Create a 5-Star Maternity Experience

Mountain View Hospital was recognized in both 2012 and 2013. Hospitals receiving the 5-star award from Healthgrades represent the top 10% of the nation’s full service hospitals that consistently provide high-quality care in specific care areas. Healthgrades objectively measures hospital quality based on the number of patients who experienced complications or died as a result of their procedure or treatment. In other words, the quality ratings tell you how well patients fared during their hospital stay.

MVH is part of the Hospital Corporation of America, which provides obstetrical services at 160 hospital nationwide. About 10 years ago, HCA began what they called their Perinatal Initiatives, focusing on a number of crucial steps in providing obstetrical care. With a work group of physicians from across the country, they began to develop standardized approaches to each individual component of care. The core principle involved here is that greater variation in practice leads to poorer outcomes, and minimizing variation within each hospital improves outcomes. By adopting the most current evidence into our care and developing what is referred to as “best practices”, we have moved to having each physician on the staff follow these consensus protocols. The nurses no longer have to figure out each physician’s individual way of treating patients. Communication skills have improved. Outcomes have clearly improved. Costs have been reduced.

If you were to take your mother or your child to the Emergency Room, you don’t want the care they receive to be dependent on which doctor or nurse happens to be on call that night. You want to be confident that whoever is covering will provide the best, standardized, evidence-based care currently possible.

The good news is that Utah has the lowest overall healthcare cost in the country, our health insurance premiums are among the lowest in the country, Utah has the lowest cesarean section rate of all 50 states. The World Health Organization ranks the USA 12th as a nation in the world in what they call WHO Mortality Amenable to Healthcare. If Utah were a country, it would rank 1st – the most effective healthcare in the world. So instead of ObamaCare, what we need is UtahCare.

This is a result of the great work of all the physicians, nurses, and other healthcare professionals in our state who have embraced the concept of evidence-based care. I think it also is a direct result of the fact that a majority of hospitals in Utah being part of a larger system such as HCA or IHC that implement standardized best-practices system wide.

The solution to the malpractice crisis in healthcare does not really lie in tort reform. The real solution is better outcomes, and that is what we are seeing as a result of the standardization of care. For example, in 2000, HCA was experiencing about 14 claims per 10,000 births (about 13%above the national average). After beginning and implementing the Perinatal Initiatives program, in 2009, the number of claims dropped from 14 to 4 claims per 10,000 births (50% below the industry average).

In 2007, as department chairman, I started what we called the Mountain View Hospital Patient Safety Program. We looked at each component of care, from admission of a laboring patient, to the moment of discharge, and looked at the way we were doing things, and how we could improve. We took each policy and protocol, many of which came from HCA from their clinical workgroup meetings, and discussed them at our department meetings. The challenge was to get physician and nurse buy-in to the concept of all agreeing on one way of doing things, and then periodically updating that consensus method as new evidence emerged.

We also have worked to develop a culture of safety. The physician is no longer the “captain of the ship”, but rather is the “leader of the team” of physicians, nurses, respiratory therapists, housekeeping services, etc. Everyone is equally important. It is important to have a blame-free environment where individuals at every level of care can report errors or near-misses (close calls) without fear of reprimand.

What about the rural hospitals in Utah where obstetrical services are provided by family physicians and certified nurse midwives?

A different hat that I wear is as a leader in the Utah Section of ACOG. A little over a year ago, we were considering the fact that over 50% of the counties in Utah do not have a board certified obstetrician practicing in any of the communities in that county. We have been regularly communicating with the OB-GYN specialists throughout the state, updating them on various clinical issues that come from ACOG. We began to realize that we could do more.

I began contacting each of the 18 rural hospitals in the state and set up an Outreach Program through their obstetrical nurse coordinator. I have personally visited 13 of the hospitals and given talks on topics such as patient safety initiatives, standardized terminology, interpretation, and management of FHR tracing patterns, and other subjects. We have sent out thus far 8 e-mail letters which include various standardized protocols to these hospitals. The nurse coordinator then forwards the communication to each physician and nurse, and they are encouraged to have a joint meeting to evaluate where they stand and how they can implement each of these current best-practices.

The response has been uniformly positive. They have been very appreciative of being brought into the loop, and know that they can call one of us at any time that they have a concern or question about any area of obstetrics.

I was asked to present our Utah Outreach Program at the last ACOG district meeting which includes the western states of Washington, Oregon, Montana, Wyoming, Idaho, Colorado, New Mexico, Hawaii, and Alaska, and they were all very enthusiastic about developing such a program in their states as well.