Resources

READINESS

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

Childbirth Connection, Hormonal Physiology of Childbearing:  Fact Sheets on Core Topics  - this set of fact sheets from Childbirth Connection outlines hormonal changes through the process of labor and delivery, highlighting how to support hormonal changes during non-physiologic birth.

Maternal preference for cesarean delivery - do women get what they want?  - this article discusses the association between maternal preference for cesarean delivery and the actual mode of delivery experienced.  Women who preferred a cesarean delivery were more likely to ultimately deliver via cesarean section.  Education to address concerns regarding vaginal delivery are important in reducing primary and overall rates of cesarean section.

Low-risk, primary cesarean births in Medicaid:  National Association of Medicaid Directors/Association of Maternal and Child Health Programs Issue Brief 2015  - this brief outlines several strategies for Medicaid payment approaches with providers to decrease the primary and overall cesarean delivery rate.  Realizing that multiple approaches will be required to successfully decrease cesarean deliveries, partnerships between state agencies are also explored.

Consequences of a primary elective cesarean delivery across the reproductive life  - this article measured maternal morbidity associated with elective primary cesarean delivery versus a trial of labor.  Measured complications of delivery included transfusion, operative injury, deep venous thrombosis, hysterectomy and death. 

Safe reduction of the primary cesarean delivery  - this consensus statement by the American College of Obstetricians and Gynecologists discusses the indications for cesarean delivery, the risks of adverse maternal and neonatal outcomes by mode of delivery, the cesarean delivery rates across the United States, and offers guidance on clinical management in each stage of labor to reduce cesarean deliveries.  The initial statement was published in 2014 and reaffirmed in 2016. 

 

RECOGNITION

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

AWHONN Women’s Health and Perinatal Nursing Care Quality Refined Draft Measures Specifications  - the draft, released in 2014, defines nursing care quality measures defined by AWHONN to improve care provided to women and children.

Primary Cesarean Delivery in the United States  - this article describes a large retrospective cohort study examining indications for primary cesarean section and highlights opportunities to lower the primary cesarean rate and thus the total cesarean rate.

CRICO Clinical Guidelines for Obstetrical Services - Guideline 15:  Assessment and Monitoring in Labor and Delivery  - this document provides guidelines for the clinical provider to include admission to labor and delivery, initial evaluation of the patient and continues through first and second stages of labor and delivery of the infant.  Also included are guidelines for patient education during and after labor and delivery.

Cesarean deliveries, outcomes and opportunities for change in California:  Toward a public agenda for maternity care safety and quality  - this white paper provides an in-depth summary of the practices behind the rising cesarean delivery rates in California.  The summary provides recommendations for decreasing cesarean delivery rates to include quality improvement, payment reform and education that can be implemented effectively in any state.

Preventing the First Cesarean Delivery:  Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal- Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop - this article summarizes the content and discussion provided at a workshop supported by the National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists on preventing primary cesarean delivery.  The discussion includes indications for delivery, labor management practices, diagnosis of arrest disorders, operative vaginal delivery, evaluation of fetal status before and during labor, and non-medical factors contributing to primary cesarean delivery.  Algorithms for the management of induction of labor, assessment of intrapartum fetal heart rate monitoring and spontaneous labor are included. 

 

RESPONSE

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

AWHONN Women’s Health and Perinatal Nursing Care Quality Refined Draft Measures Specifications  - the draft, released in 2014, defines nursing care quality measures defined by AWHONN to improve care provided to women and children.

Primary Cesarean Delivery in the United States  - this article describes a large retrospective cohort study examining indications for primary cesarean section and highlights opportunities to lower the primary cesarean rate and thus the total cesarean rate.

CRICO Clinical Guidelines for Obstetrical Services - Guideline 15:  Assessment and Monitoring in Labor and Delivery - this document provides guidelines for the clinical provider to include admission to labor and delivery, initial evaluation of the patient and continues through first and second stages of labor and delivery of the infant.  Also included are guidelines for patient education during and after labor and delivery.

Labor and delivery teamwork leads to fewer cesareans  - this article describes the collaborative practice experience between midwifery, laborists and obstetricians at a hospital in California at the Society for Maternal-Fetal Medicine 2015 Annual Pregnancy Meeting.  This model was able to demonstrate a decline in the rate of cesarean delivery for nulliparous women and an increase in the rate of vaginal birth after cesarean delivery.

Cesarean deliveries, outcomes and opportunities for change in California:  Toward a public agenda for maternity care safety and quality  - this white paper provides an in-depth summary of the practices behind the rising cesarean delivery rates in California.  The summary provides recommendations for decreasing cesarean delivery rates to include quality improvement, payment reform and education that can be implemented effectively in any state.

Safe reduction of the primary cesarean delivery  - this consensus statement by the American College of Obstetricians and Gynecologists discusses the indications for cesarean delivery, the risks of adverse maternal and neonatal outcomes by mode of delivery, the cesarean delivery rates across the United States, and offers guidance on clinical management in each stage of labor to reduce cesarean deliveries.  The initial statement was published in 2014 and reaffirmed in 2016. 

Preventing the First Cesarean Delivery:  Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal- Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop - this article summarizes the content and discussion provided at a workshop supported by the National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists on preventing primary cesarean delivery.  The discussion includes indications for delivery, labor management practices, diagnosis of arrest disorders, operative vaginal delivery, evaluation of fetal status before and during labor, and non-medical factors contributing to primary cesarean delivery.  Algorithms for the management of induction of labor, assessment of intrapartum fetal heart rate monitoring and spontaneous labor are included.

 

REPORTING

Labor and delivery teamwork leads to fewer cesareans  - this article describes the collaborative practice experience between midwifery, laborists and obstetricians at a hospital in California at the Society for Maternal-Fetal Medicine 2015 Annual Pregnancy Meeting.  This model was able to demonstrate a decline in the rate of cesarean delivery for nulliparous women and an increase in the rate of vaginal birth after cesarean delivery.

Consequences of a primary elective cesarean delivery across the reproductive life  - this article measured maternal morbidity associated with elective primary cesarean delivery versus a trial of labor.  Measured complications of delivery included transfusion, operative injury, deep venous thrombosis, hysterectomy and death. 

Like all improvement work, efforts to transform the patient care experience require thoughtful planning and full team engagement. The following videos and resources are meant to support you in your journey, and walk you through the vital steps of executing your tests of change and sustaining the gains.

Transforming the Patient Care Experience Template - a PowerPoint Template you can use to reporter work on Transforming the Patient Care Experience at your own institution

Transforming the Patient Care Experience Timeline

Assessing the Patient Experience with Patient Feedback - This collection of 3 videos explores different ways to collect patient and family feedback. Consider watching this as a team and discussing the appropriateness of each method for your particular needs, resources and environment.

 

 

 

 

 

 

 

Identifying the Ideal Care Experience - What do patients and families want and need, when it comes to care? This video walks through how to use the patient and family feedback collected to identify the ideal experience. Encourage all members of your team to learn about and assist with this process to help ensure a more objective process.

 

Analyzing Gaps In the Care Experience - Analyzing gaps in the care experience requires us to know the current state of care, as well as the ideal state of care. This video uses examples to walk through this process and describe how it is used to determine what actions are needed to move to the ideal care experience. Watch this video as a team and think through the information you need in order to understand your key factors for change.

 

Selecting a Project to Create the Ideal Care Experience - Just because you can do something by yourself, does it mean that you should? The focus of this video is on the importance of engaging all the members of your team in selecting a project and contributing to its success. As you watch this video, consider potential roles for your team members and determine who from your facility should be a part of selecting and developing a meaningful project.

 

Select Data to Support Your Project - How will you know if your project has been a success? This video discusses the importance of having data that supports your anticipated outcomes and also highlights the value of thinking through barriers and measuring their impact. Watch as a team and then brainstorm potential measures of success and challenges. 

 

Implement Your Plan - What does it take to successfully implement a project? In this video, we walk through the who, what, where, when, why and how to consider prior to implementation. Everyone on your team has a role in implementation - after watching, consider your timeline and how each team member can contribute.

 

Monitor Your Progress - The work doesn’t end after project implementation. In this video, we discuss best practices for continual monitoring of your projects and how to put a process in place that will allow your team to identify potential problems - and successes - quickly. After watching this video, work as a team to develop a structure and timeline for ongoing monitoring.

 

Identify Opportunities to Share Your Work - Considering all the resources you put into executing a project, are you reporting your hard work? This video highlights the importance of sharing your progress and discusses best practices and considerations for reporting. Gather your team to watch the video and ask each member for his or her ideas about how to share your efforts and who to share your work with.

 

A Checklist for Attitudes about Patients and Families as Advisors

A tool for exploring attitudes about patient and family involvement in their own health care and as advisors and/or members of improvement and design teams.

A Curriculum for Patient-Family Centered Care

A curriculum tool shared by Memorial Health System that includes pathways for developing skills and competencies related to patient- and family-centered care (e.g., hiring interviews, new employee orientation, training modules). 

Become a Patient and Family Advisor: Working Together to Help Improve Our Hospital

A brochure that provides information on who patient and family advisors are, how they help the hospital, and who can become an advisor. Users may personalize this tool using their own hospital’s logo and information. This resource is part of AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

Building the Business Case for Patient-Centered Care

An article from Healthcare Financial Management that examines financial and business benefits found to be associated with patient- and family-centered care. Potential benefits described in the article include reduced length of stay, lower cost per case, decreased adverse events, higher employee retention rates, reduced operating costs, decreased malpractice claims and increased market share.

Partnering with Patients and Families to Enhance Safety and Quality: A Mini Toolkit

A 26-page toolkit for health care leaders, clinicians, and staff that demonstrates ways to partner with patients and families to enhance quality and safety. It provides ideas and resources that support efforts to ensure patient care is safe and responsive to the needs, priorities, goals, and values of patients and their families. Materials include: application form for patient and family advisors, description of patient safety champions, tips for group leaders and facilitators, support for rapid response teams, and other selected resources. 

Patient and Family Advisor Application Form

A form that advisors complete that includes basic demographic information, questions on why the applicant wants to be an advisor, and questions on prior relevant experiences as an advisor or volunteer. Users may personalize this tool using their own hospital’s logo and information. This resource is part of AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

Patient and Family Advisor Information Session

A PowerPoint presentation that gives information on who patient and family advisors are, what they do, and how they help the hospital and provides tips from other advisors. Users may personalize this tool using their own hospital’s logo and information. This resource is part of AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

Patient and Family Advisor Orientation Manual 

A manual that provides information on hospital safety and quality, on what patient and family advisors do and how they help the hospital, and tips for being a patient and family advisor. Users may personalize this tool using their own hospital’s logo and information. This resource is part of AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

Patient and Family Advisory Councils: A Checklist for Getting Started

A brief checklist of things to consider when starting a patient/family advisory council. 

Patient and Family Centered Care Competency Summary

A tool for tracking observations of employee behaviors associated with patient- and family-centered care. 

Powerful Partnerships: A Handbook for Families and Providers Working Together to Improve Care

A publication intended to help both family members and healthcare professionals who are working together as equal partners to improve care through multi-disciplinary teams. This 26-page handbook includes an introduction to quality improvement and collaborative processes, answers to frequently asked questions, a glossary, and resources throughout. The guide for families describes potential roles for family members, provides examples of advisors in action, and includes tips for being an effective partner. The companion piece for providers discusses benefits of partnering with families, the importance of learning from the family experience, and includes guidance for recruiting and supporting family advisors. 

Presentations by Patients and Families: Staff Liaison Coordination and Preparation Roles

A tool that is meant to assist individuals fulfilling requests for patients and families as presenters. Guidance is provided regarding the following: clarification of content and logistical issues, selecting and preparing patients and families who are able to address programmatic goals, as well as steps to take for follow-up after the presentation has concluded. 

QSEN (Quality and Safety Education for Nurses) Patient-Centered Care Competency

Teaching strategies from the American Association of Colleges of Nursing related to patient- and family-centered care. This resource includes curriculum, assignments, questions and other guidance that may be used for educating staff.

Sample Confidentiality Statement

Sample statement that hospitals can ask patient and family advisors or council members to sign before participating in advisory activities. This resource is part of AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

Sample Invitation and Regret Letters for Advisory Council Applicants 

Sample invitation and regret letters for patients and family members who have applied to be advisory council members. Users may personalize this tool using their own hospital’s logo and information. This resource is part of AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

Staff Liaison to Patient and Family Advisory Councils and Other Collaborative Endeavors

A 4-page guidance publication that describes essential qualities to look for in a liaison to patient and family advisory councils, how the individual should prepare for the role, and the responsibilities of the position.

Strategies for Leadership – Advancing the Practice of Patient- and Family-Centered Care

A 20-page resource guide written for hospital executives that provides information about the concepts of patient- and family-centered care as well as guidance on how to advance such care within organizations. Case studies and a listing of additional resources and references also are featured. This resource guide is part of a toolkit developed by the American Hospital Association and the Institute for Patient-and Family-Centered Care, which was distributed to every U.S. Hospital CEO in 2004.

Strategies for Leadership – Patient- and Family-Centered Care: A Hospital Self-Assessment Inventory

An inventory that may be used by either a hospitals’ leadership team or an organizational cross-functional team (which includes patients) to evaluate the progress hospitals have made towards patient- and family-centered care and identify opportunities for improvement. This inventory is part of a toolkit developed by the American Hospital Association and the Institute for Patient-and Family-Centered Care, which was distributed to every U.S. Hospital CEO in 2004.

Tips for Group Leaders and Facilitators on Involving Patients and Families on Committees and Task Forces

A list of items to consider when selecting and preparing patients and families for committees and task forces. This 3-page resource also includes guidance for facilitating meetings and anticipating competing demands experienced by patient and family advisors. 

Tips for Recruiting Patients and Families to Serve in Advisory Roles

A tip sheet that provides guidance and suggestions for how to identify and recruit patients and families to serve as advisors. 

Working with Patient and Family Advisors

A PowerPoint presentation of a two-part training for clinicians and staff. Part 1, Introduction and Overview, discusses who patient and family advisors are, the benefits of working with them, and opportunities for doing so. Part 2, Building Effective Partnerships, helps clinicians and hospital staff develop partnership skills. Users may personalize this tool using their own hospital’s logo and information. This resource is part of AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

PQCNC Prerequisites Follow-Up Plan

Flowchart detailing required follow-up for teams missing one or more prerequisites...

Patient- and Family-Centered Care: Partnerships for Quality and Safety 

A video which describes the core concepts of patient- and family-centered care and features compelling stories from patients, families, caregivers and hospital leaders. This video is part of a toolkit developed by the American Hospital Association and the Institute for Patient-and Family-Centered Care, which was distributed to every U.S. Hospital CEO in 2004.

Sharing Personal and Professional Stories

An exercise designed to help participants develop an understanding of patient- and family-centered care by relating personally to the core philosophical concepts.

Engaging Health Care Users: A Framework for Healthy Individuals and Communities

A report from the American Hospital Association that includes a summary of the research supporting patient engagement and a description of proven methods and tools for successfully engaging patients and families. This resource is meant to give hospital and health system leaders concrete, practical steps grounded on evidence-based research to improve patient and family engagement in their organizations.