An Exploratory Study of the Relationship between Facility Design and the Provision of Childbirth Care

Abstract

Introduction: Across health care, facility design has been shown to significantly affect quality of care; however, in maternity care, the mechanisms of how facility design affects provision of care are understudied. We aim to identify and illustrate key mechanisms that may explain how facility design helps or hinders clinicians in providing childbirth care. Methods:We reviewed the literature to select design elements for inclusion. Using a modified Delphi consensus process, we engaged an interdisciplinary advisory board to prioritize these elements with regard to potential effect on care provision. The advisory board proposed mechanisms that may explain how the prioritized facility design elements help or hinder care, which the study team organized into themes. We then explored these themes using semistructured interviews with managers at 12 diverse birth centers and hospital-based labor and delivery units from across the United States. Results:The design of childbirth facilities may help or hinder the provision of care through at least 3 distinct mechanisms: 1) flexibility and adaptability of spaces to changes in volume or acuity; 2) physical and cognitive anchoring that can create default workflows or mental models of care; and 3) facilitation of sharing knowledge and workload across clinicians.Discussion: Facility designs may intentionally or unintentionally influence the workflows, expectations, and cultures of childbirth care.

The design of “TeamBirth”: A care process to improve communication and teamwork during labor

“…During this phase, we conducted an extensive exploratory review of professional guidance, peer‐reviewed literature, and public quality improvement toolkits to understand the context of variation in obstetric outcomes in the United States. 3 , 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 We put particular emphasis on variation in hospital‐level cesarean birth rates based on broad stakeholder interest in the relationship between cesarean birth and value‐based care and precedent for cesarean as a proxy for quality of labor management. 20 , 21 We synthesized the broad range of strategies identified into higher‐level categories to consider targeting with our solution (eg, limiting cesareans for lack of progress in the latent phase, requiring a second opinion for intrapartum cesareans) and then developed a causation map of all potential strategies and the mechanisms through which they could affect cesarean birth rates.…”

“… 6 These failures may be because of, in part, clinical environments and care processes that are not well designed to support team‐based work. 7 , 8 , 9 Nonetheless, the science of designing, testing, and implementing care models that promote communication and teamwork remains nascent.…”

Towards restorative spaces for postnatal recovery in urban tertiary hospitals

“…In particular, a very recent review by Setola et al (2019) of relevant literature in the childbirth environment shows a lack of studies investigating this all important topic. Additionally design of childbirth facilities affects care providers' ability to provide care which may have consequences on workflows and expectations in the discharge of quality recovery care (Plough et al, 2019).…”