For a study, researchers sought to determine which organizational variables, policies, and practices separate hospitals with high risk-adjusted rates of severe maternal morbidity (SMM) from those with low risk-adjusted rates. The qualitative study included 50 semistructured interviews with health care professionals (obstetrics and gynecology chairs, labor and delivery medical directors, nurse managers, frontline nurses, physicians or nurses responsible for quality and safety, and chief medical officers) in four low-performing and four high-performing hospitals in New York City, using a positive deviance approach. Previous research on risk-adjusted morbidity measurements was used to evaluate hospital performance. The structural characteristics (e.g., staffing, credentialing), organizational characteristics (e.g., culture, leadership, communication, data use), labor and delivery practices (e.g., use of standardized, evidence-based practices, teamwork), and racial and ethnic disparities in SMM were major topics investigated. All interviews were carefully recorded, transcribed, and coded with NVivo software. The qualitative content analysis was carried out by investigators blind to the group assignment. They created analytic notes to identify major themes and patterns arising from the interviews, highlight illustrative statements, and make qualitative comparisons between the two hospital clusters with varying (but unrevealed) performance levels.
High-performing hospitals were separated from low-performing hospitals by six themes. High-performing hospitals had a higher likelihood of having: senior leadership involved in day-to-day quality activities and committed to quality improvement; a strong focus on standards and standardized care; strong nurse-physician communication and teamwork; adequate physician and nurse staffing and supervision; sharing performance data with nurses and other frontline clinicians; and clear recognition of racial and ethnic differences, as well as the possibility of racism and bias in the hospital leading to uneven treatment.
Organizational variables, policies, and procedures at numerous levels separated high-performing hospitals from low-performing hospitals when it came to SMM. The findings highlighted the potential for focused quality interventions to enhance mother health and minimize obstetric inequities caused by delivery in underperforming facilities.