BIRTHING QUALITY: A GRANT PROPOSAL FOR A GROUNDED THEORY STUDY OF CLINICAL EXCELLENCE Pubblico

Abstract

ABSTRACT
The overarching purpose of this research project is to develop a theory of how clinical excellence is generated and maintained in a Birth Center long recognized for its quality of care and excellent outcomes, specifically their low cesearean section rate. The proposed research is, in essence, seeking to "deconstruct" or "reverse engineer" the successful system at Sutter Davis Hospital in Davis, California. The specific outcome of interest in this study is the primary cesarean section rate - that is, the proportion of live births delivered by Cesarean section to mothers with no previous history of a Cesarean section, since a cesarean section represents failure to achieve a "normal, i.e., physiologic" birth. The ultimate goal is to understand the system, its context and contributors with the hope that this knowledge could be applied in other sites; and by so doing provide an opportunity to make major inroads into the "cesarean epidemic" that is impairing the short- and long-term health of women and babies, and unnecessarily depleting the scarce resources of the American medical system.

The proposed project is a case study of the Sutter Davis Midwifery Service (SDH), which is comprised of a public and private arm, both of which have contractual back-up from the same five obstetricians. In this study the whole "service" is considered the case. This will be a "key informant" study, although the definition of key informant will be very broad. The time required to do the study, as indicated in the timetable below, is a reflection of the large number of interviews anticipated.

The grounded theory analysis will be done using the constant comparative method in the computer program MAXQDA.

Table of Contents

TABLE OF CONTENTS
AWHONN FACE PAGE...1
BIOSKETCH...2
ABSTRACT...6
TABLE OF CONTENTS...7
BUDGET...9
NARRATIVE...12

Problem Statement/Specific Aims...12

Research questions...13

Background and Significance...13

Rationale/framework...16
Research Design and Methods...17

REFERENCES...22
APPENDIX A. Figures...25

Figure 1. Conceptual Framework Example: Critical Success Factors from Ontario Project...25
Figure 2. Failure Mode Effects Analysis...26
Figure 3. Conceptual Framework for Focus of Root Cause Analysis...27
Figure 4. Example of RCA/Ishikawa "fish bone" Diagram...27

APPENDIX B. Solicitation of Letters of Support...29
APPENDIX C. Sample Site Permission Letter...32
APPENDIX D. Recruitment Bulletin...33
APPENDIX E. Consent...34
APPENDIX F. Instrument: Guiding Questions for Clinical Interviews...37

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Nursing Health Sciences, Public Health
Parola chiave	midwifery qualitative research cesarean collaborative model normal birth
Committee Chair / Thesis Advisor	Osburne MD, MPH, Robert, Emory University
Committee Members	Jay, PhD, RN, Susan Schaeffer, private consultant
Partnering Agencies	Does not apply (no collaborating organization)

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