Interview with Dr. Frank Mazza of Seton Healthcare Family
Texans Care for Children:
Over the past decade, Seton Healthcare
Family embarked on a groundbreaking initiative to keep babies safer and out of
the Neonatal Intensive Care Unit where possible. Can you provide some
highlights of how it worked?
Dr. Mazza: This has been an amazing project that has
dramatically changed how we do our work in the labor and delivery unit. It worked because it was a concerted effort
on the part of all parties. That may
sound like an odd answer, but keep in mind that the odds are stacked against
hospitals doing this kind of work in the first place. First, no one knew that we would be
successful in advance, so it took a leap of faith on the part of all parties to
see if this effort would lead to a reduction in birth trauma, a reduction in
premature babies, and a reduction in costs for the NICU.
There are no incentives in health
care today to do work like this. Why
would most hospitals spend precious and limited resources on a project with no
clear expectation of success but with advanced knowledge that it could mean
that all the hard work you accomplished resulted in a dramatic reduction in
your profitability for the service you were providing?
We succeeded because Seton and its
parent organization, Ascension Health, were out to make care in our hospitals
as safe as possible for our patients.
When it became evident that we were succeeding, but at great financial
cost to the organization, we were lucky to be working for a mission-driven
organization that placed high quality, patient safety, and doing the right
thing above profitability. We succeeded
because our physicians were willing to take time away from their practices to
advocate for their patients, even though it meant that their reimbursement
would suffer. And we succeeded because
our staff and administrators were willing to redesign our systems so that we
were always patient-centered, even if it meant that everyone had to work harder
and that everyone who worked in our labor and delivery unit was more
inconvenienced and less autonomous.
What sort of results did you see?
We were able to accomplish a lot, and we
continue to improve our processes, as the team that has been doing this work
continues to meet as it has done over the last 8 years. Many of the changes that we implemented were
either not known to be good practices, or at least not known to be as powerful
in changing the way that we took care of mothers and their babies until we
For instance, we redesigned how and when we
apply vacuum and forceps devices that are used to help pull the baby out of the
birth canal. These are critically important
pieces of equipment that assist the delivery process, but their use can also
harm babies, so our physicians came up with strict rules around when they could
be applied and how.
Our doctors have banned induction of pregnancy
for non-medical reasons before the 39th week of gestation, because
babies born before this period are more prone to the physical, intellectual and
emotional problems sometimes seen with prematurity if they are born before that
We follow a specified process before and during
the time we use Oxytocin, a drug used to induce labor, so that we are less
likely to have complications from the use of that drug.And we have done much more – we have limited how
and when we do caesarian sections, we regularly practice as a team for
potential obstetrical emergencies in a simulation setting, and we have adopted
the same language for doctors and nurses related to how we interpret fetal
monitor strips (believe it or not, doctors and nurses have used different
approaches to that in the past).
currently involved in trying to assure that all of our babies are exclusively
fed breast milk for at least the first six months of their life, because that is
crucial for their health and well being.
Overall, these and other best practices have allowed
us to reduce our instances of birth trauma by 93%, even though we started off
at a rate that was already about half of the national rate anyway!
It sounds as though you learned most
cases of trauma during child birth are preventable. Do you think there is
something that can be done across Texas to replicate Seton Healthcare Family's
success in helping more babies get a healthy start in life?
answer to that is "absolutely!” We have
shown that these best practices can make a difference outside of Seton because
we have spread them across our parent corporation’s hospitals, located all over
the country and elsewhere. We applaud
the Texas legislature for taking on this effort on behalf of babies and mothers
across the state. At the same time, it
is VERY hard work, and it takes time. We
are also disappointed that the legislature did not see fit to incentivize
hospitals for taking on the hard work, knowing that they were likely to suffer
financially if they did so.
To see Dr. Mazza's slide presentation from the 2011 Texas Infant Health Summit, click here.
To learn about attending the 2012 Put Kids 1st Awards luncheon, where Texans Care for Children will be honoring Seton, click here.
To see a complete list of Texans Care for Children member groups and learn how your organization can join for free, click here.