Patients and Families-

The Center of Care

Sue Gullo, RN, MS

Managing Director, IHI
 History of the Perinatal Improvement Project

Nov 2004 Feb 2005 Oct 2005 Jun 2006 Apr 2006 Fall 2006
Phase I Launce Phase II End Phase II • IHI • Premier holds
Ascension
• Premier launches Focus: Final launches Advisor Live call
Healthcare Perinatal innovation
Reliability and Deliverables
over 2,300 call in
Community with IHI
starts their Bundle concept Beginnings Perinatal
• IHI Web and
• Ten teams – PIMS Action 180 teams
effort with and Informatics Simulation drills Of a Change IMPACT learn bundle
IHI - eight customers Concept Comm. implementation
teams • March Premier and Package for • 50
Ascension team
merge OB Teams
join
PHASE II
Seton PHASE I
Healthcare Community size White Paper/
takes the increases to 26 various articles
lead teams about the project

• High Reliability Team Training  High Reliability Teams

• Primary focus is bundle  Focus on bundle compliance for
compliance for the augmentation the augmentation and induction
and induction bundles bundles; introduction of a
• Managing first stage of labor second stage of labor bundle
• Common language and  Managing second stage of labor
communication skills  Teamwork and communication
 Measuring harm reduction
HI Perinatal Community Secondary
Primary Drivers Drivers
Draft 6.12.09 1. Leadership-help establish aim & goals
2. Senior Administration-support, sponsor
Reduce Leadership/Sponsor 3. Physical plant and supplies
4. Competent trained available staff
harm to 5
or less per 1. Implement the (2) oxytocin
bundles and vacuum bundle.
100 live 2. Use ACOG/AWHONN guidelines
births for documentation.
3. Standardize administration of
Reliable design high alert medications- oxytocin,
Reduce variation magnesium sulfate, epidurals.
Improve 4. Design care process
reliability of improvements based on trigger
tool analysis, event detection,
documen- sentinel event
tation to 1. Effective communication- SBAR,
2. Common language such as adopting
100% NICHD criteria for fetal monitoring
Effective 3. Establish reliable techniques for
handoffs
Measure Teamwork 4. High risk identification and
and management-such as
multidisciplinary huddles
Improve 5. Standardize Team Response-drills,
Patient 1.simulations
Engage patients & families as
partners
6. Establish a in
justcare
culture.
Centered 2. Study patients/families
Care by Patient/family
preferences such as
Patient/Family Focus Groups.
25% Centered care 3. Transparent care with timely
communication respectful of
patient’s preferences
4. Include patients and families
on improvement teams
 Consistent
Second Stage Patients on (across disciplines) Collaborative
Safety Improvement Vacuum Bundle Credentialing And Supportive
Teams Standards Culture
12-24 months
3 months to 36 months

Engage Establish Establish

a multi- Huddles,
Patients and disciplinary team Multi-disciplinary
Care is transparent
Families training program rounds

9-12 months
Implement Design
Common EFM Reduce
Techniques Interventions
Language and Variation-
for Effective From Trigger
Training Meds, Emergencies
Communication Tool findings
6-9 months
•Effective Team
with Active
Oxytocin Perinatal Perinatal
Sponsor
Deep Dive- Oxytocin Bundles Trigger Tool
•Senior Admin
Pre-work
and Board Level 1-3 months 3-6 months
Support
 Two “Tips”
• Start before you are ready.

• When your family or friend is admitted to

your facility, do you ask for care that is
different (such as continuous presence of
a family member at the bedside) or is it
aligned with patient/family care?

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 Tool- IHI Improvement Map

http://www.ihi.org/IHI/Programs/ImprovementMap

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• Builds on the great work of participants in the 100,000 Lives
Campaign and the 5 Million Lives Campaign.
• “Help us make sense of the many complex and competing demands
we face.”
• Brings together the best knowledge available on the key process
improvements that will lead to exceptional hospital care.
• Helps hospital leaders set change agendas, establish priorities,
organize work, and optimize resources.
• An open resource, available free of charge to anyone, anywhere.
• Scheduled for full launch in September 2009.
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 Organizational Examples

Elliot Hospital, Manchester NH

Baptist DeSoto, Southhaven MS

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We plan to change our team to an OB
Patient Care Council by adding….

• Postpartum Unit Representative

• NBN Unit Representative
• Unit PI Representative
• Patient Centered Care Council
Representative
 Our aim and goals are:
• Change team to Patient Care Council by 2nd quarter
of FY09 and continue meeting bi-monthly
• Continue to have “Mock Drills” quarterly and review
with staff at quarterly staff meetings
• Implement Pro-Scheduler for all OB scheduled
services by 1st quarter FY09
• Develop and implement Gestational Diabetes
Community Service Classes by 2nd quarter of FY09
Our plan to sequence next steps…
• Change the meeting to Patient Care Council
• Improve physician participation on Patient Care
Council
• Implement Pro-Scheduler
• Develop Community Service GD Class
• Continue to work on: documentation, handoffs,
team work, pt flow, and mock drills
 2009 Aim Statement
 Maintain our 95% or greater compliance with the Augmentation and Elective Induction
bundles
 Maintain use of Trigger tool to identify areas of improvement and maintain
perinatal harm below benchmarks we set of less than 15% (or half our starting
point)
• Initiate Instrumented Delivery Bundle and achieve 95% compliance.
 We (will) need multidisciplinary training on second stage management
 Introduce Bundle components to staff and providers
─ establish tools and process for tracking bundle compliance
• Achieve over 90% multidisciplinary compliance with completion of EFM
education and formalize process to assure new staff are given this opportunity
for training.
 Implement plan for incorporating TeamSTEPPS objectives into routine practice.
 Develop and implement a plan for including a
patient representative on the Exceptional
Beginnings workgroup.
 Exceptional Beginnings
Six Goals for The Maternity Center
• Administration, care givers and staff will fully understand and support
the Maternity Center mission, vision, and goals.
• The focus of Maternity Center work will be to improve the experience
of the patient and her family.
• The Maternity Center will use evidence-based practices that ensure
the highest standards of care are delivered, with a focus on patient
safety and improved outcomes.
• The Maternity Center will implement communication methods that
ensure safe, effective care and improve patient satisfaction.
• The Maternity Center will become regarded as the most satisfactory
professional opportunity for care givers and all other team members
in the region.
• The Maternity Center will measure and communicate
its progress to administration, care givers, staff and the community.
 The focus of Maternity Center work will be to improve
the experience of the patient and her family

• Use of Coping Algorithm

• Partnering with the patient to assure that her plan is
followed by improving hand offs.
• Room Service meals for Mom and Dad
• Post Partum Mood Disorder Program
• Patient on our Exceptional Beginnings Taskforce so the
patient view is always present in decision making
• Using the New Mom’s group as an advisory group for
decision making
• Continued evaluation of Press Ganey
• Leadership rounding on patients daily
 Inspiration
• Sharing stories: overcoming our challenges and
service excellence
• When our patient representative used the word
“We” instead of “You” in offering her thoughts on
a subject
• Sharing with staff when they are acknowledged
by a peer or patient
• Hearing staff and providers say TeamSTEPPS
has “made a huge difference” in my work/job
 Contact:
Deborah Bell-Polson MSN, RNC-OB
Clinical Nurse Manager Maternity Services
Elliot Hospital
Manchester, NH 03103
office 603-663-4396
pager 564-2089

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Thank you so much for your time!

For more information go to

www.IHI.org

sgullo@ihi.org

Do not go where the path may lead; go instead where there is

no path and leave a trail. ~ Ralph Waldo Emerson