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. 2022 Sep 1;22(1):1108.
doi: 10.1186/s12913-022-08463-8.

A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH)

Victoria Brazil  1 , Darren McLean  2 , Belinda Lowe  2 , Lada Kordich  2 , Deborah Cullen  2 , Victoria De Araujo  2 , Talia Eldridge  2 , Eve Purdy  2
Affiliations

A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH)

Victoria Brazil et al. BMC Health Serv Res. .

Abstract

Background: Post-partum haemorrhage (PPH) is an obstetric emergency that requires effective teamwork under complex conditions. We explored healthcare team performance for women who suffered a PPH, focusing on relationships and culture as critical influences on teamwork behaviours and outcomes.

Methods: In collaboration with clinical teams, we implemented structural, process and relational interventions to improve teamwork in PPH cases. We were guided by the conceptual framework of Relational Coordination and used a mixed methods approach to data collection and analysis. We employed translational simulation as a central, but not singular, technique for enabling exploration and improvement. Key themes were identified from surveys, focus groups, simulation sessions, interviews, and personal communications over a 12-month period.

Results: Four overarching themes were identified: 1) Teamwork, clear roles and identified leadership are critical. 2) Relational factors powerfully underpin teamwork behaviours-shared goals, shared knowledge, and mutual respect. 3) Conflict and poor relationships can and should be actively explored and addressed to improve performance. 4) Simulation supports improved team performance through multifaceted mechanisms. One year after the project commenced, significant progress had been made in relationships and systems. Clinical outcomes have improved; despite unprecedented increase in labour ward activity, there has not been any increase in large PPHs.

Conclusions: Teamwork, relationships, and the context of care can be actively shaped in partnership with clinicians to support high performance in maternity care. We present our multifaceted approach as a guide for leaders and clinicians in maternity teams, and as an exemplar for others enacting quality improvement in healthcare.

Keywords: Healthcare teamwork; Interprofessional collaboration; Post partum haemorrhage; Simulation.

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Conflict of interest statement

All authors are employed by the Gold Coast Hospital and Health Service at which the research was conducted. There are nil other competing interests to declare.

Figures

Fig. 1
Fig. 1
Relational Coordination framework—adapted from Gittell et al [7].
Fig. 2
Fig. 2
Study methods
Fig. 3
Fig. 3
Relational coordination networks among workgroups involved in PP care
Fig. 4
Fig. 4
Interventions collaboratively designed and delivered with clinical teams
Fig. 5
Fig. 5
Relational coordination team score
Fig. 6
Fig. 6
RC matrix Maternity (PPH) Relational coordination survey. The Relational Coordination Matrix shows how each workgroup rates the others (horizontal) and how it is rated by the others (vertical). E.g., to see how Midwives -Birth Suite group rated the other groups, look across the second line in the matrix. To see how the Midwives -Birth Suite group were rated by other groups, look down the second column in the matrix (MWBS). The diagonal shows how each workgroup rates itself. Between groups scores over 4.0 are considered strong, 3.5 – 4.0 are moderate, and less than 3.5 is weak. Within groups, greater than 4.6 is strong, 4.1- 4.6 is moderate and less than 4.1 is weak
Fig. 7
Fig. 7
Maternity role allocation cognitive aid
Fig. 8
Fig. 8
STOP to handover
Fig. 9
Fig. 9
Large PPH versus total births
See this image and copyright information in PMC

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