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Upcoming important dates, next steps for the SIVB Phase II Initiative...

(The Support for Birth initiative's weekly email newsletter comes out every Tuesday.)

 
November 13, 2012
Data Needed

question marksWe would like for each of you to complete a survey to help us better assess what types of services, protocols, and practices your hospital currently has in place. This will help us to focus our Phase III efforts over the next several months and move the initiative forward.

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In the literature...

news

Zhang X, Joseph KS, Kramer MS. Decreased term and postterm birthweight in the United States: impact of labor induction

Am J Obstet Gynecol 2010;203:124.e1-7. 

 

OBJECTIVE: We sought to assess recent trends in falling mean birth- weight (BW) and gestational age (GA) among US non-Hispanic white singleton live births ��37 weeks of gestation and the contribution of in- creased rates of induction to these trends 

 

RESULTS: From 1992 through 2003, mean BW fell by 37 g, mean GA by 3 days, and macrosomia rates by 25%. Rates of induction nearly doubled from 14% to 27%. Our ecological state-level analysis showed that the increased rate of induction was significantly associated with re- duced mean BW (r �� - 0.54; 95% confidence interval [CI], - 0.71 to -0.29), mean GA (r �� -0.44; 95% CI, -0.65 to -0.17), and rate of macrosomia (r �� - 0.55; 95% CI, - 0.74 to - 0.32). 

 

CONCLUSION: Increasing use of induction is a likely cause of the observed recent declines in BW and GA. The impact of these trends on infant and long-term health warrants attention and investigation.

 

 


 

Culture:  The Road of Trials and Obstacles:

patients voice

As the journey unfolds, the road is filled with trials and obstacles. These can be viewed as a series of tests, tasks, or ordeals that the organization must undergo in order to carry on. Failure of a task is not uncommon and may be considered a test of resolve or a learning experience. For each stage of the journey, there is a corresponding pitfall. The pitfalls generally represent an attempt to accelerate the process by skipping or shortcutting required steps, or a failure to appreciate the length of time required for transformation. 

 

A failure to remove obstacles is a commonly observed pitfall that includes policies and procedures or leadership behaviors that are incongruent with the vision and values. Inability to address simple systems issues in a timely manner creates frustration and breed's negativity. There are also trust-breaking behaviors. Lack of readiness is illustrated by not having made a convincing case for change or not developing or communicating a clear and concise vision. Sometimes a state or readiness is assumed, but there is an inherent lack of understanding at a deeper level, of the potential for betrayal and lack of trust. The most common obstacle is resistance to moving forward.

 

(Kimball, 2005)

 

What pitfalls has your unit experienced? 

Do you have a well spelled out communication plan? 

Are you willing to remove barriers that hamper change efforts? 

 


 

 

 

QI Tips

PDSA

 

If data are available from both before and after a planned change, a plot of data over time can be used to see if the change resulted in improvement. If the data depicts a random pattern within a predictable range, we should not infer that a change in performance has occurred.

 

Shewhart's concept of variation can also be used to help develop a change-that is, help to answer the fundamental question of the Model for Improvement, "What changes can we make that will result in improvement?" Plotting data over time can reveal when the variation in the data no longer follows a predictable pattern. The chart may show an isolated observation or two that are outside the predictable range, or show a new trend. 

 

If the random variation in the data is disturbed by some specific circumstance, improvements can be developed by understanding what these special causes are. People can make changes to remove or overcome these causes if performance is worse, or continue them if performance is better. 

 

If the pattern of variation seen in the data is random within a predictable range, more fundamental changes are usually needed to bring about an improvement. If you don't have baseline data, don't wait to begin testing a change. It often takes time for a change to affect performance. Start collecting data when you start testing, and use the beginning data to understand the current level of performance. 

 

Langley, Gerald J.; Moen, Ronald D.; Nolan, Kevin M.; Nolan, Thomas W.; Norman, Clifford L.; Provost, Lloyd P. (2009-06-03). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (JOSSEY-BASS BUSINESS & MANAGEMENT SERIES) (Kindle Locations 904-909). Wiley Publishing. Kindle Edition. 

 

 

SIVB November Webinar

conference call The next webinar is Tuesday, November 27th, 7:30 - 8:30 AM.  Please plan to have at least one person from your team on the call so we can hear your 'voice'.

Forsyth Medical Center will share the results of their use of the C-Section Review tool. We will have a family panel to continue our discussion of home births. Please come prepared with ideas for the next PDSA cycle.
   

Click here for webinar information.

 

Contact


Tammy Haithcox  

 

Tammy Haithcox

 

PQCNC Clinical Initiative Manager

 

Tammy.Haithcox@pqcnc.org

 

 

 

 

 

 

 



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