Upcoming important dates, next steps for the SIVB Phase II Initiative...
(The Support for Birth initiative's weekly email newsletter comes out every Tuesday.)
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In the literature... |
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Doulas: An Alternative Yet Complementary Addition to Care During Childbirth
MARTHA A. KAYNE, CNM, MN, MARY BETH GREULICH, CNM, MSN, and
LEAH L. ALBERS, CNM, DrPH CLINICAL OBSTETRICSANDGYNECOLOGY
Volume 44, Number 4, pp 692-703 2001.
The doula has evolved in recent years as a welcome and sometimes necessary addition to the health care team. Cost-cutting measures have increased provider-to-patient ratios, and perinatal technology has distanced nurses from the bedside of women in labor. Nurses rarely have the opportunity to stay with one woman throughout labor and birth. On the contrary, a laboring woman is the doula's sole responsibility. They understand the intimate nature of birth and provide the "softer, quieter, gentler, more sensitive nurturing qualities of 'mothering the mother'."1 Most important, the doula stays with the woman throughout labor, beyond the confines of any shift, making the woman and her family feel cared for and never alone. Regardless of the response of the mother to labor, the doula is encouraging, provides comfort measures, and responds to each of the mother's differing needs. She explains and clarifies medical interventions, thereby decreasing the laboring family's anxiety. By her presence and comforting touch, the doula creates calmness and the essence of safety.
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Culture: The Road of Trials and Obstacles: |
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Resistance to change is generally based on loss of identity, fear of the unknown or lack of trust. Habits, attitudes, assumptions and beliefs are components of identity, which are challenged when people are asked to change. Giving up the "way we always do things" is difficult for two reasons. First, because habitual behaviors and patterns are by nature predicable and offer stability and second, because imbedded in the process of giving them up is the notion that one is being disloyal to a deep attachment-an underpinning of identity.
Because change triggers a re-definition of identity, it also can raise questions about competence. Resistance is a symptom of the underlying combination or fear, loss, disloyalty, or challenge to competence. The remedy is to proactively and systematically build trust. The Reinas' Transactional Trust model offers rich insight. Trust is a value that is often communicated in the abstract. It is emotionally provocative; highly complex and can mean different things to different people.
When change is called for, the message that "what we are today is not good enough" is often internalized as a betrayal. This is particularly true in environments where patterns of communication, collaboration and involvement are ineffective. When people experience betrayal, their capacity for trust declines and they begin to lose a sense of self. Messages about change need to reach for the higher purpose of striving to be better. Resistance is often a reflection of lack of trust in the process or the fact that people don't yet trust themselves to move to the new territory.
Capacity to trust can be increased through understanding, clear expectations and goals, and building competency and confidence. Transactional trust is created incrementally by actions that enhance character, capability and ethical truth. At the heart of transformation lies the healing and building of relationships based on trust-a cumulative, long-term process.
(Kimball, 2005)
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QI Tips:
Understanding Processes and Systems of Work
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By thinking about daily activities as processes, we gain insights for making improvements. All processes have inputs, all processes have steps, and all processes have outcomes. For each step, one could also identify where work is backing up or the reasons for rework or problems. Ideas for improvement could be developed and tested from this information.
For an individual or organization just beginning to develop the skills of improvement, creating standard processes to replace chaotic and wasteful activity is an important source of improvement. As people advance in their skills at making improvements, they realize that further improvements can be made by putting processes in the context of the system in which the processes are embedded.
A system is an interdependent group of items, people, or processes with a common purpose. Driving to work is a process. Getting a family out of bed, fed, dressed, and transported to work and school is a system. Orienting a new employee is a process; creating satisfied, productive employees takes a system. In a system, not only the parts but the relationships among the parts become opportunities for improvement.
The process of obtaining a blood analysis is part of the bigger system of delivering health care for a patient in a hospital. The process for obtaining the blood analysis may be flawless, but care will be affected by the timely and effective action taken for the patient on the basis of the analysis.
In a system, everything affects everything else. One area could make a change that results in improvement for some people but harm the overall system. From the customer's viewpoint, things could be worse. For example, the purchasing department may change suppliers of a raw material to reduce costs, which results in a lower-quality product and more returns from customers. When fundamental changes are developed, the interdependencies within the system must be considered.
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 951-953). Wiley Publishing. Kindle Edition.
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SIVB December Webinar |
| The next webinar is Tuesday, January 22nd, 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'.
Click here for webinar information.
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Contact
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Tammy Haithcox
PQCNC Clinical Initiative Manager
Tammy.Haithcox@pqcnc.org
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