Abstract
Objective
This study implemented a quality improvement program based on knowledge of medico-legal
risk in obstetrics and sought to evaluate the impact of this program on workplace
culture.
Methods
The study conducted needs assessments with front-line providers working in the obstetrical
unit of the Queensway Carleton Hospital, an urban community hospital in Ottawa, Ontario,
and included the safety, communication, operational reliability, and engagement (SCORE)
survey. The study investigators delivered training in quality improvement science
and co-developed three projects that were based on their alignment with local needs
and aggregate medico-legal risk data: an organized team response to the need for an
immediate cesarean section, a protocol for managing patients who present at term with
pre-labour rupture of membranes, and regular morning team briefings. Outcome measures
were determined for each project from a quality improvement indicator framework, and
coaching was provided to project leads. Participants completed the SCORE survey and
a program effectiveness tool after the intervention.
Results
The majority of participants (75.2% of 153 pre-intervention and 63.1% of 157 post-intervention
participants) completed the SCORE surveys. Post-intervention improvements were found
in teamwork, learning environment, and safety climate, whereas levels of provider
burnout remained high. Program effectiveness was highly rated, and most projects showed
qualitative improvements.
Conclusion
This study showed positive workplace culture change associated with the quality improvement
intervention. Lessons learned from the implementation of this program can inform future
quality improvement initiatives.
Résumé
Objectif
Cette étude visait à mettre en place un programme d'amélioration de la qualité fondé
sur la connaissance des risques médicolégaux en obstétrique et à évaluer son influence
sur la culture du milieu de travail.
Méthodologie
L'étude a évalué les besoins des fournisseurs de soins de première ligne qui travaillent
à l'unité d'obstétrique du Queensway Carleton Hospital, un hôpital communautaire urbain
d'Ottawa, en Ontario. Elle comportait notamment un sondage sur la sécurité, la communication,
la fiabilité fonctionnelle et l'engagement (sondage SCORE). Les chercheurs de l'étude
ont offert une formation sur la science de l'amélioration de la qualité. Ils ont également
mis au point en collaboration trois projets fondés sur l'harmonisation du programme
avec les besoins locaux et les données agrégées sur les risques médicolégaux, soit
les projets suivants : une intervention d'équipe organisée en cas de césarienne immédiate,
un protocole de prise en charge des patientes qui présentent une rupture prématurée
des membranes à terme et des réunions d'information d'équipe matinales quotidiennes.
Les critères d'évaluation ont été déterminés pour chacun des projets à partir d'un
cadre d'indicateurs de l'amélioration de la qualité, et les responsables de projet
ont reçu de l'encadrement. Les participants ont répondu au sondage SCORE et évalué
l'efficacité du programme après l'intervention.
Résultats
La majorité des participants (75,2 % des 153 participants préintervention et 63,1
% des 157 participants postintervention) ont répondu au sondage SCORE. Des améliorations
postinterventions en sont ressorties sur les plans du travail d'équipe, du milieu
d'apprentissage et du climat de sécurité, mais le taux d'épuisement professionnel
est demeuré élevé chez les fournisseurs de soins. L'efficacité du programme a obtenu
une note élevée, et la plupart des projets ont donné lieu à des améliorations qualitatives.
Conclusion
Cette étude a démontré un changement de culture positif en milieu de travail associé
à l'intervention visant à améliorer la qualité. Les leçons tirées de la mise en œuvre
de ce programme peuvent étayer de futurs projets d'amélioration de la qualité.
Key Words
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Article info
Publication history
Published online: August 12, 2019
Accepted:
May 15,
2019
Received:
January 7,
2019
Footnotes
Competing interests: See Acknowledgements.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
