Episode #150 Maternal Mortality Newsflash and Key Attributes of Effective Leaders

Hello and welcome back to the Anesthesia Patient Safety Podcast.  My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. Last week, we talked about the call to action for effective leaders to foster an organizational culture dedicated to decreasing burnout, a safety culture dedicated to decreasing medical errors, and psychological safety to allow for open communication, creativity, and improved patient safety. Today, we are going to talk about the key attributes of these effective leaders for Part 2 of our two part series on leadership and patient safety culture. Before we return to the conversation, we have a newsflash and update. So stay tuned.

Before we dive into the episode today, we’d like to recognize Nihon Kohden America, a major corporate supporter of APSF. Nihon Kohden America has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Nihon Kohden America – we wouldn’t be able to do all that we do without you!”

In March 2023, there were headlines in the United States related to maternal morbidity and mortality. This is something that we have talked about before on the podcast. Check out episodes 21, 22, 78, and 79 for starters. You may have seen the CNN article by Jacqueline Howard, “US maternal death rate rose sharply in 2021, CDC data shows, and experts worry the problem is getting worse.” I will include the link in the show notes as well. The article emphasizes the following points:

• The number of women who died from maternal causes in the United States rose considerably in 2021.
• The maternal mortality rate among Black women was more than double the average
• The maternal mortality for women over 40 is seven times higher than those under 25
• The US has the highest maternal death rate of any developed nation.

This is very concerning and the APSF is committed to helping improve maternal patient safety. In 2021, the APSF board approved funding of two projects in one funding cycle on childbirth safety, especially those among minority and vulnerable populations. We are going to hear from one of the PIs of one of the projects now.

[Kovacheva] “Hello, my name is Vesela Kovacheva I’m an assistant professor of anesthesia at the Harvard Medical School and the Director of Translational and Clinical Research at the Division of Obstetric Anesthesia. My research is focused on using novel bioinformatics approaches to predict and prevent adverse pregnancy outcomes.”

[Bechtel] I asked Kovacheva if she could address the recent news articles and then provide an update on her project. Let’s take a listen.

[Kovacheva] “The latest report from the CDC published two weeks ago highlights that maternal health is an area of high need. In 2021, there were 1,205 maternal deaths in the United States. An increase. Of 38% compared to the previous year. They were also marked racial and ethnic disparities, and the black non-Hispanic women had almost three times higher mortality rate compared to the white, non-Hispanic women.

This tremendous spike in maternal mortality rate is considered due to mostly preventable causes, and emphasizes the urgent need for better detection and prevention of adverse pregnancy outcomes.

I’m the recipient of an investigator initiated grant from the Anesthesia Patient Safety Foundation to develop better tools for predicting severe maternal morbidity. And I’m going to tell you about our progress. In the past year, one of the major challenges for our work was getting access to quality patient data to be used in our research.

To overcome this, we created a machine learning platform called the Medical Record Longitudinal AI System, or Merlin, which can be used for any types of medical data, including data from the electronic medical record, imaging, and also time series data. This system uses scalable microservice architecture containing multiple modules and can expand as the needs increased.

Merlin can ingest process and analyze the data of up to 15,000 patients per hour, which allows great efficiency for our small team. Our data is stored in atomized machine learning ready format, which allows fast iteration and working on multiple projects in parallel. Thanks to Merlin, we were able to create several machine learning models to predict preeclampsia, which is one of the major contributors to severe maternal morbidity and mortality.

A few additional models are also in development that have great potential to improve maternal safety during delivery. As a result, we are well on our way to accomplish the aims of our grant. I’m incredibly grateful for all APSF support and the opportunity to work on this impactful project. Thank you.”

[Bechtel] Thank you so much to Kovacheva for her important work in this area to help improve maternal patient safety. We are looking forward to hearing more about this project in the future.

And now, it’s time to return to our featured article from the June 2020 APSF Newsletter, “Effective Leadership and Patient Safety Culture” by Brooke Albright-Trainer and colleagues. To follow along with us, head over to APSF.org and click on the Newsletter heading. Fifth one down is the Newsletter archives. Then scroll down and click on June 2020. From here, scroll down until you get to our featured article today. I will include a link in the show notes as well.

Let’s get started with a quick review of some of the important concepts we talked about last week. First, we have safety culture. According to the Joint Commission, safety culture is a collection of “beliefs, values, attitudes, perceptions, competencies, and patterns of behavior that determine the organization’s commitment to quality and patient safety.” We also talked about a “just culture” where individual blame is minimized or removed, and the focus is placed on the faults in the system that led to the adverse events. Another important component of safety culture is psychological safety or the belief one will not be punished for making an error or speaking up. Just culture and psychological safety are vital ingredients in the recipe for creating a safety culture. Then, if we step back a little bit to look at the organizational culture, it is easy to see that this must include safety culture and a healthy work environment for its health care workers in order to be a place that provides safer patient care.

Now, we get to the big question on the show today. What are the key attributes of effective leaders? The authors highlight four: Effective communication, collaboration, experience, and adaptability. Check out Table 1 in the article for a list of the key attributes. I will include this in the show notes as well. Let’s go through it now.

First up, we have effective communication which includes being able to clearly articulate goals and objectives as well as being open to constructive criticism and feedback. This helps everyone in the organization to know what is expected, valued, and appreciated with clear goals to help everyone stay focused, track progress over time, and respond to challenges when they arise. Part of this attribute is regularly reviewing the organizations mission objectives with all stakeholders from frontline clinicians to senior faculty to help avoid miscommunication and continue to work towards the intended goals. Leaders who possess this attribute are able to receive and respond to constructive criticism and feedback with their team members unafraid of retaliation or humiliation just for speaking up.

Next up, we have collaboration which includes fostering a culture of teamwork and camaraderie and being inclusive and nurturing. Leaders with this attribute must have a positive attitude, take pride in the accomplishments of their team members, and nurture skill for further development so that the entire team is aligned with a common goal. The authors provide an example of collaborative teamwork with the sharing of important data metrics since clinicians are more likely to be compliant with workplace objectives when they understand why they need to do it.

The third key attribute of an effective leader is experience. This is someone with adequate experience so that they are comfortable and confident in their decision making and are able to maintain forward thinking and the need for continuous improvement. Keep in mind that not every experienced leader will be effective. In addition, inexperienced leaders may hesitate or be indecisive and this can have negative downstream effects leading to confusion or exhaustion for the rest of the employees. This is where professional development and leadership training can help high-potential individuals to gain experience and knowledge. Did you know that between 38-50% of new leaders fail within their first 18 months according to the Center for Creative Leadership? If you are a new leader, it is important to use good leadership strategies to motivate your team. These strategies may include openness to feedback, regular check-ins, and recognizing signs of failure.

The fourth trait is adaptability. Adaptable leaders are able to implement creative work strategies to streamline care and maximize efficiencies, be a good steward of resources, and strive to improve processes. This attribute is critical in the face of increasing pressure from organizational and third-party stakeholders to meet metrics and increase productivity translating into longer work hours and increased expectations. Longer employee work hours come at the cost of increased fatigue, poor mood, poor recovery from work, a 40% increased risk for coronary artery disease, and higher rates of depression and anxiety disorders. There is data to support these findings from the National Institute for Occupational Safety and Health that identifies shift work and work-related sleep loss as a workplace hazard. This organization has developed the National Occupational Research Agenda for Healthcare and Social Assistance with the goal to minimize excessive workload and other factors associated with fatigue. Adaptable and creative leaders will be able to utilize advances in information technology, electronic medical records, and machine learning to improve healthcare processes and streamline care to ensure that increased productivity demands does not lead to increased workload.

As we wrap up for the show today, the authors provide us with a call to action that effective leadership in medicine is necessary to promote patient safety. Obstacles, such as increased frustration, communication breakdown, and potential errors, may be managed and overcome by effective leaders with forward thinking, regular check ins, and taking appropriate corrective action when needed to accomplish organizational goals and keep patients safe.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

Did you know that the APSF has a YouTube Channel? That’s right. It is a great resource for conference recaps and practice updates! I will include a link in the show notes. We hope that you will subscribe to the Anesthesia Patient Safety YouTube Channel and share it with your colleagues, friends, and family as we continue to work towards improved patient safety. Almost 700 people have subscribed already, so what are you waiting for!!

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2023, The Anesthesia Patient Safety Foundation