Implementing a System-Wide Perinatal Patient Safety Initiative
- Utilize best available evidence to improve patient outcomes and safety for VBAC, elective delivery, induction of labor, electronic fetal monitoring, and second stage labor management
- Apply strategies learned to achieve and sustain lasting changes in clinical practice.
- Explain how technical, political and cultural barriers impact and challenge efforts toward standardization
Trinity Health is the fourth largest Catholic health system in the United States with 19 Ministry Organizations encompassing 47 hospitals, 379 outpatient clinics and numerous long-term, home health, hospice and other facilities in eight states. There are 26 hospitals that provide obstetrical services with annual births ranging from 50 to 8,400. In 2008, Trinity Health Executive Team launched the Perinatal Patient Safety Initiative (PPSI) to standardize high risk obstetrical processes to improve safety and the quality of care provided to mothers and babies at each of the Ministry Organizations.
Framework for the talk:
The work of the PPSI is accomplished through teams. A Steering Team meets monthly and is comprised of a small group of clinical experts, nurses & physicians, from various Ministry Organizations plus key members of the Executive Team. The Steering Team is responsible for providing professional practice standards, strategy, and clinical expertise for the Initiative. A Collaborative Team comprised of physicians and nurses from each of the Ministry Organizations gives feedback and makes recommendations to the Steering Team. The Perinatal Team at home-office supports the Steering and Collaborative Teams.
The PPSI initially targeted four areas for rapid cycle improvement. These four areas are VBAC, elective delivery less than 39 weeks and induction of labor, electronic fetal monitoring, and second stage labor management. A gap analysis by national experts was completed at each Ministry Organization to determine degree of compliance with national professional standards. Additionally, the site visits identified technical, political and cultural barriers to change. Action plans were developed by each Ministry Organization to address the gaps identified. Work teams utilized current literature and national professional practice standards to standardize processes in each of the four targeted areas through policy development and education. Education included presentations by national experts, live and via Webinar, on-line courses, and independent study materials. Expectations for compliance with standards and completion of educational requirements were clearly defined with consequences for failure. Metrics were designed to measure progress and incentives are awarded for compliance with standards.
The PPSI is on-going. As the body of evidence continues to expand and Trinity outcomes data are analyzed, new areas for process improvement are identified. Culture of safety, processes for teamwork, simulation, and just culture will be targeted in the coming year
Implications for practice:
The methodologies employed and lessons learned by the PSSI may be utilized by clinicians at any organization to improve safety and quality of care provided to mothers and babies.
