Implementing Obstetrics Quality Improvement, Driven by Medico-legal Risk, is Associated With Improved Workplace Culture

Lefebvre, Guylaine; Honey, Liisa; Hines, Kristen; Keough, Annette; Roye, Charmaine; Bellemare, Steven; Piscione, Tino D.; Falconer, Andrew; Shepherd, Lynne; Thorne, Susan; Wallace, Gordon G.; Calder, Lisa A.

doi:10.1016/j.jogc.2019.05.011

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…The majority of studies were quantitative (n = 35, 70%); fewer were mixed methods (n = 11, 22%) and qualitative studies (n = 4, 8%). The quantitative studies were systematic reviews of randomized control trials (RCT) and/or other studies (n = 4), 35‐38 analytic RCT (n = 2), 39,40 analytic quasi experimental (n = 2), 41,42 analytic observational (n = 10), 43‐52 descriptive survey (n = 10), 53‐62 and descriptive audit (n = 7).…”

Section: Resultsmentioning

confidence: 99%

“…Nearly half of the studies originated from the United States (n = 24, 48%) 42,44‐47,50,51,53‐55,59,60,62‐67,69‐74 . The remainder were from the UK (n = 9), 6,35,36,52,58,75‐78 Australia (n = 4), 38,49,79,80 Tanzania (n = 2), 41,81 Canada (n = 2), 37,57 and Brazil (n = 2) 61,68 . Single studies originated from Ethiopia, 40 Ireland, 39 Mexico, 82 New Zealand, 48 Scotland, 56 Spain, 43 and Sweden 83 .…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies which implemented a clinical governance strategy (n = 27) were classified as a patient safety and quality improvement initiative using the ACSQHC framework (see Table 2a,b). 23 The most frequently reported clinical governance strategy was organization‐led comprehensive patient safety programs (n = 9 studies) 42,51,57,59,60,65‐67,72 . The next most frequent clinical governance strategy was checklists to standardize care (n = 5 studies), 55,56,62,74,82 for example, a surgical checklist to improve safety in obstetric surgery 56 .…”

Section: Resultsmentioning

confidence: 99%

“…The remaining group of clinical governance studies measured a variety of outcomes (See Table 2b). Eight measured outcomes from the perspective of the organization, such as staff perceptions of safety culture and litigation claims 54,55,57,59,60,62,64,67 . Alternatively, six studies measured outcomes of the clinical governance strategy from the service user's perspective, such as satisfaction with care 41,61,79,81‐83 .…”

Section: Resultsmentioning

confidence: 99%

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Organizational strategies to optimize women’s safety during labor and birth: A scoping review

McCormick

Pollock

Kapp

et al. 2021

Birth

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Background Safety is a priority for organizations that provide maternity care, however, preventable harm and errors in maternity care remain. Maternity care is considered a high risk and high litigation area of health care. To mitigate risk and litigation, organizations have implemented strategies to optimize women's safety. Our objectives were to identify the strategies implemented by organizations to optimize women's safety during labor and birth, and to consider how the concept of safety is operationalized to measure and evaluate outcomes of these strategies. Method This scoping review was conducted using the Joanna Briggs Institute Scoping Review Methodology. Published peer‐reviewed literature indexed in CINAHL, Medline, and Embase, databases from 2010 to 2020, were reviewed for inclusion. Fifty studies were included. Data were extracted and thematically analyzed. Results Three categories of organizational strategies were identified to optimize women's safety during labor and birth: clinical governance, models of care, and staff education. Clinical governance programs (n = 30 studies), specifically implementing checklists and audits, models of care, such as midwifery led‐care (n = 11 studies), and staff training programs (n = 9 studies), were predominately for the management of obstetric emergencies. Outcome measures included morbidity and mortality for woman and newborns. Three studies discussed women's perceptions of safety during labor and birth as an outcome measure. Conclusions Organizations utilize a range of strategies to optimize women's safety during labor and birth. The main outcome measure used to evaluate strategies was focused on clinical outcomes for the mother and newborn.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Organizational strategies to optimize women’s safety during labor and birth: A scoping review

McCormick

Pollock

Kapp

et al. 2021

Birth

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“…Obstetrics is one of the most risky fields in medicine regarding the severity of patient outcomes and related ramifications ( 6 ) . Unsatisfactory obstetrics and gynecology training, displays its effects on the daily practicesof postgraduate surgeons, curbs professional confidence, engenders circumstances that would end up with litigations against obstetricians and most importantly worsens patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral

Akar¹,

Ceylan²,

Kahraman³

et al. 2022

tjod

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Objective: In this study, we aimed to evaluate the effects of obstetric emergencies workshops combining theoretical lectures, simulation trainers and fresh cadaver models on daily practices and referrals of obstetrics and gynecology specialists. Materials and Methods: This is a prospective observational study involving obstetrics and gynecology specialists attending the Turkish Society of Obstetrics and Gynecology endorsed obstetrics hemorrhage management courses held in 2018 and 2019. The training course is an annually organized two-day course, one day allotted to theoretical lectures and the other day to practical training on both simulators and fresh cadavers. Trainees participating in the course was surveyed with an anonymous questionnaire on their motivation to attend the course and their juridical history of obstetric patient management. Attendees were asked to disclose whether they had ever independently performed the procedures stated in the questionnaire or not, before commencing the course and 1 year after attending the course. Results: Among the attendees 22% (n=32) had at least one obstetrical malpractice lawsuit and 36.1% (n=52) were accused of Health Care Complaints Comission. The main motivation of the attendees for taking this course was Professional development followed by reducing maternal mortality and morbidity and avoiding malpractice. One year after the course, attendees applying uterine devascularization surgery increased by 36.1% (52/144), uterine compression sutures increased by 52.7% (76/144), and ability to apply uterine balloon tamponade increased by 59.7% (86/144). Besides improvement in other obstetric surgical skills an indirect effect seen that the attandees operated on high-risk cases increased in placenta previa (15.3%), placenta acreata spectrum (30.5%), operative deliveries (27.7%), peripartum hysterectomy (24.9%) and relaparotomy for postpartum hemorrhage (34.7%). Conclusion: Opportunities of attending well organized fresh cadaveric workshops on managing postpartum hemorrhage and other obstetric surgeries, can quickly adapt to daily practice, restore the professional confidence of obstetric and gynecology specialists, and eventually decrease patient referral.

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Medical-legal risk management

Kelley¹,

Lentz²

2022

Comprehensive Gynecology

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Implementing Obstetrics Quality Improvement, Driven by Medico-legal Risk, is Associated With Improved Workplace Culture

Cited by 8 publications

References 10 publications

Organizational strategies to optimize women’s safety during labor and birth: A scoping review

Organizational strategies to optimize women’s safety during labor and birth: A scoping review

Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral

Medical-legal risk management

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