Daoud Anna K, Larson Elysia, Rhone Tonia J, Conklin Claire R, Olden Heather, Vitek Kali, Cabral Howard, DeClercq Eugene, Amutah-Onukagha Ndidiamaka, Diop Hafsatou, Meadows Audra R
The Perinatal Neonatal Quality Improvement Network of Massachusetts, Boston, MA, USA.
Tufts University School of Medicine, Boston, MA, USA.
Implement Sci Commun. 2025 Mar 27;6(1):28. doi: 10.1186/s43058-025-00703-2.
Black-White inequities in severe maternal morbidity in the United States are extreme and growing. Maternal safety bundles (MSBs) have been associated with closing racial equity gaps in maternal health in some states. The objective of this study was to explore clinician perspective and experiences of implementing an Equity maternal safety bundle across five hospitals in Massachusetts to address inequities in perinatal care and birth outcomes.
Focus group discussions and interviews were conducted in Fall 2022 and Fall 2023 (before and after Equity MSB implementation) among obstetric nurses, resident physicians, and attending physicians. Discussions were facilitated using a semi-structured guide developed using the Consolidated Framework for Implementation Research (CFIR). Transcripts were independently coded by two analysts using NVivo 14. A codebook was developed using CFIR for deductive coding. We added inductive codes as appropriate. We calculated Cohen's kappa coefficients to assess interrater reliability. Themes were generated through an iterative process and compared across study time points.
Fifteen clinicians participated at each time point with similar distributions across race, ethnicity, gender, and profession. Seven themes emerged from these interviews: 1) the importance of leadership support to prioritize equity, 2) a culture of equity as a facilitator for implementation, 3) the need for improved processes for self-reported race, ethnicity, and language data collection, stratification, and dissemination, 4) staff, time, and funding as necessary resources, 5) the need for an early focus on staff education, 6) existing siloes between physicians and nurses and exclusion of trainees as barriers to implementation, and 7) differences between an Equity-MSB and other MSBs.
Leadership prioritization of equity and a culture of equity emerged as facilitators to successful implementation of elements of the Equity MSB. Challenges identified included resistance to change among colleagues, limited resources, and clinician siloes. When compared to previously implemented MSBs, participants found that leadership made this work a priority. As future hospital teams embark on implementing equity-focused action, these known facilitators and barriers should be considered and addressed during the pre- and early-implementation phases.
美国严重孕产妇发病率方面的黑白不平等现象极为严重且呈上升趋势。在一些州，孕产妇安全包（MSB）与缩小孕产妇健康方面的种族公平差距相关。本研究的目的是探讨临床医生对在马萨诸塞州的五家医院实施公平孕产妇安全包以解决围产期护理和分娩结果不平等问题的看法和经验。
2022年秋季和2023年秋季（公平孕产妇安全包实施前后）对产科护士、住院医师和主治医师进行了焦点小组讨论和访谈。讨论通过使用基于实施研究综合框架（CFIR）开发的半结构化指南进行。两名分析师使用NVivo 14对转录本进行独立编码。使用CFIR开发了一个编码手册用于演绎编码。我们酌情添加了归纳编码。我们计算了科恩kappa系数以评估评分者间的可靠性。通过迭代过程生成主题，并在不同研究时间点进行比较。
每个时间点有15名临床医生参与，他们在种族、民族、性别和职业方面分布相似。这些访谈中出现了七个主题：1）领导支持对优先考虑公平的重要性，2）公平文化作为实施的促进因素，3）改进自我报告的种族、民族和语言数据收集、分层和传播流程的必要性，4）人员、时间和资金作为必要资源，5）早期关注员工教育的必要性，6）医生和护士之间现有的壁垒以及将实习生排除在外作为实施的障碍，7）公平孕产妇安全包与其他孕产妇安全包之间的差异。
领导对公平的优先考虑和公平文化成为成功实施公平孕产妇安全包要素的促进因素。确定的挑战包括同事对变革的抵制、资源有限以及临床医生之间的壁垒。与之前实施的孕产妇安全包相比，参与者发现领导将这项工作作为优先事项。随着未来医院团队着手实施以公平为重点的行动，在实施前和实施早期阶段应考虑并解决这些已知的促进因素和障碍。
