Examining the effects of an obstetrics interprofessional programme on reductions to reportable events and their related costs.

There are many ways to account for the return on investment (ROI) in healthcare: improved communication, teamwork, culture, patient satisfaction, staff satisfaction, and clinical outcomes are but a few. Some of these are easier to quantify and associate to an intervention than others. What if the outcomes listed were not just independent results, but beget one another? In 2001, the Society of Obstetricians and Gynaecologists of Canada created the Managing Obstetrical Risk Efficiently (MORE) programme, to improve healthcare culture and patient outcomes in obstetrics by leveraging front-line ownership. Our study provides evidence that MORE lowers the frequency and cost of reportable events in maternity units. We sought to review the impact of this intervention on the frequency and cost of reportable events at the insurer level of a clinically focused, three-year interprofessional culture change intervention applied to the maternity unit. We compared the impact of reportable events both in the obstetrical and in the non-obstetrical areas of the same hospitals during the same time periods. We analysed these data using an interrupted time series (ITS) design, among 34 Ontario Canada hospitals. The ITS design assessed changes in the frequency and cost of reportable events before and after the implementation of the intervention. The method was ideally suited as the various maternity units had differing programme commencement and completion dates. The frequency of reportable events showed little change during the three-year intervention. As culture change grew, the changes in behaviour and processes that impact patient outcomes took longer to accrue. A large reduction in the frequency of reportable events occurred in the following three-year (14% reduction) and six-year (25% reduction) tranches. Our results show statistically significant reductions in the frequency and costs associated with reportable events at the level of an insurer. The results also give insight as to the investment of time required to achieve a level of sustainability.