Barriers and Facilitators to Implementation of a Multistate Collaborative to Reduce Maternal Mortality From Postpartum Hemorrhage

Abstract

Objective: To describe the barriers and facilitators to implementing the Association of Women's Health, Obstetric and Neonatal Nurses Postpartum Hemorrhage (AWHONN PPH) Project experienced by hospital leaders, project champions, and staff.

Design: Qualitative descriptive study with a grounded theory approach.

Setting: Hospital leaders, champions, and staff from hospitals in New Jersey and Georgia.

Participants: A total of 21 nurses and physicians who worked at six hospitals shared their experiences with regard to implementation of the AWHONN PPH Project.

Methods: Interviews were recorded and transcribed verbatim. Analysis included open, selective, and theoretical coding with a constant comparative method of grounded theory. Analysis was complete when a central process emerged.

Results: Successful implementation of most or all of the program elements was facilitated by support from administrators, positive attitudes, active nurse and physician champions, and an existing culture of safety. When these elements were in place, respondents reported that they believed they made a difference. Barriers to implementation included negative attitudes, lack of champions, poor staff buy in, lack of resources, and lack of support from administrators. When barriers were encountered, respondents felt discouraged and disappointed.

Conclusion: Although the road to full participation and implementation was difficult for some, lessons were learned by all. Suggestions for future projects include a step-by-step approach that begins with education, the creation and celebration of milestones, and the formation of teams to facilitate buy in and empowerment.

Keywords: attitude; barriers and facilitators; grounded theory; leadership; maternal mortality; nurses; physicians; postpartum hemorrhage; program implementation; qualitative research; quality improvement.