Birthing Centers Blossom

Joe Cantlupe, for HealthLeaders Media , March 13, 2012
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"Additionally, water facilitates a method of pain management, which helps relax the patient and relax the pelvis," she says.

Critics argue that the procedure introduces unnecessary risks to the fetus, such as infection and water inhalation. "There are not more complications with water births as compared to nonwater births," says Schmidt. "We have not had any complications related specifically to water births. We don't offer water births to people who we anticipate might have complications."

Success key No. 4:  Reducing malpractice claims

While the Ascension Health System works to improve outcomes in the birth process, it also is considering something else: efforts to reduce potential malpractice lawsuits.

The hospital system is seeking to improve patient safety at the time of delivery and reduce self-insurance expenses by improving management of adverse events, says Hendrich. The program seeks to reduce the overall expense of malpractice funding for obstetrics.

Ascension is focusing on the perinatal experience for the mother and the child and working with care providers to improve safety and reduce medical claims through a federally funded study, which Ascension created.

To do so, Hendrich says, the hospital system seeks to make improvements in specific protocols at its birth centers.

A major area that the hospital system is focusing on is shoulder dystocia, which occurs when an infant's head passes through the birth canal, but his or her shoulders get caught, either because of the weight of the infant or the small pelvis of the mother. If a doctor attempts to deliver the child without changing the position of the infant's shoulders, it could result in physical impairment. Incidents of shoulder dystocia have been the subject of much litigation, with malpractice attorneys often focusing on whether surgeons or medical staff took proper precautions or preventive measures involving monitoring position of the baby.

The hospital system is working on various protocols "to determine a series of maneuvers that could make a difference" in delivery and lessen the possibility of shoulder dystocia, she says. Those protocols involve physician, nurse, and other staff oversight and response, she adds. "If the infant is not delivered in a timely manner, it can necessitate instant attention," Hendrich says. "We developed standardized education modules in which all physicians and nurses are trained on the same content and tested with the same material in order to act as a collaborative team."

The training not only involves the clinical aspect of care, but also covers the possibility of litigation, with the intent of reducing it, Hendrich says.

If there are problems in delivery, "our physicians and nurse teams are sitting down with the mother and family and fully disclosing what happened," she says. "Medical disclosure, although we like to think it happens the same everywhere—it doesn't. This is a very patient-centered model. When something unexpected happens, a patient deserves to know.

"In an event that is unexpected and discloses harm, we're working on a program to avoid long, protracted medical liability cases. We know that medical liability and serious adverse events can be closely linked," Hendrich says.

"We are collecting data from the mothers' charts and new data for the study in real time," she says. Five hospitals within the health system have begun tracking the "human story" of the changes. "Full disclosure is empowering for the physicians and nurses, and it's the right thing to do for the mother."

Reprint HLR0312-6

This article appears in the March 2012 issue of HealthLeaders magazine.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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