O-OBS-PS-MD-118 Methods and Lessons from a Focused Quality Improvement Program in Obstetrics


      The goals of this focused education pilot program were to: (1) strengthen safety culture; (2) build quality improvement (QI) skills for physicians and their teams; (3) focus improvement efforts on high-risk topics identified by the Canadian Medical Protective Association (CMPA); and (4) create sustainable system changes.

      Study Methods

      This before-and-after quality improvement education intervention study was conducted at an urban community hospital in Ontario, staffed by obstetricians, midwives, and family physicians, seeing ∼2700 deliveries/year. Three projects were selected and implemented — a “STAT OB” code; a protocol for managing patients presenting with ruptured membranes at term not yet in labour; and daily inter-professional morning briefings. We conducted a safety culture assessment, educational bursts, and engaged in QI coaching during implementation. QI indicators for each project were selected from a CMPA menu and project implementation was staggered over 12 months. Once complete, the study will be evaluated using culture survey scores, educational effectiveness surveys and the locally measured QI indicators.


      Preliminary observations have identified the following enablers to success: hospital-wide commitment to QI and safety; engaged leadership; clinical knowledge and familiarity with QI; and the availability of the CMPA QI indicator menu and intensive coaching. Barriers include inconsistent engagement between teams; competing priorities at the hospital level; time and resource restraints; and lack of peer comparators.


      We have identified the need to emphasize inter-professional education and integrate standardized best practices; support and train leaders; and explore approaches to optimize engagement.