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Sunday, September 26, 2010
Title: Implementing a Maternal Newborn Service Excellence Program: Lessons Learned
Discipline: Women’s Health (WH), Professional Issues (PI), Newborn (NB), Childbearing (CB), Advanced Practice (AP)
Learning Objectives:
Submission Description:- Identify factors contributing to capacity and throughput challenges in a maternal-newborn environment.
- Recognize opportunities for change and improvements for the inpatient and outpatient maternal newborn services.
- Describe the importance of a committee charter to focus and restructure change processes.
Implementing a Maternal Newborn Service Excellence Program:
Lessons Learned
Capacity. Throughput. Two words becoming increasingly familiar. Obstetrical and newborn care processes are not immune to these challenges.
Our 895 bed Magnet designated community teaching hospital currently has more than 3,900 deliveries a year. Factors contributing to daily capacity and throughput challenges include maternal-fetal medicine, referrals, cesarean birth rate, and increase organic growth of the obstetrical service line.
Security and safety for our families was paramount. Quality of care needed to be maintained. Immediate actions to meet the capacity demand was identifying and utilizing an approved area off the Mother Baby Unit. While this action provided an immediate “pop off” for our mothers, it was ideal. “Holding” mothers in Labor & Delivery was happening with increased frequency. This too was not optimum. It impacted our ability to promote the family unit.
Patient satisfaction was a critical element to stay cognizant of. While our families were understanding and appreciative of their care, this was not what we wanted to continue. We needed to identify other interventions.
Nursing leadership initiated the first meeting in May, 2008. Committee membership included representation from Labor & Delivery, Mother Baby Unit, Neonatal Intensive Care Unit, Lactation Consultants and outpatient obstetrical and pediatric practices. Discussions were robust. Opportunities for change and improvements for both outpatient and inpatient services were identified. We titled our committee Maternal-Newborn Service Excellence. A mission statement was developed and approved in July, 2008. The enthusiasm and participation of the committee members continued. The culture of openness, creativity and transparency during subsequent meetings identified many additional projects and initiatives. All agreed the projects and initiatives needed to be included if we were striving for excellence.
Here we were a year later with more questions than answers. Discussions were held with program management leaders, development specialists and organizational development consultants. We needed to refocus and restructure the process. We went back to the “drawing board’. Maternal-Newborn Service Excellence Committee work would not be lost!
The outcome is an overarching Maternal-Newborn Service Excellence Committee with a formal Charter which clearly defines sponsorship, function, leadership and membership.
The Maternal-Newborn Service Excellence Committee reached a consensus to identify and develop specific workgroups to address the various projects and patient care initiatives identified. Each workgroup will have designated leadership and goals. The workgroups will assess, plan, implement and evaluate various aspects of obstetrical and newborn care. The outcome is for our families to be prepared for their birth, their post-delivery stay, and care of both mothers and babies upon discharge. Resources will be maximized to meet these outcomes and minimize the challenges, contributing to capacity and throughput.
The restructuring of the Maternal-Newborn Service Excellence Committee and the workgroups was a great learning opportunity. Staying focused, eliminating barriers/challenges and meeting our patients’ and families’ diverse needs will have a direct impact on outcomes and patient satisfaction. Proactively managing capacity and throughput while maintaining quality patient care for our obstetrical and neonatal families is our “passion for better medicine”.
Lessons Learned
Capacity. Throughput. Two words becoming increasingly familiar. Obstetrical and newborn care processes are not immune to these challenges.
Our 895 bed Magnet designated community teaching hospital currently has more than 3,900 deliveries a year. Factors contributing to daily capacity and throughput challenges include maternal-fetal medicine, referrals, cesarean birth rate, and increase organic growth of the obstetrical service line.
Security and safety for our families was paramount. Quality of care needed to be maintained. Immediate actions to meet the capacity demand was identifying and utilizing an approved area off the Mother Baby Unit. While this action provided an immediate “pop off” for our mothers, it was ideal. “Holding” mothers in Labor & Delivery was happening with increased frequency. This too was not optimum. It impacted our ability to promote the family unit.
Patient satisfaction was a critical element to stay cognizant of. While our families were understanding and appreciative of their care, this was not what we wanted to continue. We needed to identify other interventions.
Nursing leadership initiated the first meeting in May, 2008. Committee membership included representation from Labor & Delivery, Mother Baby Unit, Neonatal Intensive Care Unit, Lactation Consultants and outpatient obstetrical and pediatric practices. Discussions were robust. Opportunities for change and improvements for both outpatient and inpatient services were identified. We titled our committee Maternal-Newborn Service Excellence. A mission statement was developed and approved in July, 2008. The enthusiasm and participation of the committee members continued. The culture of openness, creativity and transparency during subsequent meetings identified many additional projects and initiatives. All agreed the projects and initiatives needed to be included if we were striving for excellence.
Here we were a year later with more questions than answers. Discussions were held with program management leaders, development specialists and organizational development consultants. We needed to refocus and restructure the process. We went back to the “drawing board’. Maternal-Newborn Service Excellence Committee work would not be lost!
The outcome is an overarching Maternal-Newborn Service Excellence Committee with a formal Charter which clearly defines sponsorship, function, leadership and membership.
The Maternal-Newborn Service Excellence Committee reached a consensus to identify and develop specific workgroups to address the various projects and patient care initiatives identified. Each workgroup will have designated leadership and goals. The workgroups will assess, plan, implement and evaluate various aspects of obstetrical and newborn care. The outcome is for our families to be prepared for their birth, their post-delivery stay, and care of both mothers and babies upon discharge. Resources will be maximized to meet these outcomes and minimize the challenges, contributing to capacity and throughput.
The restructuring of the Maternal-Newborn Service Excellence Committee and the workgroups was a great learning opportunity. Staying focused, eliminating barriers/challenges and meeting our patients’ and families’ diverse needs will have a direct impact on outcomes and patient satisfaction. Proactively managing capacity and throughput while maintaining quality patient care for our obstetrical and neonatal families is our “passion for better medicine”.
