Episode 9: HIROC, SOGC and the CMPA join forces as partners in Salus Global

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In this special episode of Healthcare Change Makers, we talk to the four leaders whose organizations have formed a new collaboration to advance the safety of obstetrical and perinatal care in Canada. Hear from Catherine Gaulton (CEO, HIROC), Dr. Hartley Stern (Executive Director and CEO, CMPA), Dr. Jennifer Blake (CEO, SOGC), and Malcolm Eade (President and CEO, Salus Global).

Today, your host Ellen Gardner, Communications and Marketing at HIROC, speaks with the four leaders whose organizations have formed a new collaboration to advance the safety of obstetrical and perinatal care in Canada.

Each year approximately 380,000 children are born in Canada. The majority of births occur safely, but patient safety events do occur, and while rare, these events can be associated with severe patient outcomes. HIROC, SOGC, and the CMPA have joined forces as partners in Salus Global to help address and reduce these rare events and improve the safety of care for mothers and newborns across the country.

HIROC and the SOGC have worked closely with Salus Global for years. In November 2017 they welcomed the newest member of the partnership, the CMPA – Canada’s largest physician organization with 100,000 members.

The partners now share equal ownership in Salus Global whose flagship program, the MOREOB program, is designed to create a culture of patient safety and performance improvement for interprofessional obstetrical teams. Together with the CMPA, the partners hope to build greater awareness and improved involvement in the MOREOB program.


Ellen Gardner: Good afternoon. I'm Ellen Gardner, I work in communications and marketing at HIROC. Today we're doing something a little different on Healthcare Change Makers. We're talking to four leaders who have recently formed an exciting new collaboration. Longtime partners HIROC and the Society of Obstetricians and Gynecologists of Canada have welcomed the CMPA as a new partner in Salus Global. With this new collaboration, the partners want to improve safety in obstetrical and perinatal care and they're also dedicated to encouraging greater access to Salus Global's flagship program, the MOREOB Program.

The first person we'll be hearing from today is Catherine Gaulton, CEO of HIROC.

So I'd like to start off Catherine, by asking you why this collaborative initiative is an exciting development for HIROC and our subscribers?

Catherine Gaulton: It's fantastic to actually have the combined force of HIROC, the SOGC, and CMPA together. We are really a party to intervene so thoroughly with physicians, with hospitals, with other healthcare organizations, midwifery practices in the country to really try and impact care. So to have a combined force of all three is fantastic. We're really happy about that.

Ellen Gardner: What are your hoped-for outcomes of this collaborative?

Catherine Gaulton: Really, what this collaborative and what Salus Global and the MOREOB Program in particular seeks to achieve is actually an improvement of how teams work together in and around obstetrical care, and those teams are made up of physicians, other healthcare professionals, midwives. So to have everyone who is giving them advice together come from the same perspective actually improves the possibility that they will work effectively together as a team, and that is how we will move the quality of care along in this area.

Ellen Gardner: So really, what this is doing is bringing together three very strong and dedicated partners in the improvement of safety. Do you think that that collaborative is going to be reinforced and even stronger now having the CMPA as part of it?

Catherine Gaulton: Absolutely, and you said it well. It is bringing together three partners who have a maximum ability to impact the safety at least as we see it, in claims, but in obstetrical care generally. So, yes, I think the combined force of the three will be huge.

I know from my own practice in healthcare that it's very important to hear a consistent voice when you want people to operate as a team together. You couldn't have HIROC providing one piece of advice and CMPA another, and expect that you're going to have consistency across teams. The fact that you have two voices come together with the backing of the SOGC, who keeps us very grounded around what is best practice in obstetrical care and in how teams work together, can only be a positive for us.

Ellen Gardner: Catherine, can you talk to me a little bit about how this collaboration is a perfect fit with HIROC's vision of partnering to create the safest healthcare system?

Catherine Gaulton: Thank you Ellen for that question. It gets me to speak about why I came to HIROC to begin with. The fact that you have an insurer who comes from a different lens already by virtue of having subscribers who are such key players in the healthcare system, but an organization that instead of talking about providing great insurance actually talks about providing safe care, talks about supporting subscribers and those it serves, the patients. That commitment to safety, and then to make it our vision partnering to provide safe care, it all really does truly come together in a collaboration like this where you're talking about impacting with other key players in the system as it relates to perinatal care, and looking to make that difference, which is of course key to HIROC and key to these two partners.

So, it's a true kind of coming to what I knew HIROC would be when I came here, and what HIROC needs to be and will continue to be for the healthcare system in this country.

Ellen Gardner: It's a wonderful development for all the parties. Is it something that's exciting for you?

Catherine Gaulton: It's fantastically exciting for me. I think back to the first meeting that Dr. Stern around this topic. We said, we've come to these roles in order to make a difference and we'll fail if we don't make that difference together as it relates to obstetrical and perinatal care. And to then hear the voice of Dr. Blake as the CEO for SOGC really share in that vision. So it's absolutely a proud day, and proud because I really think it will make a difference for the patients we ultimately serve.

Ellen Gardner: So maybe you can talk a little bit about the value of collaboration and working with different kinds of partners.

Catherine Gaulton: Absolutely. I think in Canada, we're so extremely lucky that we have perinatal care provided in many environments and through many healthcare professionals. I was actually delivered into Newfoundland society by a midwife, and so I do and of course HIROC does, see the benefit of that as an area of practice through family physicians, through obstetricians and gynecologists, and then through the wide variety of healthcare professionals that support that team of people who could provide care.

We can now collaborate around a program that actually addresses the delivery of perinatal care by whoever is involved in that care, and in whatever environment that care happens. So whether that care is in a home, in a birthing clinic, in a hospital, that we might have a program that actually speaks to professionals in all of those environments with a consistent voice is really quite definitional of collaboration from my perspective.

Ellen Gardner: Next up is Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists of Canada.

I really would like to hear from you, Dr. Blake, on why this collaborative initiative is important to your organization and your members.

Dr. Jennifer Blake: This is a really landmark collaboration. The SOGC, HIROC and CMPA, we’re all trying to accomplish the same thing, a safe and high quality birth for every mother, every baby, every family. If we are all working together, we're going to achieve that common goal that much faster and that much more effectively.

Forging a formal partnership, which is what we have just done, is the next step in a collaborative and it's a really innovative approach to improving the safety of medical care in Canada. In my opinion, it is unique in the world and has the potential of giving us the best and safest birth outcomes that any country can achieve.

Ellen Gardner: Before this happened, were you thinking that this would be a good idea to create this kind of collaboration, that this was something that was really going to be beneficial when it came to improving safe care?

Dr. Jennifer Blake: We absolutely did. The SOGC started on this journey of improving the safety and quality of birth with a program called The Alarm Program almost 20 years ago now. We created that program working with CMPA at that time, looking at the data and looking at how we could reduce harm and make birth a safer and better experience. When Alarm grew into the MOREOB Program, we partnered with HIROC and created a program that has spread across the country, and has improved the quality of care that women have received over the past decade and a half.

Now we're bringing all three of us together. We have the same mission. We have different capabilities, and it's very exciting to imagine how we're going to be able to work together to accomplish this goal.

Ellen Gardner: What makes you most excited about this new collaborative initiative?

Dr. Jennifer Blake: What makes me most excited about this collaborative is that we can take a big look at it and say where do we want to get to, what's it going to take to get there, and let's do it. It really gives us a possibility to lift our heads up and stretch ourselves, and to imagine a future where there is no preventable maternal death, no preventable harm comes to a mother or a baby.

Ellen Gardner: So it does come down to partnership as a way of building strengths and moving in a more positive direction with our combined strengths.

Dr. Jennifer Blake: To move forward comes down to a couple of things. Absolutely we need partnerships. Absolutely we need everyone pulling in the same direction, and absolutely we need to challenge ourselves by setting some very specific but attainable goals, working towards them, and once we've achieved them setting the next goal. We shouldn't be content until we have absolutely ensured that there is no preventable harm.

Ellen Gardner: Our next guest is the newest member of the partnership, Dr. Hartley Stern. Dr. Stern is the Executive Director and CEO of the Canadian Medical Protective Association.

So maybe you can start off, Dr. Stern, by telling me why is this collaborative initiative important to your organization and your members?

Dr Hartley Stern: Joining forces with two other outstanding organizations, HIROC and the SOGC, to focus on a single problem, the safety of mothers and the safety of the newborn as the delivery of the baby occurs in the birthing unit, is an extraordinarily important healthcare problem, and we can all do it better. Joining forces to make that happen is really quite a powerful and important step for our organization to take.

Ellen Gardner: So would you say then that improving the safety of obstetrical and perinatal care is particularly important at this time?

Dr Hartley Stern: There are in the neighbourhood of 250,000 to 300,000 births per year in this country. If we can improve the chances of every single one of those deliveries occurring in the safest possible way so that each mother and each father and each child comes out of this with a greater likelihood of having a normal and enjoyable life, that will be a remarkable sign of success.

So right now, the number of actual serious accidents is quite rare. The number of near-misses is not so rare, and if we can reduce the number of near-misses for things to go wrong in the birthing suite and thereby reduce overall the number of accidents that occur in the birthing suite, we will have accomplished a remarkably important societal benefit.

But the single most important factor that I think this new partnership brings together is the notion of a cultural change, where the first thing in the morning everybody is saying the most important thing we're going to do today is ensure that every baby delivered in this institution is done so safely. And that's where I think the power initially of this collaboration occurs. What the CMPA brings is our longstanding tradition of trust amongst physicians, the understanding that we're there to help the physicians and in this case by saying to our obstetricians in the country, participating in this is a good thing, it's a very positive thing. We're more likely to achieve those cultural and cooperative requirements that are the fundamental basis of improvements in quality and safety that will allow the technology to actually be leveraged.

Without the fundamentals of cooperation, creating a strong positive culture, there is no technology that's going to work. The worst thing that can happen to a surgeon is to have a preventable accident occur in the operating room or in the immediate post-operative phase, and it's the same thing to an obstetrician, a midwife, or an anesthetist involved in the care of delivery of a baby. The worst thing that can happen to us is to have a preventable mistake occur.

The most powerful thing that we can do is create the conditions where people really care about each other in that birthing suite so things just do not go wrong.

Ellen Gardner: So Dr. Stern, final question, can you talk to me about your organization's commitment to the provision of safe care.

Dr. Hartley Stern: We spent a lot of time and energy in prior years looking at how we would put our energies towards improving the safety of obstetrical units, and we came to the conclusion that trying to do it ourselves was a mistake. But doing it with two very powerful allies in HIROC and in the SOGC was the best way to move the needle of quality and safety in the birthing suite. And so we're delighted to become partners with those two terrific organizations.

Ellen Gardner: Our fourth guest is Malcolm Eade, President and CEO of Salus Global.

Can you tell me a little bit about the MOREOB Program?

Malcolm Eade: We essentially go in and change culture. Now most people who read business books and read anything about change management and leadership and things like that, they would all indicate that you have to improve the culture and improve the working environment in order for people to perform at a higher level.

What we do is no different than that. Our program goes in and is specifically targeted at improving the culture of the obstetrical unit in order for them to perform better in a very unpredictable, complex and complicated environment.

How have we done that? We recognize that culture change takes a long time. One of the things I like to say inside this organization is overnight success takes three years. And the reason I say that is our original program was three years in length as a minimum engagement, and it took that long for us to work through what was required in order to get the team performing at a level that would see substantive reduction in harm, and an improvement in the working environment. And I would actually reverse the order.

An improved, healthier work environment will show better outcomes. And I'm actually really pleased to be having this interview today because it wasn't that long ago, earlier this year, a meta-analysis done by Braithwaite et al, showed that improved culture does lead to improved results. And that's a very difficult thing for us to have defined in the past, but it is now getting support in the literature.

So our main focus is to change the culture. How we do that is we use clinical problems to galvanize the labour and delivery team around their main issues, and allow them to work through those things as a unit, and we do it through simulation drills, some basic learning, and foundational knowledge. And we put that all into one big Petri dish and improve the way they operate over the course of several months to several years.

Ellen Gardner: So you say what you're doing is creating a fundamental change in culture. Was that the goal of the MOREOB Program from the beginning, Malcolm?

Malcolm Eade: While the program has changed a great deal, that absolutely was the goal at the very beginning. I recall having a conversation with Ken Milne, the founder of the organization and founder of the MOREOB Program, when he indicated that when he did his research he was fascinated with why young men and women were not choosing obstetrics as a career. We're talking about turn of the century, and why malpractice rates were going up.

And what he discovered was that with any individual unit, you had highly effective, highly skilled technicians, whether it be nurses, physicians, and otherwise, but the reason that harm was occurring was that they didn't work well together as a unit. So, the whole foundation, brilliant in design if you think about the way quality was thought of 20 years ago and the way it is thought of today, that the MOREOBconcepts were well ahead of their time. That the whole concept was that you could improve culture by finding common problems that a unit can deal with and work through them in a step-wise function by increasing trust, as a very foundational approach. So yes, it was part of the master plan.

Ellen Gardner: So, would you say, and you did harken back to the beginning of the century when obstetrical care was not a desired choice, what can you tell me about the importance of improving the safety of obstetrical and perinatal care at this time?

Malcolm Eade: So, what we try to do is improve the work environment so people feel good about what it is that they're doing, that they look forward to coming to work. And when people come into that mindset, whether it's me in my job or any of us that are on this call, the more you enjoy coming to work, the better you're going to be at work. That just is a fact.

So, what we're trying to do is make OB a pleasant place to work as opposed to an onerous place to work. Now, does that sound like a grand vision and an aspiration? Oh sure, but if we don't have that, we'll never reach higher levels of engagement, higher levels of enthusiasm for work.

Ellen Gardner: What you've got now, what this development is, is three strong partners who are very committed to improving safety in obstetrical and perinatal care coming together to work with you on this program. Do you see that as having a big impact on the program, Malcolm?

Malcolm Eade: So when you're out there and you're fighting a difficult fight, and what we do is very difficult because we're trying to impact human nature, and humans' tendencies and it's a very difficult battle. But they all believe in it and all love it, so when I announced to the organization that the CMPA has joined this partnership, it's vindicating and it's validating for what it is that we do.

And I can tell you from our all-hands meeting that we had two weeks ago, the level of enthusiasm for this new relationship is extraordinary. I anticipated it to be strong. I didn't anticipate it to be as strong as it is. So we're thrilled because we feel like if I was to use a military analogy, we have air cover, a much stronger air cover for what it is that we do. And, that's giving our folks a lot of energy and enthusiasm to continue to fight the good fight.

Ellen Gardner: I want to thank these four leaders for speaking with us today about this exciting new collaboration, and what it will mean for obstetrical and perinatal care in Canada. To learn more about how the Salus Global MOREOB Program can help your organization, visit salusglobal.com. Thank you for listening.