The Joint Commission Journal on Quality and Patient Safety
Improving Maternal Safety at Scale with the Mentor Model of Collaborative Improvement
Section snippets
Organization of the Collaborative
The CPMS collaborative was established by the CMQCC, in partnership and collaboration with the Merck for Mothers initiative. The CPMS collaborative began in January 2015 and lasted for 18 months. Recruitment of participating hospitals and mentors and pre-work was performed between August 2014 and December 2014. During the active phase (January 2015–June 2016), the collaborative focused on implementing maternal safety bundles for hemorrhage followed by preeclampsia. Invitation to participate in
Participating Hospitals and Bundle Elements
Characteristics of hospitals participating in the collaborative are shown in Table 1. Participating hospitals were diverse in size, ownership, neonatal intensive care level, volume of deliveries, patient payer mix, and geography. About a quarter of the participating hospitals (26.2%) had prior experience with participating in a CMQCC maternal safety collaborative.
The proportion of bundle elements completed by the participating hospitals is shown in Table 2. The overall completion rates for the
Discussion
National organizations have developed clinical safety bundles to address the most common and preventable causes of maternal morbidity and mortality, including hemorrhage, preeclampsia, and venous thromboembolism. Focus on these clinical issues has been shown to improve maternal safety and outcomes.5, 6, 32 Implementation of these safety bundles across all birthing facilities is an important step to address high rates of severe maternal morbidity and mortality in the United States. Our
Conclusion
The timely translation of national guidelines into widespread clinical practice is of paramount national importance. Although there is widespread acceptance of collaboratives as a key implementation strategy, we need to expand our understanding of the specific features and individual components of the collaborative that facilitate practice change efforts. Internal mentoring has been shown to be an effective approach for hospital QI initiatives.30, 31 However, many community hospital obstetric
Elliott K. Main, MD, is Medical Director, California Maternal Quality Care Collaborative (CMQCC), and Consulting Professor, Department of Obstetrics and Gynecology, Stanford University, Stanford, California; Member, The Joint Commission's Perinatal Care (PC) Measure Maintenance Technical Advisory Panel; and Member, Editorial Advisory Board, The Joint Commission Journal on Quality and Patient Safety.
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2022, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Their “bundles” presently target Obstetric Hemorrhage, Severe Hypertension in Pregnancy, Safe Reduction of Primary Cesarean Birth, Obstetric Care for Women with Opioid Use Disorder, Cardiac Conditions in Obstetrical Care-In Development, and Postpartum Discharge Transition Bundle-In Development. Recent evidence suggesting the Quantitative Blood Loss bundle coupled with a Train-the-Trainer Program improves patient outcome [47,48]. Similar evidence supporting the other bundles has yet to be published.
Training facilitated by interinstitutional collaboration and telemedicine: an alternative for improving results in the placenta accreta spectrum
2021, AJOG Global ReportsCitation Excerpt :Accepting remote assistance and identifying local leaders with institutional support seems to be a strategy that can be replicated by other institutions seeking to improve the quality of their PAS services. Experiences with interinstitutional collaboration through remote support have been reported for other rare diseases17 and for postpartum hemorrhage18,19 and PAS,11,20,21 all using education strategies and remote assistance as facilitators. Although telemedicine requires formal processes and the institutions that use this strategy must build defined care routes,22 one of the keys to the participation of clinical professionals in virtual communities or clinical discussion groups is the ease of access to the information.21,22
Correlation between hemorrhage risk prediction score and severe maternal morbidity
2021, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :Since the development of the CMQCC's hemorrhage risk prediction tool and the subsequent widespread adoption, a validated hemorrhage risk prediction tool is now mandated in all labor and delivery units nationwide.13 Limited data suggest that implementation of this tool may improve patient outcomes and reduce the rates of hemorrhage and/or transfusion secondary to enhanced recognition and response.14,15 Understanding the cohort at highest risk for SMM is paramount to the identification of clinically relevant measures and implementation of programs aimed at improving the quality of care and maternal outcomes.
Reduction in racial disparities in severe maternal morbidity from hemorrhage in a large-scale quality improvement collaborative
2020, American Journal of Obstetrics and GynecologyCitation Excerpt :The implementation strategy was an adaptation of the Institute for Health Care Improvement collaborative model creating a community of learning, including 2 participant face-to-face meetings, and monthly check-in calls. Hospitals were organized into small teams of 6–8 hospitals led by physician and nurse mentors who provided QI coaching.26 This involved monthly team support and advice for the assessment of barriers and improvement strategies.
Designing Quality Improvement Collaboratives for Dissemination: Lessons from a Multiple Case Study of the Implementation of Obstetric Emergency Safety Bundles
2020, Joint Commission Journal on Quality and Patient SafetyCitation Excerpt :The implementation literature has had considerable focus on the local context of a single institution and its effect on implementation,49 but there is relatively less focus on, and documentation of, how QICs can addresses the external contextual environment. Our study suggests that designing subgroups within larger QICs may be an effective strategy to dealing with diverse contexts within larger QICs.42 While others have noted the importance of robust data infrastructure for quality improvement, by focusing on the perspective of the QICs, our findings suggest the importance of multistakeholder approaches to building this data infrastructure.
Creating Change at Scale: Quality Improvement Strategies used by the California Maternal Quality Care Collaborative
2019, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :Not all labor and delivery units, however, have the QI experience or leadership skills needed to drive the work. For the authors’ large collaboratives (>30 hospitals at 1 time), CMQCC organizes 8 to 10 hospitals into groups and assigns an experienced physician and nurse coach/mentor team to work with them over a period of 18 months to implement the strategies found in the tool kit and to facilitate the sharing of promising ideas formulated by the participating hospitals.13 CMQCC follows a modified Institute for Healthcare Improvement Breakthrough Series model.14
Elliott K. Main, MD, is Medical Director, California Maternal Quality Care Collaborative (CMQCC), and Consulting Professor, Department of Obstetrics and Gynecology, Stanford University, Stanford, California; Member, The Joint Commission's Perinatal Care (PC) Measure Maintenance Technical Advisory Panel; and Member, Editorial Advisory Board, The Joint Commission Journal on Quality and Patient Safety.
Ravi Dhurjati, MS, PhD, is Research Engineer, California Perinatal Quality Care Collaborative, Division of Neonatal and Developmental Medicine, Stanford University.
Valerie Cape, BA, is Program Manager, CMQCC, Division of Neonatal and Developmental Medicine, Stanford University.
Julie Vasher, DNP, RNC-OB, is Clinical Implementation Lead, CMQCC, Stanford University, and Perinatal Clinical Nurse Specialist, Salinas Valley Memorial Healthcare System, Salinas, California.
Anisha Abreo, MPH, is Biostatistician, CMQCC.
Shen-Chih Chang, MS, PhD, is Biostatistician, CMQCC.
Jeffrey B. Gould, MD, MPH, is Robert L. Hess Professor in Pediatrics, Stanford University; Director, California Perinatal Quality Care Collaborative; and Director, Perinatal Epidemiology and Health Outcomes Research Unit, Stanford University School of Medicine and Lucile Packard Children's Hospital.