Obstetric Trauma: Success Stories

British Columbia Patient Safety & Quality Council-Quality Award Winner (2009)

Managing Obstetrical Risk Efficiently (MOREOB) in Northern Health

The MORE^OB program launched in 2006, is a comprehensive patient safety, professional development and performance improvement program for hospital caregivers and administrators providing obstetrical care in Northern Health.

Over the past four years, health care providers and administrators working in obstetrics have come together as a cohesive team with a shared passion and goal for putting patient safety first. Ninety-three per cent of Northern Health obstetrical healthcare providers (including physicians, midwives, nurses and administrators) are participating in the program. Evaluation of the program has found a growth in leadership capacity with safe patient care at the core. Activities within the program include environmental scans, patient satisfaction surveys, staying current with new evidence and best practices, participating in workshops, and competency drills. The program structure is based on proven principles of High Reliability Organizations, including:

1. Patient safety is the priority and everyone's responsibility.
2. Communication is highly valued.
3. Operations are a team effort.
4. Hierarchy disappears in an emergency.
5. Emergencies are rehearsed.

Reviews with all types of health care providers are routinely held. The MORE^OB program's Annual Cultural Assessment for 2009 revealed that the participants had an improved sense of work culture, including: open communication with respect to patients and general knowledge; valuing each other's knowledge-base and skills sets; and an improved sense of teamwork. An improvement in staff retention and recruitment has been seen in all sectors.

Statistical information from the B.C. Perinatal Health Program database shows improved statistics on the number of: labour inductions, mothers who received an epidural, intermittently listening to the unborn baby's heart during labour (auscultation), number of Caesarean-section deliveries, and newborns with cord blood gases after delivery.

Changes and efforts that were made to achieve these outcomes and spread the initiative included the following:

• promoting the annual program components of the MORE^OB program for all participants;
• monthly regional obstetrical rounds via videoconference;
• development of a Regional Perinatal Council, including quality;
• practice working groups;
• growing communities of practice;
• design of a template to support Council development for other disciplines, such as critical care, emergency care and long-term care; and
• annual planning conference for core team leaders. (BC Patient Safety & Quality Council, 2009)