Use of a maternal newborn audit and feedback system in Ontario: a collective case study

doi:10.1136/bmjqs-2018-008354

. 2019 Aug;28(8):635-644.

doi: 10.1136/bmjqs-2018-008354. Epub 2019 Feb 16.

Use of a maternal newborn audit and feedback system in Ontario: a collective case study

Jessica Reszel^{1

2}, Sandra I Dunn^{3

2

4}, Ann E Sprague^{3

2

4}, Ian D Graham^{5

6}, Jeremy M Grimshaw^{5

6

7}, Wendy E Peterson⁴, Holly Ockenden³, Jodi Wilding², Ashley Quosdorf⁴, Elizabeth K Darling⁸, Deshayne B Fell^{2

6}, JoAnn Harrold^{2

5

9

10}, Andrea Lanes^{3

6}, Graeme N Smith¹¹, Monica Taljaard^{5

6}, Deborah Weiss^{3

6}, Mark C Walker^{3

5

6

12

13

14}

Affiliations

¹ Better Outcomes Registry & Network (BORN), Children's Hospital of Eastern Ontario - Ottawa Children's Treatment Centre (CHEO-OCTC), Ottawa, Ontario, Canada jreszel@cheo.on.ca.
² Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
³ Better Outcomes Registry & Network (BORN), Children's Hospital of Eastern Ontario - Ottawa Children's Treatment Centre (CHEO-OCTC), Ottawa, Ontario, Canada.
⁴ School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁸ McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada.
⁹ Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ontario, Canada.
¹⁰ Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ Department of Obstetrics & Gynecology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
¹² Obstetrics, Maternal and Newborn Investigations (OMNI) Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹³ Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
¹⁴ Department of Obstetrics and Gynecology, The University of Ottawa, Ottawa, Ontario, Canada.

PMID: 30772816
PMCID: PMC6663061
DOI: 10.1136/bmjqs-2018-008354

Use of a maternal newborn audit and feedback system in Ontario: a collective case study

Jessica Reszel et al. BMJ Qual Saf. 2019 Aug.

. 2019 Aug;28(8):635-644.

doi: 10.1136/bmjqs-2018-008354. Epub 2019 Feb 16.

Authors

Affiliations

¹ Better Outcomes Registry & Network (BORN), Children's Hospital of Eastern Ontario - Ottawa Children's Treatment Centre (CHEO-OCTC), Ottawa, Ontario, Canada jreszel@cheo.on.ca.
² Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
³ Better Outcomes Registry & Network (BORN), Children's Hospital of Eastern Ontario - Ottawa Children's Treatment Centre (CHEO-OCTC), Ottawa, Ontario, Canada.
⁴ School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁸ McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada.
⁹ Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ontario, Canada.
¹⁰ Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ Department of Obstetrics & Gynecology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
¹² Obstetrics, Maternal and Newborn Investigations (OMNI) Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹³ Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
¹⁴ Department of Obstetrics and Gynecology, The University of Ottawa, Ottawa, Ontario, Canada.

PMID: 30772816
PMCID: PMC6663061
DOI: 10.1136/bmjqs-2018-008354

Abstract

Background: As part of a larger study examining the effectiveness of the Maternal Newborn Dashboard, an electronic audit and feedback system to improve maternal-newborn care practices and outcomes, the purpose of this study was to increase our understanding of factors explaining variability in performance after implementation of the Dashboard in Ontario, Canada.

Methods: A collective case study. A maximum variation sampling approach was used to invite hospitals reflecting different criteria to participate in a 1-day to 2-day site visit by the research team. The visits included: (1) semistructured interviews and focus groups with healthcare providers, leaders and personnel involved in clinical change processes; (2) observations and document review. Interviews and focus groups were audio-recorded and transcribed verbatim. Qualitative content analysis was used to code and categorise the data.

Results: Between June and November 2016, we visited 14 maternal-newborn hospitals. Hospitals were grouped into four quadrants based on their key indicator performance and level of engagement with the Dashboard. Findings revealed four overarching themes that contribute to the varying success of sites in achieving practice change on the Dashboard key performance indicators, namely, interdisciplinary collaboration and accountability, application of formal change strategies, team trust and use of evidence and data, as well as alignment with organisational priorities and support.

Conclusion: The diversity of facilitators and barriers across the 14 hospitals highlights the need to go beyond a 'one size fits all' approach when implementing audit and feedback systems. Future work to identify tools to assess barriers to practice change and to evaluate the effects of cointerventions to optimise audit and feedback systems for clinical practice change is needed.

Keywords: audit and feedback; case study; knowledge translation; maternal-newborn care; obstetrics; qualitative.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Sample Maternal Newborn Dashboard homepage.

See this image and copyright information in PMC

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References

1. Pfuntner A, Wier L, Stocks C, 2013. Most Frequent Conditions in U.S. Hospitals, 2010: Statistical Brief #148. Available: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb148.pdf411 [Accessed 5 Dec 2018].
1. Canadian Institute for Health Information , 2017. Inpatient hospitalizations, surgeries, newborns and childbirth indicators, 2015-2016. Ottawa, Canada. Available: https://secure.cihi.ca/free_products/cad_hospitalization_and_childbirth_... [Accessed 5 Dec 2018].
1. Better Outcomes Registry & Network (BORN) Ontario , 2016. 2014-2016 biennial report. Ottawa, Ontario. Available: https://www.bornontario.ca/en/about-born/governance/annual-reports/2014-... [Accessed 5 Dec 2018].
1. Public Health Agency of Canada Perinatal health indicators for Canada 2017. Ottawa ON, 2017.
1. Sprague AE, Dunn SI, Fell DB, et al. . Measuring quality in maternal-newborn care: developing a clinical dashboard. J Obstet Gynaecol Can 2013;35:29–38. 10.1016/S1701-2163(15)31045-8 - DOI - PubMed

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[1] Pfuntner A, Wier L, Stocks C, 2013. Most Frequent Conditions in U.S. Hospitals, 2010: Statistical Brief #148. Available: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb148.pdf411 [Accessed 5 Dec 2018].

[2] Pfuntner A, Wier L, Stocks C, 2013. Most Frequent Conditions in U.S. Hospitals, 2010: Statistical Brief #148. Available: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb148.pdf411 [Accessed 5 Dec 2018].

[3] Canadian Institute for Health Information , 2017. Inpatient hospitalizations, surgeries, newborns and childbirth indicators, 2015-2016. Ottawa, Canada. Available: https://secure.cihi.ca/free_products/cad_hospitalization_and_childbirth_... [Accessed 5 Dec 2018].

[4] Canadian Institute for Health Information , 2017. Inpatient hospitalizations, surgeries, newborns and childbirth indicators, 2015-2016. Ottawa, Canada. Available: https://secure.cihi.ca/free_products/cad_hospitalization_and_childbirth_... [Accessed 5 Dec 2018].

[5] Better Outcomes Registry & Network (BORN) Ontario , 2016. 2014-2016 biennial report. Ottawa, Ontario. Available: https://www.bornontario.ca/en/about-born/governance/annual-reports/2014-... [Accessed 5 Dec 2018].

[6] Better Outcomes Registry & Network (BORN) Ontario , 2016. 2014-2016 biennial report. Ottawa, Ontario. Available: https://www.bornontario.ca/en/about-born/governance/annual-reports/2014-... [Accessed 5 Dec 2018].

[7] Public Health Agency of Canada Perinatal health indicators for Canada 2017. Ottawa ON, 2017.

[8] Public Health Agency of Canada Perinatal health indicators for Canada 2017. Ottawa ON, 2017.

[9] Sprague AE, Dunn SI, Fell DB, et al. . Measuring quality in maternal-newborn care: developing a clinical dashboard. J Obstet Gynaecol Can 2013;35:29–38. 10.1016/S1701-2163(15)31045-8 - DOI - PubMed

[10] Sprague AE, Dunn SI, Fell DB, et al. . Measuring quality in maternal-newborn care: developing a clinical dashboard. J Obstet Gynaecol Can 2013;35:29–38. 10.1016/S1701-2163(15)31045-8 - DOI - PubMed

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Use of a maternal newborn audit and feedback system in Ontario: a collective case study

Affiliations

Use of a maternal newborn audit and feedback system in Ontario: a collective case study

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Abstract

Conflict of interest statement

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