Culture That Facilitates Change: A Mixed Methods Study of Hospitals Engaged in Reducing Cesarean Deliveries

Emily C. White VanGompel; Susan L. Perez; Avisek Datta; Francesca R. Carlock; Valerie Cape; Elliott K. Main

doi:10.1370/afm.2675

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RE: Culture That Facilitates Change: A Mixed Methods Study of Hospitals Engaged in Reducing Cesarean Deliveries
Sneha Magesh and Lorraine S Wallace

Published on: 09 April 2022
RE: Important study on improving maternity care
Debra Stulberg

Published on: 11 June 2021

Published on: (9 April 2022)
Page navigation anchor for RE: Culture That Facilitates Change: A Mixed Methods Study of Hospitals Engaged in Reducing Cesarean Deliveries
RE: Culture That Facilitates Change: A Mixed Methods Study of Hospitals Engaged in Reducing Cesarean Deliveries
Sneha Magesh, Undergraduate, The Ohio State University
Other Contributors:
Lorraine S Wallace, Associate Professor—College of Medicine
As an aspiring healthcare professional, I found VanGompel and colleagues' mixed methods study to shed light on important maternal and infant health issues. In 2020, just three states—Idaho, Utah, and South Dakota—had overall cesarean delivery rates in the Centers for Disease Control and Prevention’s lowest category (22.9-25.96%).1 Labor Culture Survey respondents, in your study, included nurses, obstetricians, certified nurse midwives, family physicians, anesthesiologists, nurse educators, and nurse managers from California. Given that California is one of the nation’s most populated and diverse states, does your research team believe that similar findings would emerge across other geographical regions of the United States?

I was intrigued by the qualitative data collection arm (i.e., key informant interviews) of your study. Key informants (n=12) included a total of 5 physicians and 7 registered nurses with leadership roles at their respective hospitals in both urban and rural settings. In reviewing your findings, it crossed my mind that other healthcare professionals (e.g., midwives) may provide different perspectives regarding cesarean deliveries. Given that much work remains in this area, does your research team have plans to expand your qualitative data collection to include other healthcare team members? Additionally, including patients in future studies would provide rich information and unique perspectives on this increasingly important population health...
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As an aspiring healthcare professional, I found VanGompel and colleagues' mixed methods study to shed light on important maternal and infant health issues. In 2020, just three states—Idaho, Utah, and South Dakota—had overall cesarean delivery rates in the Centers for Disease Control and Prevention’s lowest category (22.9-25.96%).1 Labor Culture Survey respondents, in your study, included nurses, obstetricians, certified nurse midwives, family physicians, anesthesiologists, nurse educators, and nurse managers from California. Given that California is one of the nation’s most populated and diverse states, does your research team believe that similar findings would emerge across other geographical regions of the United States?

I was intrigued by the qualitative data collection arm (i.e., key informant interviews) of your study. Key informants (n=12) included a total of 5 physicians and 7 registered nurses with leadership roles at their respective hospitals in both urban and rural settings. In reviewing your findings, it crossed my mind that other healthcare professionals (e.g., midwives) may provide different perspectives regarding cesarean deliveries. Given that much work remains in this area, does your research team have plans to expand your qualitative data collection to include other healthcare team members? Additionally, including patients in future studies would provide rich information and unique perspectives on this increasingly important population health issue.

Reference

1. Centers for Disease Control and Prevention. Cesarean delivery rate by state. Published Accessed April 9, 2022. https://www.cdc.gov/nchs/pressroom/sosmap/cesarean_births/cesareans.htm
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Competing Interests: None declared.
Published on: (11 June 2021)
Page navigation anchor for RE: Important study on improving maternity care
RE: Important study on improving maternity care
Debra Stulberg, Associate Professor and Chair of Family Medicine, University of Chicago
This mixed methods study makes an important contribution by helping us understand factors that contribute to success in a hospital quality improvement initiatives, specifically here, an initiative to support vaginal birth. I am delighted to see rigorous measurement of institutional culture, which many clinicians know in their gut contributes critically to the care they provide, but which is difficult to measure and I feel is under-studied. The paper is also important because quality improvement initiatives abound, but the assessment of when and how they work deserves more attention. Finally, I am grateful that the authors highlight a few important take-home points: 1) The voice of patients in clinical decision making needs to be central (perhaps no more so than in giving birth, which is such a personal and impactful moment in life), but often patients lack information to be full participants. 2) When we level our traditional hierarchies in medicine, so that members of a care team feel comfortable communicating across roles, hospitals are more likely to improve the care that patients receive. 3) Doulas, nurses, midwives, and family physicians continue to play important roles in the care of birthing patients, and hospitals that welcome and empower these providers may see better patient outcomes.

Competing Interests: None declared.