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  • August 2017
  • Article
  • Obstetrics & Gynecology

Relationship Between Labor and Delivery Unit Management Practices and Maternal Outcomes

By: Avery C. Plough, Grace Galwin, Zhonghe Li, Stuart R. Lipsitz, Shehnaz Alidina, Natalie J. Henrich, Lisa R. Hirschhorn, William R. Berry, Atul A. Gawande, Doris Peter, Rory McDonald, Donna L. Caldwell, Janet H. Muri, Debra Bingham, Aaron B. Caughey, Eugene R. Declercq and Neel T. Shah
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Abstract

OBJECTIVE: To define, measure, and characterize key competencies of managing labor and delivery units in the United States and assess the associations between unit management and maternal outcomes. METHODS: We developed and administered a management measurement instrument using structured telephone interviews with both the primary nurse and physician managers at 53 diverse hospitals across the United States. A trained interviewer scored the managers' interview responses based on management practices that ranged from most reactive (lowest scores) to most proactive (highest scores). We established instrument validity by conducting site visits among a subsample of 11 hospitals and established reliability using interrater comparison. Using a factor analysis, we identified three themes of management competencies: management of unit culture, patient flow, and nursing. We constructed patient-level regressions to assess the independent association between these management themes and maternal outcomes. RESULTS: Proactive management of unit culture and nursing was associated with a significantly higher risk of primary cesarean delivery in low-risk patients (relative risk [RR] 1.30, 95% CI 1.02–1.66 and RR 1.47, 95% CI 1.13–1.92, respectively). Proactive management of unit culture was also associated with a significantly higher risk of prolonged length of stay (RR 4.13, 95% CI 1.98–8.64), postpartum hemorrhage (RR 2.57, 95% CI 1.58–4.18), and blood transfusion (RR 1.87, 95% CI 1.12–3.13). Proactive management of patient flow and nursing was associated with a significantly lower risk of prolonged length of stay (RR 0.23, 95% CI 0.12–0.46 and RR 0.27, 95% CI 0.11–0.62, respectively). CONCLUSION: Labor and delivery unit management varies dramatically across and within hospitals in the United States. Some proactive management practices may be associated with increased risk of primary cesarean delivery and maternal morbidity. Other proactive management practices may be associated with decreased risk of prolonged length of stay, indicating a potential opportunity to safely improve labor and delivery unit efficiency.

Keywords

Health Care and Treatment; Management Practices and Processes; Performance Evaluation; Outcome or Result; United States

Citation

Plough, Avery C., Grace Galwin, Zhonghe Li, Stuart R. Lipsitz, Shehnaz Alidina, Natalie J. Henrich, Lisa R. Hirschhorn, William R. Berry, Atul A. Gawande, Doris Peter, Rory McDonald, Donna L. Caldwell, Janet H. Muri, Debra Bingham, Aaron B. Caughey, Eugene R. Declercq, and Neel T. Shah. "Relationship Between Labor and Delivery Unit Management Practices and Maternal Outcomes." Obstetrics & Gynecology 130, no. 2 (August 2017): 358–365.
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About The Author

Rory M. McDonald

Technology and Operations Management
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More from the Authors
  • Productive Tensions: How Every Leader Can Tackle Innovation’s Toughest Trade-Offs By: Chris Bingham and Rory McDonald
  • The Past Is Prologue? Venture-Capital Syndicates' Collaborative Experience and Start-Up Exits By: Dan Wang, Emily Cox Pahnke and Rory McDonald
  • Managing Innovation at Atrium Health: 'Never Let a Good Crisis Go To Waste' By: Derek van Bever, Rory McDonald and Anibha Singh
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