Risk Management: 
Obstetrics - Risk Management Considerations
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Systems Approach to Obstetrical Care

Injuries in obstetrics often involve system failures, such as delays in response times, lack of recognition of high-risk situations, inadequate transfer of information and understaffing, just to name a few.  The multifaceted, technical environment of the hospital obstetrical unit requires a focus on reviewing systems for managing clinical risk and adverse events as well as building and sustaining a multidisciplinary team that learns, trains and communicates together to affect change and create a care model that will improve patient safety and quality of care.

One such model, The High Reliability Organization model[i], draws heavily from the work of psychologists and industry and uses a systems approach to identify cause and assists the multidisciplinary obstetrical care team to identify gaps or holes in the complex systems of the hospital environment. Using the key values and principles of High Reliability Organization systems enables the patient care team to integrate evidence-based obstetrical practice with the six key principles below:

• Safety is everyone's responsibility
• Operations are a team effort 
• Communication is highly valued
• Hierarchy disappears in an emergency
• Emergencies are rehearsed and the unexpected is practiced
• There is a multidisciplinary review of near misses

A systems approach to obstetrical care recognizes patient safety as a fundamental principle.   Achieving improved patient safety within the hospital environment requires substantive, sustained change within the clinical practice culture and care delivery systems.

In High Reliability Organizations, the patient care team relies on a practice model in which all disciplines work and learn together to create a practice community that is rich in knowledge and experience by breaking down traditional hierarchies and establishing an environment of respect, trust and continuous learning.