Driving Statewide Improvement in Perinatal Care
Across the nation, 43 state and multi-state perinatal quality collaboratives (PQCs) are working to improve health outcomes for moms and babies. Comprised of multidisciplinary teams, PQCs work with clinical teams, experts and stakeholders, including patients and families, to advance evidence-informed clinical practices, reduce variation, optimize resources, and address gaps in perinatal care.
Launching and sustaining a PQC (or any quality improvement collaborative) is complex though. It’s not just about identifying best-practices for treatment and care; it’s about spreading those best-practices to people and institutions across the state, many of which have different organizational structures, are balancing different priorities, and are working with different resources.
“No state PQC should feel alone in this work,” says Pat Heinrich, RN, MSN, CLE, NICHQ Executive Project Director for the National Network of Perinatal Quality Collaboratives (NNPQC), an initiative that provides resources and support to state-based PQCs. “By facilitating collaborative learnings, the NNPQC gives states a critical opportunity to share what’s worked for them, and ultimately accelerate national improvements.”
To help PQCs (and other quality improvement collaboratives) benefit from this collaborative learning, we’ve compiled advice states shared on developing and sustaining a PQC. Along with helping emerging PQCs launch their work, these strategies can support existing PQCs searching for inspiration and ideas. And while the advice focuses on perinatal health, these ideas can benefit any quality improvement collaborative seeking to improve care delivery across a state or community.
Three Strategies for Developing a Successful PQC
- Don’t skimp on developing your mission and vision
“We often want to jump right in and start improving clinical practices,” says Barbara O’Brien, MS, RN, who leads the work for the Oklahoma PQC. “It’s important, though, that we step back and take time to develop a formal mission and vision that all stakeholders agree on.”
Without that central guiding light, she explains, future decisions to advance the work can easily get roadblocked. How will you agree on what initiatives to pursue? Where will you get your funding and what will you invest in? Will you have a conference and, if so, how will it be planned and structured? By checking these questions against your agreed upon mission and vision, you can more easily align stakeholders and efficiently move the work forward.
Moreover, a core mission and vision can help your collaborative foster a trusting relationship with the health professionals and hospitals in your state, explains O’Brien. It validates your PQC as a leader they can count on, one with an established goal that consistently guides its actions. Even if the individuals working on the collaborative vary over time, the mission and vision can be trusted to stay the same and inform the work.
Already running a PQC without a shared mission and vision? It’s not too late to step back and have that conversation. Pausing to do that now will spur your PQC to move forward more cohesively and efficiently. Moreover, while your mission and vision should not change through the years, it is important to take an annual look at how you are carrying it out.
- Pursue widespread buy-in
If you’re seeking to improve care delivery across a state (or states), you’re going to need the support and energies of a widespread group of people: doctors and nurses, hospital administrators and lab technologists, to name a few, at care facilities throughout the region. After all, it’s the people working on the ground who will ultimately be responsible for implementing the change.
Offering opportunities for face-to-face interactions can help establish much-needed buy-in, says Charlene Collier, MD, MPH, MHS, the Director of the Mississippi PQC. When possible, collaboratives should allot time and resources for visiting not only individual hospitals but also obstetric private practices and individual practitioners who work in rural communities. Different facilities and different individuals have different attitudes and working norms. Taking the time for in-person meetings (or at least video conferences, using Zoom or another free app) helps ensure that requests to change practices and collect data are informed by an understanding of individual and organizational priorities and constraints.
Finally, if funding allows, hosting a regional meeting or conference provides a venue for connecting with multiple care centers and individuals at once, while also encouraging collaboration and shared enthusiasm across the state.
If you are already running a PQC—especially a long-established one—take time at an upcoming meeting to discuss ways to reach out and fill in your ranks. Reviewing your membership and establishing an outreach plan for new faces is important for continued successful spread of ideas and practices.
- Diversify your funding
Funding is critical for sustainability. And relying on single-source funding, no matter how long it has been available, can be dangerous, says O’Brien. If those sources dry-up or budgets are cut, funding disappears and with it, jobs, dedicated time, and resources. Along with state budgets, both O’Brien and Collier recommend pursuing funding through the Title V Maternal and Child Health Services Block Grant, as well as tracking grant opportunities funded through the Centers for Disease Control and Prevention.
State insurance and malpractice providers can also be an important funding avenue, says Collier. For example, Mississippi’s PQC partnered with Blue Cross Blue Shield (BCBS) to launch a series of trainings for their network hospitals about implementing Maternal Safety Bundles, a set of evidence-based best practices for improving obstetric hemorrhage and hypertension care. Along with funding the trainings, BCBS updated their policy guidelines to reflect the safety bundles, helping spread best-practices to all network hospitals.
Successful PQCs still have funding challenges and are always on the watch for opportunities to raise the money that their efforts require. As your PQC matures, you might initiate a membership plan, like California does, where organizations pay an annual fee for the benefits the PQC offers. Along with national foundations, local community and family foundations focused on infant health are potential partners.
Remember, says O’Brien, “Stay positive, smile and keep moving forward. Say yes to the opportunities that come your way. Be willing to take that risk. There is no failure—you are going to learn from every experience.”
North Carolina’s Strategy to Address Social Determinants of Health
North Carolina is developing a system that connects individuals with resources to address social, economic and environmental barriers to their health—such as housing, food insecurity, and transportation. By putting funding and policy efforts into addressing social determinants of health, North Carolina is building a system that can improve health outcomes for children and families across the state.
NICHQ Employee Spotlight: Colleen Bernard
In honor or our 20th anniversary, we're sharing insights, memories and goals from the NICHQ team. Here, NICHQ Project Specialist Colleen Bernard shares her proudest moment during her time at NICHQ and her goals for NICHQ's future.
Breastfeeding in 2019: Safe Sleep, Bias, Gender Equitable Norms, and Paid Leave
In honor of National Breastfeeding Month, we’ve taken time with NICHQ Faculty Expert, Lori Feldman-Winter, MD, MPH, an internationally and nationally recognized expert on breastfeeding nutrition, education and policy, to recognize successes and learn about opportunities for improvement. Her frank description of bias and her passion for promoting gender-equitable social norms have inspired us to continue pursuing sustainable improvements.
Successful Strategies Hospitals Can Use to Support Safe Sleep
Hospitals on a national initiative to improve safe sleep came together to share successes and lessons-learned. Here, find their highest-rated strategies and change ideas, all of which reflect early successes in their work. Hospitals seeking to improve safe sleep education can refer to this list as a place to start and guide for gaining quick wins.
Improving Transitions in Care Saves Lives
Advancements in care have helped more children with rare diseases reach adulthood, but health systems and providers have struggled to help children transition to adult care, resulting in high rates of complications and mortality for young adults. These strategies for helping young adults with sickle cell disease transition to adult care can save lives.
“The Act of Making a Referral is Not Enough”
Universal developmental screenings can help identify children at risk for developmental delays and connect them with needed supports. An effective screening process relies on successful referrals though—if there is no follow-up with the referred child, families can never access the supports the child may need, and that child may ultimately fall through the cracks. Here, Dipesh Navsaria, MPH, MSLIS, MD, Associate Professor of Pediatrics at the University of Wisconsin School of Medicine and Public Health provides five steps to build a referral process that works.