Premium
Sustaining and spreading quality improvement: Decreasing intrapartum malpractice risk
Author(s) -
Santos Palmira,
Joglekar Anju,
Faughnan Kristen,
Darden Jennifer,
Masters Lisa,
Hendrich Ann,
McCoy Christine Kocot
Publication year - 2018
Publication title -
journal of healthcare risk management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.221
H-Index - 16
eISSN - 2040-0861
pISSN - 1074-4797
DOI - 10.1002/jhrm.21329
Subject(s) - psychological intervention , liability , malpractice , medicine , odds ratio , quality management , odds , emergency medicine , business , obstetrics , medical emergency , operations management , nursing , accounting , logistic regression , economics , political science , management system , law
Background Malpractice liability is an ongoing problem in obstetrics. However, developing, sustaining, and spreading effective interventions is challenging. The aim of this study is to examine the spread and sustainability of a multilevel integrated practice and coordinated communication model 66 months after its original implementation. Methods Data on labor and delivery patients from 37 hospitals (5 beta sites and 32 expansion sites) were analyzed for the 81‐month time period from January 2010 through September 2016. Results High‐risk occurrence rates per 1000 live births decreased by over 70% at both beta and expansion sites. The likelihood of a high‐risk occurrence was statistically significantly lower during the final study period than in the preintervention period at both beta sites (odds ratio [OR] = 0.218; p < .0001) and expansion sites (OR = 0.288; p < .001). Conclusion The multilevel integrated practice and coordinated communication model was successfully spread and sustained. Key elements contributing to this success included developing and maintaining evidence‐based guidelines, ensuring leadership buy‐in and support, collecting and reporting performance measures, holding teams accountable, providing training, and ensuring transparent communication.