physicians, and physician offices were provided a disc which contained all the new forms, guidelines for use, in-services, and personal letters to staff to facilitate the education process.
          Indicators were defined and measured monthly to monitor compliance of the new process.  Action plans for metrics below established target levels were developed and physicians and staff were re-educated when compliance fell below target.  OSF Saint Francis Medical Center continues to monitor compliance to ensure the process remains in control.
          The results consist of induction bundle compliance being at 100% for inductions since September 2007 and augmentation bundle compliance at greater than 90% since January 2008.