It takes a team to deliver high performance obstetrics

Windsor Regional Hospital MOREOB Team with Dr. John Tomc (far left) and Devon Lanspeary (far right front).
Windsor Regional Hospital MOREOB Team with Dr. John Tomc (far left) and Devon Lanspeary (far right front).

With MOREOB WRH has discovered a winning formula

Monday, November 27, 2017 – Amy Sept

When Windsor’s Grace and Metropolitan Hospitals were realigned in late 2003, Dr. John Tomc, city-wide chief of obstetrics knew he needed to bring people from both obstetrics teams together. “People had different ideas of how things should be done,” he said. “There was a lot of disgruntlement.”
Tomc and Devon Lanspeary, manager of the Family Birthing Centre (FBC) at Windsor Regional Hospital found a solution in Managing Obstetrical Risk Efficiently (MOREOB), a program that helped the FBC improve patient care through standardized language, practices, roles, and expectations. FBC recently earned an award of recognition as well as an international patient safety award for their efforts around performance improvement in obstetrics.

The award and recognition didn’t happen by accident – Tomc and Lanspeary agree that overseeing this team and moving the bar continuously higher has been tough but very rewarding.

Time…and making the most of it

MOREOB was initially created by the Society of Obstetrics and Gynecology of Canada (SOGC) to produce better clinical outcomes for mothers and babies. In 2007, the SOGC partnered with HIROC to unite their common interest in improving patient safety – the result was Salus Global and MOREOB is still its signature program.
Salus Global recognizes that most problems [within obstetrical units] are not connected to a lack of knowledge or competence but occur because of breakdowns in teamwork, communication, trust, and respect.
MOREOB was definitely the right solution for Windsor Regional Hospital, but its implementation presented bigger challenges than either Tomc or Lanspeary anticipated.
Their biggest problem was time. “MOREOB is a well-constructed quality and safety program,” says Tomc, “but it’s also time-consuming to manage.” Gathering data, organizing monthly events, facilitating regular debriefings and case reviews, and actively promoting the MOREOB program – they quickly realized they couldn’t do it without leadership support and a dedicated core team.
The circle of voices they created dealt effectively with the uncertainty of the early days and has entrenched MOREOB as an integral program within the hospital.
It’s a diverse team comprised of physicians, midwives, frontline staff and two clinical practice managers, including Lanspeary. They also engage with other teams, such as anesthesiology when there are situations and initiatives they need help with.
“Every year we listen to feedback on the program’s strengths and weaknesses,” says Tomc. “On the basis of that we’re always changing what the core team is focused on and finding new ways to address problems.”
Over the years, they’ve rolled out a long list of initiatives including safety huddles, an emergency c-section team, post-partum hemorrhage kits, bedside reports, OB rapid response, oral immune therapy, a skin-to-skin initiative, and a formal debriefing process.

A winning formula with Quiet Time

More recently the FBC launched “Quiet Time – Baby Bonding at its Best,” a program initiated after a presentation by Dr. Guy-Paul Gagné about the long-term benefits of skin-to-skin contact for babies in the first year of life. “Contact within the first two hours post-delivery was already happening [in the FBC], but we wanted to be more consistent by giving new mothers a minimum one hour of uninterrupted skin-to-skin bonding over the first 24-48 hours,” says Lanspeary.
They soon discovered that giving mother and baby that one hour of uninterrupted time had immediate and long-term effects. Comparing numbers from 2016 with the same period of time in 2015, it was clear there were:
  • Lower levels of supplementation at discharge for infants whose mothers intended to breastfeed (26% to 22.7%)
  • Improvements to patient emotional support (69% to 74%)
  • An increase in overall patient satisfaction (90% to 94%)
Salus Global recently presented FBC with an international patient safety award for the Quiet Time program.
“We aren’t afraid to try an idea, even if some ideas don’t work,” Lanspeary says. “We also do a lot of audits during the year to gather data. When staff have concrete data to show the necessity for change, the process of creating change is easier.”
The time pressures are always there, but the FBC leaps over hurdles in order to ensure staff participate in skills-training initiatives. “We make it a priority for everyone in the FBC,” says Lanspeary. “For example, when new staff are cross-trained from postpartum to labour, the use of the MOREOB educational chapters, skills and emergency drills, debriefing, and communication tools accelerate the novice nurse to a high performing, knowledgeable member of the team.”
The continuous training efforts solidify that this is how we do things, Lanspeary says, which leads to more knowledgeable team members who perform better. It also puts more awards on the shelf. MOREOB requires that at least 80 per cent of staff participate in skills-training initiatives – the FBC has received the award every year since the award’s inception in 2012.
“The award is recognition of a lot of hard work,” says Lanspeary. “It really is a team effort from top to bottom.”

Amy Sept is a freelance writer and communications professional who lives in Winnipeg, Manitoba.