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The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff

Maternal and Child Health Journal volume 20, pages 2003–2011 (2016)Cite this article

Abstract

Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was ‘average’ in complexity, with variation depending on participant’s role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.

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Acknowledgments

This project was supported by funds from the Florida Department of Health. We would like to thank all of the hospitals and multidisciplinary staff members who participated in this study for their time and willingness to share their candid experiences implementing this quality improvement initiative.

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Affiliations

  1. Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA

    Cheryl A. Vamos, Allison Cantor, Erika L. Thompson, Linda A. Detman & William M. Sappenfield

  2. The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA

    Cheryl A. Vamos, Erika L. Thompson, Linda A. Detman, Emily A. Bronson & William M. Sappenfield

  3. Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA

    Linda A. Detman, Emily A. Bronson, Annette Phelps, Judette M. Louis, John S. Curran & William M. Sappenfield

  4. Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, STC, 6th Floor, Tampa, FL, 33606, USA

    Judette M. Louis

  5. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, P.O Box 100294, Gainesville, FL, 32610, USA

    Anthony R. Gregg

  6. Faculty and Academic Affairs, USF Health, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA

    John S. Curran

Authors
  1. Cheryl A. Vamos
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  2. Allison Cantor
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  3. Erika L. Thompson
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  4. Linda A. Detman
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  5. Emily A. Bronson
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  6. Annette Phelps
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  7. Judette M. Louis
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  8. Anthony R. Gregg
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  9. John S. Curran
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  10. William M. Sappenfield
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Correspondence to Cheryl A. Vamos.

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Vamos, C.A., Cantor, A., Thompson, E.L. et al. The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff. Matern Child Health J 20, 2003–2011 (2016). https://doi.org/10.1007/s10995-016-2020-2

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  • DOI: https://doi.org/10.1007/s10995-016-2020-2

Keywords

  • Obstetric hemorrhage
  • Quality improvement
  • Implementation
  • Evaluation
  • Qualitative