The American College of Nurse Midwives began a project in 2015 that encouraged hospitals to make system changes that result in reduced rates of primary cesarean. In the first year of the initiative, 15 hospitals participated. You can read more about it at the Birth Tools website.
If it began in 2015, why watch it now?
The project is gaining momentum. I don’t mean just the idea of reducing the primary cesarean rate (which is supported by ACOG, The Joint Commission, basically every health organization), but this particular project. Vanderbilt University Medical Center announced participation just last week. This is great news because it widens the data collection about the bundles to reduce primary cesarean AND because we may get evidence about other quality improvement and policy changes that helped. This is important data because it can be used to inform change at non-participating hospitals; so change can happen faster and be more effective.
I’ve got a few projects in preparation right now, and one of them is exploring ways to translate this quality metric to the population level so we can assess differences in systems (think regionalization or state laws) that may affect the ability of hospitals to create environments where these goals can be achieved.