Tuesday, October 11, 2011

A Few Reasons Why Occupying a Hospital Won't Change Policies & Procedures

Several days ago I posted this on my Facebook page:

"What if we 'occupied' hospital parking lots?  Would that facilitate policy and procedure change?"

Several people, within just a few minutes, were ready to paint signs and begin the sit-in.  I was very surprised at the response, yet have since realized that it is through the frustration of years of "telling the truth" that this must have been a visceral response.

Occupying any location in a hospital or near a hospital for the purpose of facilitating policy and procedural change would be folly.  Why?  If you have ever worked in any type of business and tried to facilitate change, then you already know that change does not happen because someone is protesting or beating the door while yelling "you must change because we said so".

As with most change, it happens sssslllooowwwlllyyy.  It happens because more and more become educated that the "way we've always done it" is no longer desirable, gets the desired responses or is no longer useful.  It is difficult because we are creatures of habit and typically multitask - so habit enables multitaking.

Change also happens from the top of the pile.  Hospitally speaking, it happens when nurse managers, directors of nurses, administrators and the finance people all realize that this change will impact their numbers.  Yes, it is a numbers issue.  And who impacts the numbers most of all?  THE CONSUMER.

But unlike when this happened back in the 1970s, the consumer cannot take the larger responsibility of informing the professional that excessive intervention rates and unfathomable cesarean rates hurt mothers and babies rather than help them.  Exposing the facts from the CDC and World Health Organization about the maternal morbidity/mortality rates and infant morbidity/mortality rates is paramount in bringing about change.  Getting this information to the top, to those nurse managers, directors of nurses, administrators and yes, even the finance people is paramount.  While the the finance people may see early preterm births as revenue from the added intervention (cost) and admission into the NICU (cost) as a benefit, we need to also inform the consumer that professional who pay the bills on the very backs of the healthy consumers must be informed and educated.  And ultimately, stopped.

In a state of economy as this country (the US) is currently experiencing, all are conscious about keeping their jobs.  L/D nurses and childbirth educators are not excluded.  But it is beyond my personal thinking that especially these two groups of which I am a part of both, can continue to protect their jobs and not tell the absolute truth about the hazards of induction/medication for labor and the risks/benefits about intervention (especially cesareans).  This is called teaching informed consent and I thought it was the foundation of every childbirth education certification program.

But perhaps, as childbirth educators and nurses, need to go back and look at why we chose this profession?  At least for myself as a nurse, I chose nursing to take care of people and get them (in obstetrics) from one state of health to the next.  As a childbirth educator, the choice was similar but instead of me caring for them, I wanted them to become active in their own health care and make the choices that are best for them.

So what is the answer?  If we advocate for change from the "top" (directors/administrators) as well as from the "bottom" (parents), just as we did in the 70s, then there will be an educational squeeze play and change will occur.  Rational behavior with a side order of evidence based information, referenced to the hilt is the order of the day.  Every professional organization should talk about it.  We must insist that The Joint Commission and Magnet Recognition change/add to their definitions of quality by insisting on evidence-based best practice.

And as childbirth educators, we need to present information in the complete risk/benefit style that we all know is best practice.  We need to be bold, be true and be educated ourselves.  Our classes can still be exciting and enriching without being overly humorous (portraying to parents that childbirth is something funny) or aggressive.

This is serious business.  And we are only contributing to the statistical nightmare if we don't ramp up best practice now.


Kimmelin Hull said...

Excellent, excellent post, Connie! I couldn't agree more...changing the landscape of birth in our country needs to happen at multiple levels in a consistent, evidence-based fashion.

Hillary said...

Just stumbled upon this blog via facebook and really enjoyed this post. When we were organizing for state legislative change for midwifery in New York we were constantly coming across the instantly activated (and passionate!) groups who wanted to go "occupy" a public space with inflammatory signs etc. What I learned along the journey is that it takes movement from a variety of people/roles. There is a place for rabble rousing, but then there needs to be the peacemakers who swoop in and are able and willing to compromise. There needs to be folks working on the the inside of institutions to lend a trusted voice/opinion/experience when needed. There needs to be skilled educators and birth professionals helping to guide consumers into effective action. What most surprised me in community organizing was that all the different parts didn't always agree or work together so well. In my ideal eyes I thought when you were on the same side you were on the same side. Someone shared a story about how we look back and glorify the Civil Rights movement but in reality there was a lot of discourse between separate leaders and groups within that movement. It make sense.

Anyways, great blog and I look forward to reading more!