An Interview with Texans Care for Children member Seton Healthcare Family

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.

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 tried them.

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 39^th 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 time.

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.

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?

The 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.