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Six Strategies for Quality Improvement in Maternal and Neonatal Care

April 1, 2021
April 1, 2021

This blog is the second of three taken from a recent Webinar featuring Lindsay McAlister, BSN, RN; Alexander Walker, PhD, Senior Director, Learning and Research Design, MedStar; Dr. Tamika Auguste, Associate Medical Director and Director OBGYN Simulation, MedStar Health; and Kris Karlsen, PhD, APRN, NNP-BC, FAAN, Program Author and Founder, S.T.A.B.L.E.

The Case for Preparedness

To make the case for our need to improve maternal and perinatal care, Dr. Tamika Auguste starts off with some disappointing statistics on infant and maternal mortality in this country.

  • The U.S. currently ranks 55th of 183 countries in maternal mortality.
  • Up to 74% of all OB claims are related to a lack of clinical judgment.
  • Approximately 34% of maternal death and injury is related to inadequate monitoring.

Dr. Auguste acknowledges that it is somewhat difficult to determine the root cause of these disappointing figures. Some physicians and researchers believe that the issue is actually a result of better data collection and more accurate reporting of maternal deaths and complications. Or, is it possible that these statistics could simply be reflecting changes in the characteristics of pregnant women? Factors such as advanced maternal age and health issues such as obesity and diabetes may also play a role. However, Dr. Auguste and many of her colleagues believe that these issues are likely accounting for just a small percentage of the problem and that clinical issues directly under the control of providers and healthcare organizations play the most significant role. So, with the problem fairly well defined, where do we begin our improvement efforts?

Six Strategies for Quality Improvement in Maternal and Neonatal Care

Dr. Auguste recommends the following tactics for providers and organizations seeking quality improvement in maternal and neonatal care.

  1. Continue to study and share the data. Maternal mortality reviews help us better understand the causes of maternal deaths. Understanding the cause of death is critically important, but Dr. Auguste believes that sharing is also critical as it facilitates learning from one another. She recommends using the data to raise awareness of these clinical issues so that successful interventions from one unit in one hospital can be shared and lead to more significant changes nationally.
  2. Use existing tools. Dr. Auguste cited numerous organizations with robust bundles and toolkits that have been created specifically to address unique OB clinical issues.
  3. Remember to address communication when planning education for providers. Learning that simply addresses clinical skills is missing a critical component. Dr. Auguste believes that providers will make the biggest improvements when they learn how to communicate effectively in an emergency.
  4. Maintain a focus on critical thinking. This includes helping providers feel comfortable enough to do a brief timeout to think through and discuss complicated clinical issues.
  5. Help providers and patients understand and embrace shared decision-making. Dr. Auguste specifically defines this as, “healthcare teams and patients discussing care options, the consequences of those options, other available options, and then making the decision about care together – the healthcare team, the patient and the patient’s family.”
  6. Be mindful of the damaging effects of hierarchies in healthcare organizations. Everyone on the team should be encouraged to speak up regarding safety issues without fear of personal or professional repercussions.

Educational Solutions  

Alexander Walker, PhD leads MedStar’s SiTEL (Simulation, Training and Education Laboratory). Dr. Walker advocates a systems-based approach to organization-wide issues that includes education as part of the solution. The first step in the process is a thorough understanding of the problem. Dr. Walker and his team then use this understanding of the problem to design the most effective education that includes the appropriate topics and educational tools. Dr. Walker’s rigorous approach to educational design is just a part of HealthStream’s Quality OB program (co-developed by MedStar SiTEL). The approach produced some very impressive results for the healthcare system. After implementing the Quality OB program, they attained zero serious OB safety events in 2019 and zero lawsuits related to shoulder dystocia in FY 2018-2019.


Maternal care is one of the highest risk levels of care. Not having the right training can lead to poor communication, higher costs, and unnecessary harm. HealthStream offers industry leading solutions that will train your staff to deliver the highest quality of care for mother and baby before, during, and after delivery. 

Learn more about HealthStream's Quality Obstetrics program