Table 2 Key elements of organizational transformation to deliver high-quality group prenatal care
Key themes | Description | Adopters | Non-adopters |
|---|---|---|---|
Impetus to transform | Motivation can arise either externally, influenced by external pressures, or internally, driven by a myriad of factors within the organization | Multiple benefits “Providing group prenatal care would draw new patients and improve patient education, clinic efficiency, provider satisfaction, and cost-effectiveness of care.” Cultivating advocates “Group prenatal care was initially championed by hospital administrators or clinicians.” Effective communication “We communicated our vision to other stakeholders within our respective organizations to gain buy-in.” | Did not anticipate efficiency improvements “While we are motivated to deliver group prenatal care as a means of improving patient experience and outcomes, we did not expect increases in efficiency or cost-effectiveness of care.” Top-down approach lacks complete buy-in from health care providers “While administrators were said to be on board, the message did not reach those responsible for making referrals.” |
Leadership commitment to quality | Leadership commitment begins at the top of the organization but includes all levels | Leadership and support by senior clinicians “We had senior clinicians overseeing group prenatal care implementation who could draw on their own experiences facilitating group sessions to provide support to other health care providers.” Hospital leadership “Adequate space, including a meeting area spacious enough for all participants, was provided for the group sessions, in contrast to the confines of an examination room.” | Lack of leadership buy-in “How can you implement a new model of care when you cannot even implement regular care? |
Improvement initiatives that engage staff | Improvement initiatives mobilized diverse staff at all levels to solve a pressing and meaningful problem collaboratively | Implementation of an “opt-out” policy for group prenatal care "The head of our obstetrics department introduced an 'opt-out policy' for patient scheduling, wherein eligible individuals were primarily presented with the option to enroll in group prenatal care unless they chose otherwise." Collaborative efforts for optimizing group prenatal care "We collaborated on various initiatives to enhance group prenatal care, including evaluating and shifting protocols aimed at improving the recruitment and retention of patients." | Staff disengagement toward new initiatives "How can we earnestly drive change when resources are limited?" |
Alignment to achieve organization-wide goals | Consistency of plans, processes, information, resource decisions, and analysis to support key organization-wide goals | Resource allocation and actions “We have dedicated resources to enhance health outcomes, including personnel, time, supplies, and space. However, there needs to be more consistency in aligning goals and expectations for implementing this supplementary care model.” “…It is problematic to introduce, try to sell [group prenatal care] when you are using the traditional model.” "To fully integrate and sustain group prenatal care, aligning financial incentives is essential." | Inability to adjust processes and redistribute resources “We did not have a designated space and that was a huge, huge obstacle.” |
Integration | Integration involves aligning structures and processes to facilitate the widespread adoption of improved clinical practices across all organizational levels | Systematically incorporated into the services "We provide information about group prenatal care to every new patient, including those identified as high-risk." Institutional barriers “The new program exists in addition to the clinic’s regular services.” “… It will never be a default as long as you designate it as something alternative.” Challenges in sustainability “We are unable to sustain the model after a significant leadership change.” | Institutional barriers "Innovations often require additional financial and logistical resources." Misconception "I believe this innovation is best suited for specific patient profiles, particularly those with high social risk factors." Resistance to collaborative patient care “At the end of the day, the physicians just did not want to give up control of their patients.” |