TeamBirth is an innovative approach to improve communication and teamwork in childbirth pioneered by Ariadne Labs’ Delivery Decision Initiative (DDI). The care process, which relies on a patient-facing planning board and team huddles, ensures people giving birth and clinicians have shared input and understanding into decision-making during labor, delivery and postpartum.
Three recently published papers in Birth: Issues in Perinatal Care detail how, following the Ariadne Labs Arc methodology to design, test, and spread solutions, the DDI team developed, researched, and implemented TeamBirth. The papers also examine TeamBirth’s impact on the birth experience for both patients and clinicians and strategies for successful implementation in U.S. hospitals.
“About 90% of preventable adverse medical events in the U.S. are caused by gaps in communication and teamwork,” said Amber Weiseth, DNP, MSN, RNC-OB, Director of the Delivery Decisions Initiative. “Not only do these breakdowns in communication leave patients feeling like their wishes aren’t being heard, but they also create very real safety risks. TeamBirth was developed to close those gaps and put all members of the team on an even playing field so that every patient has a central role in all decisions about their birthing experience.”
Design
In the first paper, “The Design of TeamBirth: A Care Process to Improve Communication and Teamwork During Labor,” the DDI team describes the process by which they developed TeamBirth. The design process included working with an interdisciplinary group of experts, clinicians, community members and patients to create an initial prototype solution for rapid cycle testing by clinicians and patients.
This process led to the current TeamBirth solution, which includes a patient-facing planning board and other decision aids, along with team huddles at key moments throughout labor. The patient is recognized as a member of the care team, and their preferences are integrated with clinical data to inform patient care plans.
Test
After designing the model, the team launched a pilot study in four hospitals in the U.S. to evaluate whether the model was feasible to implement and both acceptable and safe to clinicians and patients. The paper “Improving Communication and Teamwork During Labor” detailed the test phase of the Arc. The DDI team used patient and clinician surveys, abstracted clinical data, and administrative claims to test the acceptability and feasibility of TeamBirth. The outcomes were striking:
- 99% of patients had the role they wanted in making decisions about their labor.
- 99% of patients reported that their nurse and provider talked about their labor in a way they could understand
- 90% of nurses, midwives, and obstetricians reported they would recommend TeamBirth for use in other labor and delivery units
- 94% reported that the project improves care for patients.
The paper found that TeamBirth’s success hinges on the teamwork and communication among the stakeholders comprising the care team, including the birthing person, support person, nurse, and midwife or obstetrician.
Spread
In the paper “Implementation Strategies Within a Complex Environment,” the team explored how to effectively spread TeamBirth by describing strategies for successful implementation. Researchers identified that contextual factors such as strength of leadership, physician practice models, and quality improvement culture all had an important effect on implementation. Other factors for success include multidisciplinary implementation teams with a strong understanding of their facility’s implementation climate. The paper’s analysis offers tangible lessons for other labor and delivery unit leaders as they seek to integrate patient-centered practices in their own settings to improve teamwork, communication, and respectful maternity care.
A nurse involved in the pilot study told researchers: “…I think it’s been really empowering to the patient to feel like they do have a voice and that they can use that voice in communicating sort of what they want….I’ve heard patients say, you know, ‘I just felt so much more informed. I felt like I had a say in what was happening.’”
DDI researchers concluded that future research should explore the acceptability and feasibility of TeamBirth in additional contexts including less engaged hospitals and with lighter-touch models for implementation support. Future work may also study the effectiveness of TeamBirth in improving clinical outcomes in labor and delivery.
As of March 2022, TeamBirth has been implemented in 27 hospitals around the country, including the four systems involved in our pilot study: South Shore Hospital in Massachusetts, EvergreenHealth Medical Center and Overlake Medical Center in Washington, and St. Francis Hospital in Oklahoma. There are 20 additional hospitals preparing to launch TeamBirth later this year.