The policy had an impact. Valley had to staff up to perform inductions and C-sections spontaneously—now on weekends, too—which Grande says increased hospital costs. And Valley saw a decrease in revenue from what she called the hospital's "cash cow," the 15-bed NICU, because premature baby NICU admissions dropped from 15.2% of births in 2009 to 12.9% in 2012, with shorter lengths of stay and lower payments to the hospital amounting to $10,000 per day per child not admitted.
Asked if that makes the hospital's chief financial officer nervous, Grande responds, "It does. But we really live by our patient safety culture. And when we can explain that it's safety and quality we're after, it's okay."
There were a few missteps along the path to Valley's success, she acknowledges.
"What we forgot to do at the beginning was really educate the patients," she says. There was pushback, for example, from women who had delivered with a scheduled labor at 36 weeks and recalled that everything went fine. So the hospital took pamphlets to physician offices, offered prenatal classes, established a hotline, and set up booths at area health fairs. "We talked about the importance of letting nature take its course," she says.
Across the country, several other hospitals have noted stellar improvement.
An hour outside of Chicago, for example, with a much less affluent population, 210-bed Rush-Copley Medical Center in Aurora has seen its early elective delivery rate drop from 33.5% to zero, says Diane Homan, MD, Rush-Copley's patient safety officer and vice president of quality. With more than 4,000 births a year at the hospital, Homan acknowledges that getting those numbers down was a challenge.
"We've been interested in making sure we're providing culturally sensitive care for a long time, so when it became apparent to us in 2010 that many organizations, especially ACOG and the American Academy of Pediatrics, were endorsing not intervening electively until the completion of 39 weeks of gestation, we found we weren't following those recommendations, including those scheduling a repeat cesarean.
"And when we talked with our medical staff, we learned that women were, more and more, pushing for early deliveries and our medical staff was complying; they weren't really going by evidence-based guidelines."
Initially, it was tough to convince their 35 obstetricians that they might be part of the problem. "Everyone said they were doing it right; it was the other doctors who were doing it wrong," she says.