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Investigating Systems Challenges in Maternal Care
DescriptionMaternal mortality and severe maternal morbidity are increasing in the United States (US). Prior research has found that maternal mortality and morbidity are largely preventable with timely and appropriate care; suggesting opportunities to intervene at the point of care to improve outcomes. To investigate systems issues contributing to adverse maternal outcomes, we conducted over 100 hours of direct observations in maternal care units - including labor and delivery (L&D), antepartum, postpartum, and a prenatal clinic – at a large, academic health system in the Southeastern US. Observations were conducted at the main urban center and a smaller, rural site. We also interviewed 10 maternal care providers including obstetricians, nurse midwives, obstetric anesthesiologists, nurses, and safety coordinators. Using this data, we developed of a process map of patient flow through L&D and postpartum, a task analysis of nursing care on both of these units, and a sociotechnical model illustrating barriers to care. The model displayed a broad range of system safety issues in maternal care including communication challenges the between the maternal care team, inadequate training and knowledge gaps, poor technology integration and maintenance, workarounds created due to organization policies and procedures, staffing and resource shortages, high and uneven distribution of workload, and physical environments that impedes efficient workflow. These findings combined with additional systems analysis and human-centered design approaches can support system redesign and intervention development to improve safety in maternal care.