Beyond Obstetrics

Elyas Bakhtiari, for HealthLeaders Magazine , March 12, 2009
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But such a large and diverse audience has to be segmented. Marketing obstetrics is very different than marketing heart care, for instance, in part because women of childbearing age—primarily Generation X and Y—respond to different media and make decisions differently than baby boomers, says Graf. Obstetrics relies on event-based marketing—whether it is a class, seminar, or advertisement, everything is centered on the birth—whereas other women's health offerings focus on building relationships.

Consider prenatal classes. Some might consider them a cost center and calculate the immediate financial impact. But they are "critical marketing tools" because they build an event-based campaign that will bring in downstream revenue, Graf says. Relationship-based classes or seminars targeting baby boomer women, though also important, need to be measured with different criteria.

"You have different databases, differently oriented than relationship- based marketing so people think of you first for cancer or orthopedics. Your tactics change, but the overall strategy is one is either event-based and one is relationship-based," Graf says.

For help building those relationships, AtlantiCare Regional Medical Center, along with hospitals in about 60 cities nationwide, has turned to the Spirit of Women hospital network, which provides a "customized toolbox" of outreach programs, community events, a consumer-focused magazine, and other marketing strategies. These events and outreach strategies are at the core of the marketing approach, Szapor says.

Success Key No. 4: Hire laborists
The work force pressures that forced Southern Hills Medical Center to shut down its maternity department are affecting hospitals across the country. Malpractice premiums are straining OB/GYNs, and some are discontinuing obstetric services—focusing only on gynecology—or decreasing deliveries. Call coverage is becoming an ever-contentious issue, and many doctors are demanding compensation for covering the ED. And like many specialties, OB/GYN is in or on the verge of experiencing shortages, depending on the location.

For a growing number of hospitals and groups, laborists are offering a glimmer of hope. Also known as OB hospitalists, these physicians are based on site at the hospital and handle emergencies, freeing up private practice OB/GYNs from call duties. It can be a powerful physician relations tool, as local physicians' quality of life and patient panels typically improve when call is no longer an issue.

At Prentice Women's Hospital in Chicago, laborist-like physicians serve as 24/7 attendings to create a safety net. At Katz Women's Hospital, it was a local physician group that initiated the move, designating two out of the five members to focus on deliveries. AtlantiCare relies on laborists to handle a portion of call coverage.

Regardless of how the model is arranged, one of the most notable benefits is an improvement in quality. If a patient goes into delivery before the primary OB/GYN arrives, the laborist is on site to monitor the situation and intervene in the event of an emergency. In fact, this knock-off hospitalist model brings many of the same results as hospitalist programs—lower lengths of stay, higher patient satisfaction, and higher physician satisfaction.

But there are a few obstacles for the nascent subspecialty. For one, because labor and delivery fees are typically bundled, working out the financials can be tricky if a hospitalist is present for the majority of labor and the community doctor arrives for delivery, Graf says. In its purest form of the laborist model, community OB/GYNs would focus solely on outpatient care, and a team of laborists would handle all inpatient care.

Although that might be feasible in the future, patients "aren't quite ready for being delivered by a doctor they haven't seen through the pregnancy, and many physicians aren't ready to give that up, either," Szapor says.

Still, many public hospitals have already forged ahead with laborist options, and private hospitals aren't far behind. "If you're in a public hospital, the future is now. In a private hospital, the future is not now, but it's coming," says Szapor. "What we see is that there is increasing difficulty attracting young practitioners without laborist options."

Elyas Bakhtiari is an editor with HealthLeaders magazine. He can be reached at
Doctor da Vinci

The future of gynecology, like other specialties, is in outpatient, minimally invasive procedures, according to projections from Illinois-based Sg2. Enter the da Vinci Surgical System. Many women's health programs have an eye on the robotic surgical tool because it is less invasive and can reduce length of stay for gynecological surgeries.

Northwestern Memorial's Prentice Women's Hospital in downtown Chicago has used the da Vinci robot for a little more than two years. It is a costly investment—the price tag approaches $1.5 million—but it can boost a hospital's reputation, says Betsy Finkelmeier, director of women's services at Prentice.

"On the one hand it's a technology that is great from the patient perspective because it shortens length of stay, is a less invasive procedure, and has demonstrated improved clinical outcomes," she says. "On the other hand, the robotic capital equipment and associated supply materials are costly for the organization."

Bundles of joy

The United States ranks near the bottom of industrialized nations in infant mortality, even though the majority of birth injuries are considered preventable. With that in mind, some hospitals are turning to intensive care, a service line with a heavy focus on preventable errors, for guidance.

Kettering Health Network, a five-hospital system in Ohio, was one of a handful of participants in a perinatal task force in 2005 that tested safety bundles in preventing birth injuries such as birth asphyxia or permanent neurologic disability. Bundles are most commonly used in ICUs for preventing ventilator-associated pneumonia, and their concept is simple: Crucial procedures are grouped on a checklist, and each requirement must be met to be in compliance—three out of four doesn't cut it.

The pilot program, which was spearheaded by the Institute for Healthcare Improvement and Premier, Inc., created bundles for labor inductions and delivery complications, says Miriam Cartmell, administrative director of women's and children's services at Kettering. The progress was measured with two outcomes: the percentage of elective inductions under 39 weeks gestation—when newborns are more prone to birth injuries—and the percentage of elective induction births requiring a trip to the special care nursery.

The first measure dropped from 27.5% in 2004 to 12.4% in 2008, making injuries less likely. And the number of elective inductions with injuries dropped dramatically—from 17.25% of all elective inductions before the program to just 1.1% in 2008.

The bundles concept is now being expanded to other hospitals as part of a broader safety initiative.

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