Date Published | April 20, 2007
BY NORM TOLLINSKY

Statistics featured on the Society of Obstetricians and Gynecologists of Canada website for its MOREOB professional development program explain the health-care sector’s current emphasis on patient safety.

One study found that 7.5 per cent of patients admitted to acute care hospitals in Canada had one or more adverse events. Of those, 39.6 per cent were classified as highly preventable and 70 per cent potentially preventable.

In obstetrics, too, there is cause for concern. According to the Canadian Medical Protective Association, six per cent of Canadian obstetricians face litigation every year and in a majority of out-of-court settlements, expected standards of care were deemed unmet.

Designed to promote a culture of continuous improvement in obstetrics units, MOREOB has signed up 137 hospitals across Canada. Its most recent client, the Sault Area Hospital, received 100 per cent buy-in from obstetricians, nurses and midwives in the community. Hospitals in Red Lake and Thunder Bay have also signed up for the MOREOB program.

Joanne Messier-Mann, the Sault Area Hospital director responsible for obstetrics, had recently hired five new staff, diluting the collective experience of the unit. MOREOB, which stands for Managing Obstetrics Risk Effectively, offered a structured professional development program and a blueprint for team building.

It assists in bringing new hires in the obstetrics unit up to speed and fostering a culture of continuous improvement.

“A maternity department is like a fire department because sometimes it’s a little quiet, and the next thing you know, there are six people at the door and all hell breaks loose,” said Messier-Mann.

“One way to reduce stress, and improve performance is to educate people so they know what they’re doing. We do a lot of quality things now, but you can always get better.”

The three-year program includes computer-based learning, hands-on multi-disciplinary workshops, emergency drills and case analysis reviews.

“I’m not convinced that obstetrics is unique, but the issues that obstetrics faces are issues that involve communication and co-operative team function,” said Dr. Ken Milne, the society’s associate executive vice president and an architect of the MOREOB program.

Stress

In a stressful environment characterized by high complexity and work overload, teamwork and good communication are important, said Milne. When team members “working elbow to elbow in high-pressure situations are able to work in an environment of trust and mutual respect, they are better able to handle the complexities and scope of the challenges they face,” he added.

“How effective is the communication? Is it highly valued? Does everyone on the team feel valued? Do they feel empowered? Can they speak up without feeling intimidated?”

Ridding the workplace of blame and shame is part of the preferred culture, said Messier-Mann. “Ninety-nine per cent of errors are not caused by the person, they’re caused by the system, so we sit down, discuss what happened and how to prevent it from happening in the future.

“Shaking your finger at a nurse just upsets her and she performs worse.”

MOREOB was introduced on a pilot basis in July 2002. By the fall of 2004, it was in 33 hospitals and ready for a national launch. It’s now in five provinces, boasts several sites in the U.S. and serves the professional development needs of more than 5,200 obstetricians, nurses and midwives.

According to Milne, the program has resulted in a positive downward trend in reported adverse events and a reduction in incurred costs for liability claims.

MOREOB leads to “better outcomes, better quality care, improved patient satisfaction and higher health-care provider satisfaction,” he said.

www.moreob.com