Can Standard Work Reduce Childbirth Injuries?

Lean can be used to address many types of problems in hospitals. One of the more heartbreaking areas is highlighted in a new report from the Agency for Healthcare Research and Quality. Its title: “Potentially Avoidable Injuries to Mothers and Newborns During Childbirth.”

The report, which is based on data from 2006, actually contains good news: The rates of these types of injuries in the U.S. actually fell significantly from 2000 to 2006. But the numbers are still disturbing, even if the rate isn’t that high. Out of 4.3 million births in 2006, there were nearly 157,700 injuries that may have been avoidable.

The injuries to newborns during birth include broken collarbones, infections and head injuries. The injuries to mothers include tears in tissue during delivery.

The report classifies births as vaginal, with and without instruments, and caesarian. It found a variety of correlations between injury rates and certain categories of mothers and infants.

For example, newborns covered by Medicaid had higher injury rates than newborns covered by private insurance. And rates of obstetrical trauma for mothers were highest among women living in the wealthiest communities, and women with private insurance had higher obstetrical trauma rates than those with Medicaid.

The report does not discuss why the rates vary. It may have something to do with the training and skill of doctors. But from a lean standpoint, it almost certainly has something to do with standard work.

I see this as a very difficult area to tackle, as each obstetrician works pretty much independently, which means the doctor, rather than the hospital, is in charge of the process of delivery.

However, the fact that injury rates have been declining offers hope that improvements are possible.

Your thoughts?


darrint said...

While more or less uninsured for maternity, we worked with a midwife who handled a lot of Medicaid cases. I got the impression (how is fuzzy, long time ago) that this office handled a much higher proportion of high risk cases than a normal office handling insured cases.

The story I would expect to find is that economic pressures plus isolation from negative influences of private insurance allow these offices to solve more root problems, resulting in higher quality care.

Collar bone injuries to infants may be due to life saving procedures and I'd expect those to associate with high risk deliveries.

Also, the study looks at a very narrow measurement, and it's not a terribly useful count they are doing.

We have to see a big picture. Medicaid handling offices are going to be much more sensitive to problems at home after Mom and baby leave. So they might be less likely to advise a C-section on a single mom they know is going to go home alone.

Anyway, unless they are adjusting those statistics to account for some elephants in the room, that study seems like a poor basis act.

Peter P Patterson, MD MBA said...

The good news here is that the rate of obstetrical injuries has fallen significantly over the last five-year period. More good news in the background -- not contained in this report -- is that obstetrical practitioners are among the most accomplished in medicine at the game of clinical improvement -- exceeded only by anesthesiologists. That being the case, I would expect further improvements over the next five-year period.

That said, a great deal more could be accomplished with the application of lean methods coupled with this commitment to clinical improvement. Reports like this one can definitely inform that kind of effort -- if we can resist the urge to draw trans-galactic societal conclusions from limited data. I think this is what Darrin T above is poking at and there is a lot of wisdom in what he says.

Thanks for giving us some food for thought.
/Dr. Pete