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New York State Obstetric Hemorrhage Project

Recruitment & Pre-work Package October 11, 2017

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Table of Contents

This document provides details about the New York State (NYS) Obstetric Hemorrhage Project (Project). The package is divided into two sections. The first section includes information related to the project’s recruitment process. The second section includes information on how to prepare for the project’s Informational Call and first in-person Learning Session (which will be held in conjunction with the ACOG Safe Motherhood Initiative meeting). Overview of the New York State (NYS) Obstetric Hemorrhage Project (Project) ............ 4

Purpose and Goals of the Project ............................................................................... 4 Project Planning Group ............................................................................................... 5 Initial Schedule ............................................................................................................ 8

Part Two: Pre-work ........................................................................................................ 10 Pre-work Checklist ..................................................................................................... 10

Appendix A: Overview of a Learning Collaborative ....................................................... 11 Appendix B: Model for Improvement ............................................................................. 13 Appendix C: Project and Team Expectations ................................................................ 15 Appendix D: AIM Statement .......................................................................................... 17 Appendix E: Storyboards ............................................................................................... 18 Appendix F: Project Glossary ........................................................................................ 19 Appendix G: Project Leadership and Faculty ................................................................ 21 Attachments Attachment 1: NYS Obstetric Hemorrhage Project Participant Form Attachment 2: SMART AIM Statement Worksheet Attachment 3: Storyboard Instructions and Template Attachment 4: Current Practices Assessment

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New York State Obstetric Hemorrhage Project

Recruitment & Pre-work Package

Part 1: Recruitment

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Overview of the New York State (NYS) Obstetric Hemorrhage Project (Project)

Purpose and Goals of the Project The goal of the NYS Obstetric Hemorrhage Project is to reduce maternal morbidity and mortality statewide by translating evidence-based guidelines into clinical practice to improve the assessment and management of obstetric hemorrhage. Regional Perinatal Centers (RPCs), RPC-affiliate birthing hospitals, New York State Department of Health’s (NYSDOH) New York State Perinatal Quality Collaborative (NYSPQC), American Congress of Obstetricians and Gynecologists (ACOG) District II’s Safe Motherhood Initiative (SMI), Healthcare Association of New York State (HANYS), Greater New York Hospital Association (GNYHA), and other stakeholders will work together for approximately 18 months to implement interventions to improve obstetric outcomes. This will be accomplished by:

• Implementing a learning collaborative among participating birthing hospital teams to share and learn from one another;

• Participating birthing hospital teams will implement evidence-based strategies for the assessment and management of obstetric hemorrhage;

• Clinical experts will provide tailored clinical and quality improvement education and technical assistance; and

• Monthly data collection, regular analysis of the data and feedback provided monthly to birthing hospital teams on relevant measures.

The NYS Obstetric Hemorrhage Project will focus on:

• Improving readiness to respond to an obstetric hemorrhage by implementing standardized policies and procedures and developing rapid response teams;

• Improving recognition of obstetric hemorrhage by performing ongoing objective quantification of actual blood loss and triggers of maternal deterioration during and after all births;

• Improving response to hemorrhage by performing regular on-site, multidisciplinary hemorrhage drills;

• Improving reporting of obstetric hemorrhage though the use of standardized definitions resulting in consistent coding.

These evidence-based interventions build upon work previously done in NYS birthing hospitals through the NYSDOH’s NYSPQC / New York State Partnership for Patients’ Maternal Hemorrhage and Hypertension Initiative and ACOG District II’s SMI. The SMI’s obstetric hemorrhage bundle (available on the ACOG District II website) was the culmination of 18 months of targeted work on the part of hospitals of every level of maternity care in the state. The bundle itself is meant to be tailored accordingly to individual facility needs and available resources, and includes a variety of tools such as checklists, algorithms, and other visual aids that you will continue to find valuable for use throughout the NYS Obstetric Hemorrhage Project and that will help to enhance your team communication and help you reach your quality improvement goals.

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The NYS Obstetric Hemorrhage Project will use the Institute for Healthcare Improvement’s (IHI) Breakthrough Series (BTS)1 learning model (Appendix A) modified to meet the requirements and unique needs of this topic and context, and a quality improvement change model, the Model for Improvement (Appendix B), that have demonstrated effectiveness in previous Healthcare Quality Improvement projects. As part of the improvement process, teams will learn quality improvement strategies, and collect data that are sensitive to the changes they will be testing and implementing, to track performance and results over the 18-month period. Further, the NYS Obstetric Hemorrhage Project will continue to convene obstetric leadership and participating hospital teams from across the state as means to motivate teams, share best practices and continue to impart implementation strategies for the assessment and management of obstetric hemorrhage. Project Benefits Facilities participating in the NYS Obstetric Hemorrhage Project will benefit from:

• Support from national and state faculty, including trained quality improvement and obstetric experts;

• Coaching and technical assistance, including in-person Learning Sessions, regular Coaching Call webinars, support to implement and test improvements, data collection, data analysis and real-time feedback on data, including sending monthly run charts to hospital teams so you can track improvements;

• Access to the project website, a virtual learning community that will be used to share resources and engage participants in ongoing discussions;

• Opportunities to connect with other participating hospital teams to share strategies, identify lessons learned, overcome barriers and expedite the implementation of project goals; and

• The opportunity to build quality improvement knowledge and capacity that

can be applied beyond the scope of this project.

Project Planning Group The Project planning group will guide and inform the project, sharing evidence based information, implementation strategies and coach teams on improvement methodology. The project planning groups consists of staff from NYSDOH’s NYSPQC, ACOG District II’s SMI, HANYS, GNYHA, and national and local clinical and quality improvement experts. A listing of the full Project Planning Group can be found in Appendix G. Project Data Participating hospitals teams will be required to submit baseline and ongoing monthly data through the centralized NYSPQC Data System application securely accessible via the NYSDOH Health Commerce System (HCS) to track progress in achieving their hospital team’s AIM. Data will be analyzed by the NYSDOH, and run charts available on the NYSDOH HCS Visualization Portal will be updated nightly for the purposes of

1 Institute for Healthcare Improvement (IHI), Boston MA

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continuous quality improvement. Project measures and the data collection strategy are currently under development. These documents will be provided once finalized. In determining whether to participate in the Project, hospital teams should consult internally to ascertain institutional bandwidth in the context of other commitments, regulations, applicable laws, standards of professional conduct and practice, and ethical and societal norms for your institution. If your birthing hospital chooses to participate, you may be required to obtain Institutional Review Board (IRB) review from your hospital. The NYSDOH will be applying for IRB approval for the Project and, often, this is the only IRB review a participating birthing hospital will need. Please check with your birthing hospital’s IRB for guidance. What is a Learning Session? Learning Sessions bring teams together in-person to become skilled in quality improvement fundamentals through theoretical application with real-time coaching. Through plenary addresses, small group discussions and team meetings, attendees can:

• Learn from faculty and colleagues;

• Review case studies;

• Receive individual coaching from faculty members;

• Gather new information on the subject matter and process improvement;

• Share information and create detailed improvement plans; and

• Develop strategies to overcome improvement barriers.

A minimum of two key members from each birthing hospital team are expected to attend the Learning Sessions. Please save the date for the first in-person Learning Session, scheduled for Friday, November 17, 2017, in conjunction with the ACOG District II SMI in-person meeting. The meeting will be held from 10:30 AM to 3:00 PM in Albany, NY at the Empire State Plaza, Meeting Room 6. If you plan on attending the kick-off Learning Session, please register now using this link: NYS Obstetric Hemorrhage Project - Learning Session 1 Registration. A detailed agenda and meeting materials for the Learning Session will be forthcoming. Pre-work Activities for Hospital Teams Prior to the first Learning Session, teams will be asked to complete multiple activities that will accelerate the start-up of their improvement efforts and equip them to gain the most from the event. These Pre-work activities include: holding an internal team meeting; completing the Participant Form (Attachment 1); developing a SMART AIM (Specific, Measurable, Achievable, Realistic, Time bounded) (Attachment 2) aligned with overall project goals; sharing of existing policies and tools; preparing a Storyboard (Attachment 3) to share with other teams; and completing a Current Practices Assessment (Attachment 4, https://www.surveymonkey.com/r/NYSOBHemorrhage).

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Informational Call All NYS birthing hospital teams are invited to participate in an Informational Call to discuss the Project and its activities. The Informational Call is scheduled for: Thursday, October 19, 2017 from 3:00 to 4:00 PM. Please register for the call using this link, NYS Obstetric Hemorrhage Project - Informational Call Registration, to receive call-in information.

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NYS Obstetric Hemorrhage Project

Initial Schedule

Action Item Date and Time

Recruitment and Pre-Work Package sent to all NYS birthing hospitals

Week of October 10

Register for Informational Call at: NYS Obstetric Hemorrhage Project - Informational Call Registration

Weeks of October 10 and October 16

Attend Informational Call October 19, from 3 to 4 PM

Teams will need to complete these steps following the Informational Call:

1. Review the materials in the Recruitment and Pre-work Package,

including all appendices.

2. Complete and submit the Participant Form (Attachment 1)

electronically to NYSPQC@health.ny.gov.

3. Complete and submit the Current Practices Assessment

(Attachment 4) using this link:

https://www.surveymonkey.com/r/NYSOBHemorrhage.

4. Email existing OB Hemorrhage policies and protocols to

NYSPQC@health.ny.gov.

November 3

Receive acknowledgement of receipt of completed Participant Form

Ongoing

Storyboard and Pre-work completed for Learning Session (refer to Appendix E). Please send an electronic version of your team’s storyboard to NYSPQC@health.ny.gov.

Week of November 13

Register for Learning Session 1 at: NYS Obstetric Hemorrhage Project - Learning Session 1 Registration – note that this meeting will be held in conjunction with the ACOG SMI meeting

Attend Learning Session 1 in Albany, NY at the Empire State Plaza

Meeting Room 6

November 17, from 10:30 AM to 3 PM

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New York State

Obstetric Hemorrhage Project Recruitment & Pre-work Package

Part 2: Pre-work

Information that will help prepare your hospital team participate in the NYS Obstetric Hemorrhage Project.

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Part Two: Pre-work

Pre-work Checklist

Thank you for your interest in the NYS Obstetric Hemorrhage Project. We are delighted for the opportunity to work with your team to make improvement happen together! This section of the package contains information that will help your team prepare to participate in the Project. This packet includes specific activities that we ask your birthing hospital’s team to complete prior to the first in-person Learning Session (to be held in conjunction with the ACOG SMI meeting), as well as detailed instructions for completing these tasks. Some technical language used in this packet may be unfamiliar. Please check the Project Glossary (Appendix F) of this document for clarification. More detailed explanations will follow at the first Learning Session. If you have any questions, please contact NYSPQC@health.ny.gov, or by calling (518) 473-9883. Please complete the following activities prior to the first Learning Session. Details on each section can be found in the Appendices and related attachments

✓ Pre-Work Checklist

Read the Overview of a Learning Collaborative (Appendix A) to get an understanding of the Collaborative process.

Review the Model for Improvement (Appendix B).

Formalize your team members, keeping in mind team expectations (Appendix C).

Register for and attend the Information Call on October 19 from 3-4 PM, NYS Obstetric Hemorrhage Project - Informational Call Registration.

Complete and submit the Participant Form (Attachment 1) electronically to NYSPQC@health.ny.gov.

Review Project goals, structure, and expectations with your hospital team.

Complete your team’s AIM Statement (Appendix D).

Complete and submit the Current Practices Assessment (Attachment 4)

using this link: https://www.surveymonkey.com/r/NYSOBHemorrhage.

Submit existing facility-specific OB hemorrhage policies and procedures by e-mail to NYSPQC@health.ny.gov by Friday, November 3.

Develop a Storyboard with your team and submit the final product electronically to NYSPQC@health.ny.gov (Appendix E, Attachment 3) the week of November 13.

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Appendix A: Overview of a Learning Collaborative

A Learning Collaborative is a time-limited effort by multiple organizations that come together with faculty to learn about and create improved processes in a specific topic area. The expectation is that the teams share expertise and data with each other; thus, “everyone learns, everyone teaches.” A Collaborative provides a systematic approach to healthcare quality improvement. Each hospital team in the Project will learn quality improvement fundamentals to create small tests of change before a broader organizational rollout of successful interventions. At the same time, each team will collect and submit monthly data on measures to track improvements. Learning is accelerated as the Project teams work together and share their experiences through monthly reports, Learning Sessions, conference calls and e-mail. The three phases of the Learning Collaborative are: Pre-work activities, Learning Sessions and Action Periods as shown in Figure 1 below.

Figure 1. Breakthrough Series Model What is Pre-work? Teams will be involved in Pre-work from the time they join the Project in Fall 2017, until the first in-person Learning Session (on November 17, 2017, in conjunction with the ACOG SMI meeting). The purpose of the Pre-work is to prepare the participating birthing hospital teams to launch the Project at their site and prepare for this first face-to-face meeting. During this time, the birthing hospital teams have

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several important tasks to accomplish, including: creating an AIM statement2, developing a Storyboard, and participating in the Informational/Pre-work call. What is a Learning Session? Learning Sessions bring teams together to become skilled in quality improvement fundamentals through theoretical application with real time coaching. Through plenary addresses, small group discussions and team meetings, attendees have the opportunity to:

• Learn from faculty and colleagues;

• Receive coaching from faculty members;

• Gather new information on the subject matter and process improvement; and

• Share information and create detailed improvement plans. The Project will include two in-person Learning Sessions facilitated by the Project team and expert faculty. The in-person Learning Sessions will occur at the start of the Project and at the end of the 18-month project period. What are Action Periods? The time between in-person Learning Sessions is called an Action Period. During Action Periods, hospital teams work within their organizations toward major, breakthrough improvements by initiating small tests of change. Although each participant focuses on his/her own organization, continuous contact with other Project participants and faculty is provided. Monthly Coaching Call webinars and regular emails maintain this continuous contact during the Action Period. Each organization collects data to learn if the tests of change are resulting in improvement. Monthly hospital-specific data are reviewed by each team and then submitted to NYSDOH via the web-based Health Commerce System (HCS). These data are analyzed and reported back to the hospitals in the form of run charts that display the data in a more useable way for improvement. Teams are encouraged to include additional staff in Action Period activities as needed.

2 An AIM statement is "a specific statement summarizing what your organization hopes to achieve. It should be time specific and measurable." (Institute for Healthcare Improvement, www.ihi.org)

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Appendix B: Model for Improvement

The Model for Improvement3 is a simple yet powerful strategy for making improvements in the care you provide to your patients. Developed by Associates in Process Improvement, the application of the model has two components. First, your team will address three fundamental questions. These questions will guide your team in creating an AIM Statement, measures and specific change ideas. Secondly, your team will use PDSA cycles to easily test these changes in your work environment. Successful tests of change pave the way for full scale implementation within your system. A brief synopsis of the model is presented below. More details are available on the Institute for Healthcare Improvement (IHI) Web site at: www.ihi.org.

Associates in Process Improvement

Three Key Questions for Improvement 1. What are we trying to accomplish? (AIM Statement) When you answer this question, you are creating an AIM Statement (Attachment 2) – a statement of a specific, intended goal. A strong, clear AIM Statement gives necessary direction to your improvement efforts. Your AIM Statement should include a general description of what your team hopes to accomplish and a specific patient population on which your team will focus. A strong AIM Statement is specific, intentional and unambiguous. It should be aligned with organizational goals and all team members involved in the improvement process should support it.

3 The Model for Improvement was developed by Associates in Process Improvement. www.apiweb.org/API_home_page.htm

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2. How will we know that a change is an improvement? (Measures) Your team will use a set of defined measures to determine if the rapid cycle changes in care are working. They can also be used to monitor performance over time. These measures are designed to help you know if the changes you are testing are resulting in improvement. This quality improvement measurement strategy should not be confused with the type of measurement used for research. Where research focuses on one fixed and testable hypothesis, the methods for measuring improvement rely on sequential testing using practical measurement strategies. The measures for this Project were selected by the project’s planning team, based on improvement strategies, which were considered critical in terms of reducing maternal morbidity and mortality from obstetric hemorrhage. 3. What changes can we make that will result in an improvement? (Best

Practices and Ideas) The collection of evidence-based changes that we will use in this Project will focus on the four R’s: Readiness, Recognition, Response and Reporting/Systems Learning. In addition to these changes, we may incorporate lessons learned from previously conducted projects. This collection of changes is called the Change Package and includes multiple opportunities for improving care at your site. More detail on the use of the Change Package will be provided at the first Learning Session. PDSA Cycles The PDSA (Plan-Do-Study-Act) cycle is a method for rapidly testing a change - by planning it, trying it, observing the results, and acting on what is learned. This is a scientific method used for action-oriented learning. After changes are thoroughly tested, PDSA cycles can be used to implement or spread change. The key principle behind the PDSA cycle is to test on a small scale and test quickly. Traditional quality improvement has been anchored in laborious planning that attempts to account for all contingencies at the time of implementation; usually resulting in failed or partial implementation after months or even years of preparation. The PDSA philosophy is to design a small test with a limited impact that can be conducted quickly (days, if not hours!) to work out unanticipated “bugs”. Repeated rapid small tests and the learning gleaned build a process ready for implementation that is far more likely to succeed.

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Appendix C: Project and Team Expectations

Form a Team and Review Team Expectations An appropriate and effective team is a key component of successful improvement efforts. Team members should be selected based on their knowledge of the hospital systems that will be impacted by improvement efforts and their commitment to make the specific changes encompassed in the Driver Diagram and Change Package. The complete Driver Diagram and Change Package will be shared at the first Learning Session. Hospitals are recommended to select a team of at least five people, including one Physician Champion and one Day-to-Day Leader/Key Contact. Members should include multidisciplinary staff from appropriate departments who will work together to achieve the project goals and be impacted by improvement efforts. Selecting Team Leaders Team activities will be guided by a Physician Champion and a Day-to-Day Leader/Key Contact. Individuals in these roles will represent the team at the Learning Sessions and share their learning with other team members. Ideally team members should have the following attributes: Physician Champion

• Is a practicing OB-GYN provider who is an opinion leader and is well respected by peers. This may be the OB Department Chair;

• Has authority to allocate the time and resources needed to achieve the team’s improvement efforts;

• Has authority over areas affected by the change;

• Will champion the spread of successful changes;

• Understands the processes of care in the obstetric unit;

• Has a good working relationship with colleagues and the Day-to-Day Leader; and

• Wants to drive improvements in the hospital system. The Physician Champion will be a critical member of the team, and is asked to attend all Learning Sessions. Day-to-Day Leader/Key Contact

• Drives the project, ensuring that cycles of change are tested and implemented;

• Coordinates communication between the team, Project faculty and other teams;

• Oversees data collection; and

• Works effectively with the Physician Champion. The Day-to-Day Leader/Key Contact should understand how changes will affect hospital systems, and is asked to attend all Learning Sessions. This person might be a nurse manager/educator, L&D nurse manager, etc.

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Selecting Other Members In addition to team leaders, the team should include members from areas potentially affected by system changes. These members might include individuals who represent multiple roles in your delivery of care such as: registered nurses (labor/delivery and postpartum), nurse midwives, obstetricians, perinatologists, anesthesiologists, interventional radiology team, blood bank staff, quality improvement staff, information technology staff, a family representative (particularly if a Patient and Family Advisory Council has been adopted by your birthing hospital), etc. All teams should designate an individual to fill the following role: Data Coordinator

• Primary contact for data management.

• Responsible for coordinating monthly data collection and submission to NYSDOH via the Health Commerce System.

Team Members who should attend the Learning Session Teams should choose a minimum of two individuals who can most effectively work together, learn the methodology and plan for action when returning to their hospital. Different team members can attend the Learning Sessions; however, past teams have found it beneficial to send the same members to the Learning Sessions. We recommend that the Day-to-Day Leader and Physician Champion attend whenever possible. Team Expectations Hospital teams participating in the Project are expected to:

• Engage with senior leaders to communicate and collaborate to promote change and improve processes;

• Complete Pre-work activities to prepare for the first Learning Session;

• Create and share Storyboards (Attachment 3) at the first Learning Session as requested;

• Use rapid change cycles (Plan-Do-Study-Act [PDSA] tests) to implement the Change Package;

• Participate in Coaching Call webinars;

• Regularly communicate with faculty and other teams; and

• Report on the achievement of selected process and outcome measures, including details of changes made and data to support these changes.

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Appendix D: AIM Statement

Identify Your Team’s SMART AIM A SMART AIM Statement answers the question, “What are we trying to accomplish?” It is an explicit statement summarizing what your practice plans to achieve during the project. A SMART AIM Statement will focus your team’s actions, helping to improve the planning for and response to obstetric hemorrhage. The SMART AIM Statement should be time-specific, population specific and measurable. When writing your birthing hospital team’s SMART AIM Statement (Attachment 2), state your AIM clearly, and use specific numeric goals. Teams make better progress when they have unambiguous, specific goals. Setting numeric targets clarifies the AIM, helps to focus change efforts, and directs measurement activities.

Example AIM Statement Within 18 months, we aim to reduce maternal morbidity and mortality in NYS by improving the assessment and management of obstetric hemorrhage. To accomplish this, we will form a multidisciplinary team (with members from our L&D and post-partum care units) and work to implement evidence-based strategies to achieve our goals including:

• Improving readiness to respond to an obstetric hemorrhage by implementing standardized policies and procedures and developing rapid response teams;

• Improving recognition of obstetric hemorrhage by performing ongoing objective quantification of actual blood loss and triggers of maternal deterioration during and after all births;

• Improving response to hemorrhage by performing regular on-site, multidisciplinary hemorrhage drills;

• Improving reporting of obstetric hemorrhage though the use of standardized definitions resulting in consistent coding.

As you begin to develop your team’s SMART AIM Statement, be sure to:

• Involve the birthing hospital’s senior leaders: Leadership must ensure the SMART AIM Statement is aligned with the strategic goals of the organization. They should also help identify an appropriate patient population for initial focus of the team’s work.

• Base the goals of your team’s SMART AIM Statement on existing data or organizational needs: Examine available information about obstetric care processes within your organization, and focus on issues that matter most to your patients and families.

• Revise your original SMART AIM Statement as needed during the first Learning Session. Please review and revise the project SMART AIM statement to meet your birthing hospital’s individual needs. You should not delete goals, but you may add additional.

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Appendix E: Storyboards

In preparation for the Project’s first in-person Learning Session, birthing hospitals teams are asked to create a Storyboard to share information. This Storyboard is an opportunity for teams to briefly describe their birthing hospital team’s composition and what they plan to accomplish during the Project. Storyboards will also be on display for all participants to review during the first in-person Learning Session. Please bring a paper copy of your Storyboard to post on a display board at the Learning Session (this display board will be provided to you at the Learning Session). We ask that you print each page of the Storyboard / PowerPoint on a separate piece of paper for the event, and do not print on both sides of paper. In addition, prior to the Learning Session, please e-mail an electronic copy of your birthing hospital team’s Storyboard to NYSPQC@health.ny.gov. Your audience will be other participating birthing hospital teams, Project leadership, observers and faculty. Therefore, the Storyboard should be as clear and concise as possible. A template is attached to help guide you in completing your Storyboard (see Attachment 3).

Here is a sample outline for what you might include in your Storyboard:

Name and location of your organization

Brief description of your hospital and OB Units (providers, staff, community characteristics, etc.)

Improvement team (names, titles, roles)

Team’s SMART AIM for project

Initial ideas for improvement

Other relevant information (e.g., current programs/activities targeted to obstetric care)

Storyboard display tips:

✓ Use fewer words and more pictures/graphics

✓ Use pictures of real people …. at least of your team! (Hint, hint ☺)

✓ Make font size as big as possible

✓ Don’t worry about making the display fancy

✓ Use color to highlight key messages if no access to a color printer, use bright highlighters.

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Appendix F: Project Glossary

Action Period The period between Learning Sessions when teams work on improvement in their home organizations. During this time, teams will be supported by the Project Team and faculty, and are connected to other Project team members. AIM Statement A written, measurable and time-sensitive statement of the expected results of an improvement process. Coaching Call Webinar During the Action Period, teams and faculty participate in monthly webinars called Action Period Calls. These virtual meetings allow teams to share their team’s tests of change and lessons learned. Teams work together problem solving and sharing successful strategies. Faculty provide coaching and additional clinical and technical content. Collaborative A time-limited effort (usually 12 -24 months) by multiple organizations, which come together with faculty to learn about and to create improved processes in a specific topic area. The expectation is that the teams share expertise and data with each other, thus: “Everyone learns, everyone teaches.” Cycle or PDSA Cycle A structured trial of a process change. Drawn from the Shewhart cycle, this effort includes:

Plan: a specific planning phase; Do: a time to try the change and observe what happens; Study: an analysis of the results of the trial; and Act: devising next steps based on the analysis.

Consecutive PDSA cycles will lead to the plan component of a subsequent cycle. High Leverage Change Concepts A high leverage change concept will result in improvement in the system of care and result in better care, improved outcomes, reduced hospital stays and lower costs. Key Changes – Change Package The list of essential process changes that will help lead to breakthrough improvement, usually created by the leadership team and chair based on literature and their experiences. Learning Session An in-person meeting during which participating organizational teams meet with faculty and collaborate to learn key changes in the topic area, including how to implement them, an approach for accelerating improvement and methods for overcoming obstacles

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to change. Teams leave this meeting with new knowledge, skills and materials that prepare them to make immediate changes. Measure Key measures should be focused, clarify the team’s AIM Statement and be reportable. A measure guides the ability to track patients for delivery of proven interventions and to monitor their progress over time. Model for Improvement An approach to process improvement, developed by Associates in Process Improvement, which helps teams accelerate the adoption of proven and effective changes. Pre-work Packet A packet containing a complete description of the Project, along with expectations and activities to be completed prior to the first meeting of the Project. Pre-work Period The time prior to the first Learning Session when teams prepare for their work in the Project, including selecting team members, scheduling initial meetings, consulting with senior leaders, preparing their SMART AIM Statement and initiating data collection. Physician Champion The Physician Champion supports the team and controls the resources employed in the processes to be changed. The Physician Champion works to connect the team’s SMART AIM with the organization’s mission, provides resources for the team and promotes the spread of work of the team to others. Spread The intentional and methodical expansion of the number and type of people, units or organizations using the improvements. The theory and application comes from the literature on Diffusion of Innovation (Everett Rogers, 1995). Storyboard A Storyboard is a display of information to promote sharing across teams at the Learning Sessions. Storyboards usually include demographic information about the hospital team, the team’s AIM Statement, data and lessons learned during the Action Periods. Test A small-scale trial of a new approach or a new process. A test is designed to learn from it if the change results in improvement and to fine-tune the change to fit the organization and patients. Tests are carried out using one or more PDSA cycles.

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Appendix G: Project Leadership and Faculty

New York State Department of Health Marilyn Kacica, MD, MPH, Executive Director, NYSPQC Kristen Lawless, MS, Project Director, NYSPQC Lusine Ghazaryan, MD, MPH, Project Advisor, NYSPQC Chris Kus, MD, MPH, Project Advisor, NYSPQC Victoria Lazariu, PhD, Maternal Mortality Director, NYSPQC Eileen Shields, Data Systems and Analysis Manager, NYSPQC Solita Jones, MS, Data Systems and Analysis Manager, NYSPQC Amanda Roy, MPH, Data Systems and Analysis Manager, NYSPQC Brandi Wells, MPH, Assistant Project Manager, NYSPQC Akua Boakye-Yiadom, Project Assistant, NYSPQC American Congress of Obstetricians and Gynecologists, District II Christa Christakis, MPP, Executive Director Kristin Zielinski, MA, MPP, Senior Director of Operations Greater New York Hospital Association Lorraine Ryan, BSN, MPA, Esq., Senior Vice President, Legal, Regulatory and Professional Affairs Wing Lee, MBBS, MPH, Senior Project Manager Healthcare Association of New York State Loretta Willis, RN, BS, CPHQ, CCM, Vice President, Quality and Research Initiatives Kathy Rauch, RN, MSHQS, BSN, CPHQ, Director, Quality and Research Initiatives National Institute for Children’s Health Quality Patricia Heinrich, RN, MSN, Quality Improvement Advisor Emma Smizik, MPH, Project Manager Aviel Peaceman, MPH, Project Manager Clinical Advisory Work Group Fouad Atallah, MD, Maimonides Medical Center Peter Cherouny, MD, University of Vermont College of Medicine / National Institute for Children’s Health Quality (NICHQ) Adriann Combs, DNP, NNP, Winthrop University Medical Center Lisa Fraine, PhD, CNM Christopher Glantz, MD, MPH, University of Rochester Medical Center / Strong Memorial Hospital Dena Goffman, MD, Columbia University Medical Center Whitney Hall, LM, CCE, CLC Maria Hayes, RN, BA, MaEd, Champlain Valley Physician’s Hospital Wendy Wilcox, MD, NYCHHC - Kings County Hospital

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All rights reserved. Individuals and organizations participating in this Project may reproduce any of these materials solely for training within their organizations. Any such reproduction should include an acknowledgement as follows: Reproduced, with permission, from the Pre-work Syllabus for the “New York State Obstetric Hemorrhage Project”, copyright New York State Department of Health, American Congress of Obstetricians and Gynecologists District II, Greater New York Hospital Association and Healthcare Association of New York State. No other reproduction is authorized without the written permission of the copyright holder. This project is funded by the New York State Department of Health, American Congress of Obstetricians and Gynecologists, District II, Greater New York Hospital Association and Healthcare Association of New York State. Additional support is provided by the Centers for Disease Control and Prevention (CDC) through a State-based Perinatal Quality Collaborative grant awarded to the NYSDOH (NU58DP006375). For more information, e-mail NYSPQC@health.ny.gov, or call (518) 473-9883.