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Managing Obstetrical Risk Efficiently (MOREOB) in British Columbia

The MOREOB program is an interprofessional patient safety program that aims to decrease the number of adverse events and errors in obstetrics. The program is designed to help create a working environment in the birthing unit that eliminates professional autonomous silos, organizational hierarchy, communication gaps, uncoordinated teamwork, and culture of blame.

The program is able to accomplish this goal by bringing together the obstetrical team for regular training, practise, and case review. Activities within the program include environmental scans, patient satisfaction surveys, staying current with new evidence and best practices, participating in workshops, and competency drills.

The structure of MOREOB is based on the high-reliability organizations principles:

  1. Patient safety is the priority and everyone's responsibility.
  2. Communication is highly valued.
  3. Operations are a team effort.
  4. Hierarchy disappears in an emergency.
  5. Emergencies are rehearsed.
  6. Interprofessional reviews are held routinely.

The MOREOB program was initially created by the Patient Safety Division of the Society of Obstetrics and Gynaecology of Canada (SOGC) in 2002. In 2006, Northern Health Authority in British Columbia adopted the MOREOB program in its clinical sites.
IMPACT

Evaluation of the program in 2009 indicated that 93 per cent of Northern Health obstetrical healthcare providers, including physicians, midwives, nurses, and administrators, have been participating in the program. Upon evaluating the outcomes, the Patient Safety and Quality Council stated that the health region experienced a growth in leadership capacity towards safer patient care. Surveys have indicated that care providers have an improved sense of work culture, resulting in improved retention and recruitment in all sectors. There is a greater sense of teamwork and, since participants work more cohesively, there is a growing pride in the team in which they are part. There has been steady growth and improvement with self-reported culture change as per the Culture Change Assessment tool. Knowledge enhancement results have improved; specifically, all disciplines demonstrate a common knowledge base. Participants are getting the value of audits and tracking no-harm events on a regular basis as well as participating in routine skills/emergency drills in many sites. Statistical information from the BC Perinatal Health Program database also shows improvements in the number of labour inductions, Caesarean section deliveries, and newborns with cord blood gases after delivery.

Since Northern Health Authority's implementation of MOREOB, the program has been implemented across Canada and the United States with positive results. It has expanded to include more than 260 hospitals and 13,000 participants.

In over 10 years of North American MOREOB activity, participating hospitals indicate that it has:

  • improved outcomes and reduced harm to mothers and babies;
  • decreased liability incurred costs and average cost per claim;
  • improved standardization and consistency of care practices;
  • improved and sustained patient safety culture;
  • increased core clinical knowledge for participants in all hospital care levels; and
  • created an environment in which participants want to stay engaged.

In addition, independent study data found that the MOREOB program had significant and lasting positive effects, such as:

  • length of stay greater than two days reduced by 12 per cent;
  • infants on ventilators reduced by 31 per cent;
  • severe infant morbidity reduced by 24 per cent; and
  • infant mortality reduced by 18 per cent.

In British Columbia, MOREOB was implemented in Kamloops and Kelowna in 2012 and 2013, respectively. Evaluation at these sites has not been undertaken to date.