By Siena Davis, MPH & Cassidy Hine, MPH
Ronald Iverson, MD, MPH, is an obstetrician/gynecologist at Boston Medical Center in Massachusetts and vice-chair of obstetrics. He co-chairs the Massachusetts Perinatal Quality Collaborative (PQC) with Audra Meadows, MD. On April 7, 2020, the Perinatal Neonatal Quality Improvement Network (PNQIN) partnered with the Betsy Lehman Center to hold a virtual town hall meeting to present on developing perinatal care solutions during the COVID-19 pandemic.
Can you give me some background? How did you decide to conduct a state-wide town hall meeting with perinatal clinicians?
“We had seen the excellent presentations from the California and Illinois PQCs. We had been thinking about how to contribute to collaboration in the state and to other PQCs. When we learned that the Betsy Lehman Center (BLC) team was interested in collaborating with us, we decided that to put together some sort of town hall that could be an area for sharing and group learning.”
What was the format for the meeting you conducted?
“We basically came up with the idea of an opening remark, discussion of the state of knowledge on COVID-19, then presentations and Q&A. The six presentations would include the problem statement, any data, development of solutions, then implementation. The idea was that we didn’t want to put out just absolute solutions that you could just get in an email. We wanted to talk about how you developed those solutions collaboratively. How did you roll it out? Pilot testing? results? lessons learned? We are about implementation and sustainment, not just great ideas. I thought that’s what we could bring to the table and emphasize. Not every one of the final products would be applicable to every space, but if people saw how it was developed and implemented, that would be useful as an analogy. A way to do work in these rapidly changing times. The amazing thing is, we dreamed this up on a Wednesday afternoon, had speakers on Thursday, an agenda on Friday, slides by Monday afternoon, and the speakers presented 5-7 slides (up to 7 minutes) on Tuesday. We decided to have each speaker give a short presentation, so participants would remember the bulk of the information the speakers shared.”
What topics were discussed in the town hall meeting?
“We started the conversation around COVID-19 updates and management. We then talked specifically about multiple topics such as, how women can get blood pressure cuffs so they can take their own blood pressure for the telehealth visit, provide labor support and also keep staff safe in labor and delivery units, and communication between teams. One speaker talked about the process of conducting postpartum follow up with patients remotely, with an emphasis on supporting patients’ mental health. Two nurse leaders gave a presentation on leadership and how they are using rapid cycle quality improvement to innovate, run small tests of change, and re-adjust the processes as needed. They pointed out that what seemed like a good idea in theory did not always work out in reality.
All of the presentations were outstanding. The speakers were intentional in giving very succinct and clear presentations. We are operating in an environment where people don’t have a lot of time to keep up with all the changes.
We got really good feedback in the survey that the Betsy Lehman Center sent out to the participants. Fifty-four of the about 250 participants responded. Ninety three percent of them are ‘likely to attend’ to our next town hall. They generally liked a 60 or 90 minute duration. They seemed to appreciate the format and topics.”
How many people attended the town hall?
“We had 250 participants, including administrators, nurses, doctors, midwives. We’re holding another meeting on Tuesday April 14, again with an emphasis on process and implementation.”
As you think back over the town hall meeting, what parts of the meeting went well?
“We were very lucky to have the Betsy Lehman Center help us run the meeting. In addition to having a lot of experience with webinars and collaborative learning, they have many staff to help with the online process. What went well was the preparation was very complete. We looked like we knew what we were doing. We had people running the meeting in the background - helping with technological difficulties, monitoring the chat box, and working with Dr. Meadows to prepare for Q&A in the last 20 minutes. Having the Q&A session based on chats was very effective. I think having somebody there to help organize the topics for the chats so she could put them in her own words then direct them to experts was helpful. We prepared ourselves. We knew there would be questions on things we didn’t present on. We knew there would be questions about COVID-19 positive mothers breastfeeding their babies. We asked some experts in the state to be ready to answer some of these questions on the during the meeting.
We also prepared the speakers. We all met the day before and showed our slides to each other so there was no repeating of information. I felt like, with them knowing what everyone else was talking about, the transitions felt very smooth. They were able to adjust their theme and angle on the presentation by seeing the common thread that we were aiming for. No matter how much you explain through email, you can’t explain the emphasis you are looking for. It was helpful to have them look at each other’s presentations, make comments, and help each other.”
What parts of the meetings did not go as well as you hoped?
“Next time, we will do a better job keeping track of who attends the meeting. I want to be able to say how many hospitals we touched. The last town hall was 90 minutes long - from 12-1:30 pm. I watched participant levels. Most people stayed on until 1 pm. I know some people had clinics and other meetings, so they had to drop off. We will try one hour for another next meeting.”
What advice do you have for other perinatal quality collaboratives (PQCs)?
“Trust yourselves. From what I’ve seen with other PQCs, they know what they are talking about when it comes to implementation and organizing care. People are hungry for information. This is an excellent time for us to remember the importance of process and evaluation in our projects. For widespread implementation within the system, you still need to be thoughtful. Don’t just say something and hope that it sticks, but evaluate it and quickly take the learning and put it back into the process you are working on. If you continue to emphasize what PQCs are really about, implementing good practices, people will respond.”
What were some key insights that were gained by having the town hall?
“I run a lot of webinars and I have to say having a single slide set going in is key. I’ve seen situations where presenters share their screen sequentially, which can be tricky. Simple technical difficulties can lose the momentum. You really need to have a smooth transition, continual material for people to digest.”
At this point, what do you think are the most pressing questions related to COVID-19 and maternal care?
“People are still struggling with what PPE to be using as they take care of mothers. Not just because of science not telling us what to do, but because resources are so stretched.
People are also struggling with the best medications to use. We still don’t know everything about transmission from mother to fetus. We are working on best practices for delivery and supporting the family immediately after delivery, but we don’t know exactly what that should look like. We continue to look to the colleges to give us suggestions. It’s always changing.”
Could you summarize recommendations for other hospital and state leaders?
“If you have the resources to put on a collaborative meeting, this is the time to do it. This is the time to reinforce good implementation and appropriate process development in all of the spaces where we are working. My recommendation would be don’t wait, get something together, bring in your experts, and those experts can include all the people working on their teams. Have them present.”
When is your next town hall meeting?
“Our next town hall meeting is Tuesday, April 14, 2020 from 12-1:30pm ET. Click here for more information and to register. Please also let people know they can visit our website for more information: Visit the PNQIN COVID-19 Response page for additional COVID-19 resources and hospital guidelines and to find out about future Town Hall Meetings.”