Across the United States, health care organizations are coordinating efforts throughout the continuum of pregnancy and postpartum care to improve birth outcomes and reduce maternal morbidity and mortality. AHA’s Better Health for Mothers and Babies Initiative is working alongside our member hospitals and health care systems to help mothers and their babies thrive.
This discussion guide is designed to help teams of health care leaders identify opportunities to advance their pregnancy and postpartum care strategies. The questions are aligned with the four core principles that AHA encourages hospitals to apply to their maternal health improvement efforts.
- Examine quality and outcomes data to guide strategy
- Apply an equity lens
- Involve patients and community in their own care
- Engage and diversify workforce
How to Use this Discussion Guide
Assemble your team. Make sure that you have stakeholders present from across the continuum of your organization’s maternal health care team. It is important to hear the perspectives from your clinicians, quality improvement leaders, lay health care providers, patients, community stakeholders and health care administrators.
Create time and space for conversation. These discussion questions may elicit in-depth, nuanced conversations, so we recommend convening your team in a space where everyone can devote their time and attention to maternal health.
Space out your conversations. You do not need to complete this discussion guide in one sitting. Consider scheduling five meetings with your team — devoting one meeting to each core principle and a final convening to reflect on your discussions and identify opportunities for programming.
You do not have to have all the answers. This discussion guide asks a lot of questions - you might not have the answers on hand. Ask team members to review questions in advance so they can investigate the data and follow up on outstanding questions.
Give yourself time to reflect. We ask these questions to prepare you to think critically about how your organization is addressing maternal health. Some of what you find and hear might be challenging. It will be important for all team members to bring humility and an open mind to the conversation.
What’s next? Use your team discussions as a launching point. Addressing maternal health is not a one size fits all approach — customize your approach to the unique situation of your hospital and community. What themes arose during your discussions? What new tactics can you build into your strategy? What is necessary for your organization to improve maternal and infant outcomes?
1.Examine quality and outcomes data to guide strategy:
Systematically collect data, review metrics and identify inequities to drive strategies for improvement.
Collecting Data
- How does your organization track maternal and infant morbidity and mortality data among your patients?
- Which metrics matter most/are your key indicators?
- How are you incorporating metrics from the postpartum period?
- Which sociodemographic variables (e.g., race, ethnicity, language spoken) are collected and tracked?
- What social needs (e.g., food security, housing security, transportation needs) does your organization screen for during perinatal care?
- At what points during the continuum of pregnancy do you screen for mental health needs? What do you do with that data?
- How do you track maternal and infant outcomes in your community, region and/or state?
- How are you reporting collected data across the organization?
- How do you share these data with your board?
Analyzing Data
- What insights are you discovering in your analysis of maternal and infant health outcomes for both your patients and the broader community?
- What are the most common causes of maternal morbidity and mortality?
- What are the most common infant health challenges?
- How do your organization’s outcomes compare to state and national benchmarks?
- In what areas are you doing well? What can you attribute that to?
- Where do you see opportunities to improve care during pregnancy, labor and delivery and the postpartum period?
- What do you find when you stratify your collected data by race, ethnicity, age, socioeconomic status and/or other social domains specific to your community?
- How are you identifying the root causes of contributors to these indicators?
Acting on Data
- What quality and performance improvement strategies does your organization employ or participate in to improve outcomes (e.g., AIM Patient Safey Bundles, perinatal quality collaboratives, or other toolkits)?
- What metrics are you measuring to gauge progress?
- What are challenges or opportunities for improvement in this space? What types of clinical guidelines would facilitate progress?
- How does your state hospital association engage with your quality improvement initiatives? What is their role?
- What systems do you have in place to review maternal health complications?
- How does your organization respond to a poor outcome during pregnancy, delivery and/or postpartum?
- How do you identify which outcomes were potentially avoidable?
- How do you monitor patients for complications during the postpartum period?
2. Apply an equity lens
Investigate the equity implications of clinical and community-based strategies and ensure commitment toward eliminating identified disparities.
Addressing Societal Factors that Influence Health
- What types of social needs are most prominent in your perinatal patients and families?
- What programs does your organization have in place to address social needs?
- How could they be specifically targeted at/designed for pregnant and postpartum women?
- What programs or resources do you have for pregnant patients with substance use disorders?
- What community-based organizations are you partnering with to support pregnant and postpartum women?
- How are you identifying and addressing implicit bias in pregnancy and postpartum care?
- What programs or strategies have you specifically designed to address the medical, social and cultural needs of community segments experiencing health inequities (e.g., Black, Indigenous, immigrant)?
- What programs do you have in place to address upstream factors that influence maternal health outcomes?
- How do you assess the impact of your processes and programs? What feedback do you collect from patients, community members and providers?
Advancing Your Maternal Equity Strategy
- How is improving maternal health outcomes designated on your organization’s strategic plan? Who is accountable?
- Who are the champions for maternal health equity in your organization? How can you work with them to improve care delivery?
- What would it take to make improving maternal and infant outcomes an organizational priority?
- Describe challenges preventing your organization from eliminating maternal health inequities. What support or resources are needed to make progress?
- What can your organization do to raise awareness about maternal health inequities?
3. Involve patients and community in their own care
Engage patients, families and community stakeholders to design care that is responsive to their needs and preferences.
Engaging Pregnant Women and Families
- What processes does your organization use to identify patients’ needs and preferences for maternity care and birth experiences?
- How do you elicit patients’ feedback about their birth experiences? Surveys? Interviews?
- Are respondents representative of your community? Whose voices and perspectives may you be missing?
- Does your organization have a patient family advisory council? If so, how do you engage the PFAC or other patient advisory groups?
- How might maternal care needs be reflected in your community health needs assessment process?
- Are you hosting conversations with community stakeholders to better understand the layered issues people encounter during pregnancy and postpartum?
- What aspects of maternal care do your patients rate highly? What are the areas for improvement?
- How might you empower patients to advocate for themselves and engage them in their own care?
- What types of strategies have worked in building a trusting provider-patient relationship?
- How does your organization engage fathers and other family members during pregnancy and postpartum care?
Partnering with Community Stakeholders
- What community-based organizations do you partner with to address maternal health needs?
- Do you have an inventory of existing resources to support mothers and families?
- Are there opportunities to build upon or expand your partnerships? Consider community health centers, churches/religious organizations, schools, birth centers and mental health providers.
- How do you measure the impact of your partnerships?
Supporting Perinatal Mental Health
- What programs and resources do you offer pregnant patients with mental health needs (e.g., existing mental health diagnoses, perinatal depression/anxiety, substance abuse)?
- How are clinicians trained to address maternal mental health?
- How can these resources be tailored to meet the social and cultural needs of your community?
- What strategies are in place if there is a shortage of mental health professionals?
- What support do you offer to families experiencing complications related to birth (e.g., baby in the NICU or infant loss)?
4. Engage and diversify workforce
Deploy interdisciplinary care teams who are trained to provide culturally appropriate care and are representative of the patient population.
Deploying Interdisciplinary Care Teams
- In your health care organization, what types of medical and lay professionals are involved in maternity care across the continuum of pregnancy?
- Obstetricians? Nurse midwives? Nurses? Doulas? Community health workers? Psychiatrists/ psychologists? Lactation specialists? Social workers? Other?
- What types of professionals might be missing from the care team?
- What would it look like to build a culture of team-based maternal care?
- What could your organization do to more effectively coordinate care throughout pregnancy and postpartum?
Training Your Care Teams
- What kind of continuing education/training does your organization offer your maternal health workforce on implicit bias, cultural appropriateness, health equity and active listening?
- Is the training mandatory or optional?
- Who receives the training? Are there any professions that should be trained that currently are not?
- How is your organization cross-training health care professionals in deliveries and emergencies to help increase access and availability of obstetric care?
Diversifying the Workforce
- To what extent is your maternal health workforce reflective of the community you serve?
- What types of partnerships or efforts is your organization using to increase diversity in the workforce?
- What limitations and challenges does your organization face in employing diverse health care professionals?
