Charlene was a nurse in the Labor and Delivery Department of a large metropolitan medical center. The hospital had the highest Cesarean Section rate in their state, which was the source of some rather large headlines and an embarrassment to the hospital. It was also the source of millions of dollars in costs. The Board of Directors and hospital management commissioned a team to solve this problem. Working with the team of doctors, nurses, and other healthcare professionals to reduce the number of unnecessary Cesarean Section surgeries was one of the high points of Charlene’s professional career.
As a dedicated nurse, Charlene saw the benefit to the patients. Sure, there was the cost aspect, a C-Section cost thousands more than normal delivery. But there was increased risk to the patients too. While seldom fatal, C-Sections were still surgeries and complications were not uncommon. And the last thing a new mom needed was to be incapacitated or hospitalized.
Some literature showed that other hospitals experienced a decline in C-Sections when they used Doulas. A Doula is a trained professional who works with the prospective parents before the delivery, and helps them when in the hospital having the baby. The theory was that many moms-to-be panicked when labor got tough and demanded C-Sections to get it over with. The Doula’s assurance and emotional support helped such moms go through with a normal delivery. But research papers can only tell so much. When the team asked for volunteers to research the matter further by visiting hospitals that used Doulas, Charlene jumped at the chance.
When the team told management of their idea, the reception was lukewarm. The idea of Doulas rubbed the Head of Nursing the wrong way. Her nurses would resent having another person around, suspecting that the Doula might interfere with them and the doctors. Months dragged by without approval for funding the trip. Finally, Charlene decided to take matters into her own hands. Using vacation time, and at her own expense, she arranged visits with several hospitals.
When Charlene returned she was overflowing with excitement. The Doula idea worked wonderfully! In addition to the reduced C-Sections, there were all sorts of other benefits, such as increased patient satisfaction, better pre-natal and post-natal results, and so on. As the consultant to the C-Section Team, I helped Charlene put together a presentation of her findings. Charlene’s excitement proved contagious. The other team members left the meeting nearly as enthused as she was about the idea. While it wouldn’t, by itself, solve the problem of unnecessary C-Sections, it would put a pretty good dent in it. Several team members took action items to follow up on.
A few days later I received a phone call from Charlene. She was nearly in tears. The Doula project was off, and she had been severely chastened by her supervisor for making the presentation to the C-Section team without going through the proper channels. I phoned the supervisor, who told me that the pressure to stop Charlene had come from several sources. Charlene had violated hospital etiquette, if not procedures, in several ways. Many of the nurses viewed her self-financed trip as arrogant, and perhaps even a desertion of her post. In their enthusiasm, the team members had spread the word of Charlene’s presentation far and wide. To their embarrassment the Head of Nursing and Medical Director heard about it through third parties and were unable to answer questions about her proposal.
Charlene’s reward for her expenditure of time, energy, and money was to find her job in jeopardy. The pressure continued for weeks. Finally, Charlene applied for and accepted a job at another hospital where she is being allowed to pursue the Doula project. The original hospital’s low energy system of management was not able to handle the human energy of a dynamic quality improvement team or a dynamic and enthusiastic individual.
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