If you have taken your journey to midwifery along a path that has you employed in a hospital, you are likely familiar with the Joint Commission. If not, you need to know how this organization improves perinatal care.
The Joint Commission is an organization that accredits hospitals for meeting certain benchmarks, they call these the core measures. The idea is the core measures represent what is expected in an institution which provides high quality, evidence-based care. This accreditation is one of the most powerful bits of advocacy for high quality care in the US. Why?
Hospitals invest large amounts of time and money to achieve accreditation, and once they have it they don’t want to lose it. So when the Joint Commission does something like expanding the threshold for hospitals which must report the perinatal care core measures to be accredited, hospitals pay attention and change the way they operate. It’s a whole different type of “grass roots” – its other people within the field of health care calling for change. And it works.
Just what are these perinatal core measures? The full descriptions are a bit technical, but you can read them here. Basically the Joint Commission expects hospitals to decrease rates of elective delivery before 39 weeks, cesarean delivery rates, and neonatal infections; and increase the rates of breastfeeding and use of antenatal steroids for infants at risk of delivery before 34 weeks.
Incidentally, I completed a project for a class in implementation science when I was in public health school. At that time I recommended we reduce the repeat cesarean rate by including repeat cesarean for low risk pregnancy as a Joint Commission perinatal core measure. Maybe someday they’ll use my idea.
So the big news is that the joint commission is going beyond simple inclusion of the perinatal core measures for accreditation by creating a perinatal care certification. According to the joint commission, “Perinatal Care Certification focuses on achieving integrated, coordinated, patient-centered care for clinically uncomplicated pregnancies and births.”
Not only that, but the Joint Commission has also taken up the call for hospitals to review all cases of severe maternal morbidity (similar to what the World Health Organization calls near-miss maternal mortality). According to the Joint Commission, severe maternal morbidity is a sentinel event (something that triggers the need for immediate investigation and response). While the hospitals do not have to report sentinel events, the support of the Joint Commission in this effort will do much to further the cause of improving maternal health.
Start asking around in your area — which of your hospitals are accredited, and are they going for perinatal certification?