Engage medical leadership to change culture of c-sections
There has to be engagement by the medical staff and leadership to achieve the cultural changes and initiatives necessary to reduce cesarean sections, says Robin Kish, MBA, BSN, RN, CPHQ, vice president of Marsh Clinical Healthcare Consulting in Nashville, TN.
Kish offers these tips for achieving the culture change:
- Stay current and up-to date on literature as the pendulum continues to swing regarding c-sections vs. vaginal deliveries.
- Conduct self-assessment of culture, protocols, and practice guidelines; review current data collection and any limitations to data capture; assess potential roadblocks due to information technology, financials, leadership abstinence, or other causes.
- Educate patients, staff, and physicians regarding statistics, trends, and legal vulnerabilities.
- Ensure sound processes for patient informed consent, patient choice regarding delivery choices. Work with medical staff to develop and adopt/approve practice guidelines that are consistent with the American Congress of Obstetricians and Gynecologists (ACOG) recommendations for c-sections, inductions, and vaginal births after cesarean (VBACs).
- Partner with local obstetrical practices to ensure adequate patient education for women early in the pregnancy.
- Collect and analyze data regarding VBACs, c-sections, inductions prior to 39 weeks, and use of other interventions. Identify appropriateness and consistency with hospital policy, approved guidelines, and protocols. This would include staff feedback regarding physician practice patterns, murmurs of convenience scheduling, and similar issues to provide direction for further analysis as needed.