1. Driver Diagrams Reduction of Early Elective Deliveries OHA HEN 2.0

2. Reduction of Early Elective Deliveries AIMPrimary Drivers Secondary Drivers Change Ideas Reduction of Early Elective Deliveries by 40% Reduction in DEMAND for elective deliveries prior to 39 weeks Raise awareness of EED risks for physicians, nurses and hospital staff. Raise awareness of risks of EED for patients/families and the community. Provide education to physicians and nursing staff regarding risks of EED -Provide data for outcomes of EED in your hospital -Use a physician champion to help educate and influence medical staff Provide education to patients regarding risks of EED - Assist staff physicians in obtaining national educational tools to distribute in offices - Include this education in patient admitting materials - Partner with community groups, media and other groups to highlight risks of EED Reduction of AVAILABILITY of elective deliveries prior to 39 weeks Create a hospital policy and procedure that guides scheduling and oversight for elective deliveries. Develop mechanisms to support the implementation and enforcement of these P&P’s. Include physicians in the development of P&P’s - This is physician driven. Input and buy-in is crucial - Use physician champion to bridge the gap Use an established evidence-based policy/protocol for the policy that follows ACOG and national quality criteria. - Include elements of an elective induction bundle in the policy, such as the IHI Labor Induction Bundle

3. Reduction of Early Elective Deliveries AIMN=Primary Drivers Secondary Drivers Change Ideas Reduction of Early Elective Deliveries by 40% Reduction of AVAILABILITY of elective deliveries prior to 39 weeks. (cont.) Create a hospital policy and procedure that guides scheduling and oversight for elective deliveries. Develop mechanisms to support the implementation and enforcement of these P&P’s. Cont. - Use an established sample from a state or national organization such as the “39 Week Toolkit” from CMQCC Establish procedures for approving exceptions to policy. - Medical indications and exceptions must be decided by Medical Staff -Use established standards from ACOG or Joint Commission - Clearly define who determines the exception, such as the Chair of the Department Establish a defined procedure for scheduling elective deliveries - Include standardized format that includes all required details such as gestational age and reason for induction. Include a “Hard Stop” for halting scheduling process when induction does not meet criteria. - Define in policy the escalation process for Chain-of- Command to be notified to make decisions when a Hard Stop occurs. Patient and Family Engagement Patient and Family Involvement Foster a culture that allows for patient and family involvement in care. Provide information and education to patients, family and community