An uncomplicated pregnancy. An easy delivery. A healthy baby. Such perfect scenarios in a woman’s life can be elusive if medical problems or risks are not discovered and remedied during pregnancy and soon after the child is born.
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That is why a group of healthcare leaders in Los Angeles County are making critical systemic changes to set clear goals, motivate front-line workers and gather better health data to help women and their babies thrive.
“The whole culture of an organization and how it is run involves good leadership,’’ says Debra Keyes, MS, the director of Maternal Child Health |
at Watts Healthcare Corporation. “It’s a key component to ensuring you have the best quality care for the participants you serve. Being part of a collaborative can help make that happen.’’
Launched by LA Best Babies Network in 2006 with the National Initiative for Children’s Healthcare Quality as its partner, the Healthy Births Care Quality Collaborative (HBCQC) works with 10 prenatal clinics serving a total of 4,000 women in L.A. County. One of only a handful of prenatal collaboratives of its kind in the United States, the HBCQC uses evidence-based interventions to help women stop smoking, detect and treat maternal depression, fight infections and treat other problems. An unhealthy environment before and during pregnancy increases the risks for complications. Being born on time, with a healthy birthweight, and being breastfed can greatly improve a child’s development and intellectual capacity.
Keyes says the HBCQC’s emphasis on incremental shifts in procedures has helped make the case for permanent changes because workers can see the benefits quickly.
“We might have jumped in and made changes before. Now we are taking baby steps,” she says. Keyes notes they had different ways of screening prenatal patients for obesity, such as using prenatal weight-gain grids. By first training one staff person to use a new tool such as the body mass index (BMI) calculator wheel, many of the other staff were able to see how straightforward the process was.
Now they have additional tools to screen prenatal patients for obesity, and the clinics are recording close to 100 percent of patients’ BMI results. They are charting patient data in the Healthy Births database, a Web-based registry for Best Babies Collaboratives, and using the data to direct services to at-risk patients.
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Such small modifications are part of a successful improvement model called PDSA, or Plan Do Study Act, says Janice French, CNM, MS, the director of programs for LA Best Babies Network. The technique of studying, testing and then implementing changes means “you don’t end up making expensive investments, such as buying expensive equipment, until you know if something is working.”
Theresa Nitescu, MS, RD, chief operations officer of the Northeast Valley Health Corporation, says taking these small steps would not be possible without the strong support from company executives. Their CEO regularly participates in the learning sessions with clinicians, doctors and senior management staff to discuss goals and troubleshoot problems.
“It is always going to take strong leadership to get staff to commit extra time and extra work because there are no dollars put on the table to participate,’’ Nitescu says. “So leaders must understand it’s good for the company because it will improve patient outcomes and staff morale.”
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Nitescu adds that it helps to be a cheerleader and remind staff that their extra efforts are part of a shared goal of helping usher healthy babies into the world. “You have to give the front-line people a lot of strokes along the way to get them out of their comfort zone,” she says. Already, she has seen some promising results. Overweight women are being referred more to dietitians. Managers who conduct prenatal intake now follow the women through the |
entire pregnancy. Northeast Valley Health Corporation also introduced a new breastfeeding screening form, which asks doctors to investigate early in the pregnancy whether the patients may have any physical impediments to breastfeeding so they can be referred earlier to a lactation consultant.
Some of the collaborative’s participants note, however, that one challenge to improving the quality of care is that the data entry systems are sometimes incompatible with the online registry. Erika Sockaci, assistant vice president / health services administrator for AltaMed Health Services, says they are moving ahead with tracking postpartum patients and conducting nutritional assessments, but they can’t often spare the time or staff to enter data into two separate computer systems. “If you don’t do the data entry, you don’t have the results to analyze,’’ she says.
Despite that impediment, Sockaci says she is thankful for the chance to gain insights on successful strategies from her colleagues during the collaborative’s meetings.
“One of the biggest benefits is you hear what problems others have had and what solutions they’ve used to deal with them,’’ Sockaci says. “The networking is invaluable.’’
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