Transforming Maternal Care: How Leadership, Technology, and Collaboration Are Shaping the Future of Women’s Health

<p>hello everyone this is Cole from the American Journal of healthc care strategy really special guest today who's going to talk about an important topic uh Cassandra Cassandra can you please introduce yourself and give us a little bit of information about your background absolutely well I'm Cassandra stomo and I have been a labor and delivery nurse for the majority of my nursing career which has been um a little over 24 years um I got into leadership about six years ago five six years ago um and been in different leadership roles with the majority of my lead leadership has been within Women's and Children's Services um that's that's that's a high level I guess overview um of course about me and and what I've come [Music] from and then now you're you're doing leadership and you're doing consulting and you've you've kind of become uh you know taking these Frontline skills and then also applying these business and strategy skills to it what caused you to make that transition um I have to I'll go way back and um as a bedside labor and delivery nurse um there was all kinds of times where people would come to me as a natural leader um on the floor within the unit and just you know talk to me about different things whether it was niku things postpartum things anything really um and want me to kind of step forward um to bring those to upper management um and with that being said I would come home from the hospital working my shifts and say you know this is what's going on to my husband and he would be like well he'd listen for a long time and then finally I think he said to me well it's time to put up or shut up and you can either go back and get your Masters and try to do something different and make a difference or or you going to continue to do what you're doing at the bedside knowing that leadership will potentially you're not going to have a whole lot of say in it um with that being said rolled that fall in in in to get I was at an ASN I had my associates I do have a psychology degree um that I had initially um but yeah I went back to school with two kids in school three actually all four of our kids we have four kids um from yeah nine years 10 years apart kind of thing from B from the oldest to the baby and I decided it was time for me to go back to school to see if I can make a difference um and so here I sit um many years later um a lot of lessons learned a lot of different educational things that I've taken away from other leaders both good and bad um to to kind of bring that transition different kind of leadership um to the floor absolutely and and we're we're so happy that you did go back to school and uh and be a leader because you're able to help educate us on some of these really impressing uh you know really important and very pressing issues and I think that's kind of the first question I just want to ask is you know from from my perspective the two issues that stick out are the cost people are really upset about the cost of of this because it's so expensive to have a child in the United States and then the other issue uh is this disparities right we have different sections of the city different sections of the country races and and income status that have very different outcomes when it comes to Maternal Fetal health so from where do you sit on that what are kind of the biggest issues is there any that I left out that come to mind there's a there's a lot to unpack there um with those two even those two basic um there and and a lot of concerns come from you know that um we can start with disparities um when it comes to those those kind and there's many many different kinds um obviously we have you just talked about socioeconomic you also talked about racial I mean there's just a whole lot um that factor into that um the the biggest thing and I guess the first step that I have seen and that I have helped Implement as I do my Consulting is looking at it everybody has to kind of realize that there there are these implicit biases that we have you don't mean to have them it's just they are just there um and so recognizing that there are differences right there are differences within um culture there's differences with I mean we have a lot of different nationalities and cultures in the United States We Are The Melting Pot um and we need to be recognize where we stand with those um and especially in labor and delivery there's a lot of different things that you're trying to do and you know patient arrives and if they're not speaking English then we need to get that we need to recognize that we need to get an interpreter like we need to have that we need to address that um and being a lot of hospitals are moving towards I not all but the majority of them are moving towards having annual competencies in these different biases that we have um and making sure there's a difference even within the hospital not just there's a difference between a labor and delivery patient and a med surge patient when it comes to those biases so we have to recognize that and educate and make sure that we're doing that um on an annual basis and when we see something um if if a coworker you see some kind of bias there we need to address that in the moment because we do need to make sure that we're taking care of our our the complete patient mom baby family as well um when it comes that's that's just the the tip of the iceberg right there's so many different things that kind of go with that one of the main focuses now um is surrounding depression and postpartum depression and what that looks like and how do we address those kinds of issues within um the pregnant postpartum patient um a lot of this is education within not only the labor and delivery staff but also including the family um and having that they see that patients every single day they're they're having that discussion with them and we need to make sure that we're addressing that and recognizing it there's no shame in having postpartum depression there's no shame in having any kind of mental health issue in general um but we need to make sure that we're opening up and the lines of communication so that we can address those and take care of our patients holistically when it comes to that stuff and that includes doing it they have started we have started doing postpartum depression scale screening prenatally we do it at delivery um they do it postpartum as well so these are all questions that are being asked prenatally the first time you come to a present to the hospital whether it's for a triage or for an induction or just active labor but also postpartum most of these um followup conversations regarding postpartum depression are not generally focused around sorry that was my phone going off um not not recognizing um that it's not always handled within the prenatal or the postpartum um OBGYN visits they are finding that a lot of these are being handled um when they the mom goes to their pediatricians because they're having more frequent conversations with those you know new baby checkups no well baby checkups that the pediatricians are seeing these moms and these family members more often and so they can start addressing what that looks like um at those visits so that's that's a lot that like I said to impact there that that seems like a very important program right because we've known and that that's another issue that I I didn't uh think of too is that the postpartum depression and mental health especially women's mental health in this country of course as we know it's been neglected for so long and it makes sense that that flows into U maternal mental health and so I I think one of the questions is how did you is there any techniques you use to actually Implement that program you know as an early careerist it seems like implementing a program like that would be very challenging um and as a consultant any advice on how to implement these programs at at institutions I think that there's a again opening lines of communication right um we don't need to reinvent the wheel there's there's hospitals across the United States that I have either worked in or a consultant in that you don't have to you bringing bringing these forward and talking about these with upper leadership is is really being it's it's a patient safety Focus right we need to make sure that we're doing what's best for our patients and and our staff and so how do we take care of everybody um across the board and so you don't need to reinvent the wheel it's a matter of reaching out and saying to another hospital local hospital um sister hospitals right what have you seen what are you doing how do how have you addressed this issue here and if you don't have that connection it's trying to find you know reaching out and saying okay I need some help in this area um again no shame in asking for help because if again no we're not trying to reinvent the wheel if something is working in the state of New York you know what can we do in California or the state of Washington how do we build that to be um similar maybe not the same because you have different states different laws different things there codes and what they need to do but how can you use that same information to build what you have um and that's kind of where it takes and again it's opening communication between your pediatricians um your obgym providers you have social workers um within the hospitals bringing everybody together to understand that this is what's going on and how they do it and what needs to happen with that one of the questions I have on that note is how do you stay up todate how do you stay in contact with all these organizations like you said that collaboration that knowledge sharing is important but that seems very time consuming is this where you're where you know as a consultant you're spending a lot of your your time is gathering this knowledge um some of it yes but the other part of it is you know Women's and Children's Services as a whole that we have that National prr Awan is is our governing you know that we look at they have their guidelines and they have their standards so it's almost like a One-Stop shop sometimes that you can go in there and you can look up you know what what are they doing what and that can maybe start the ball rolling to kind of see what's going on across the entire whether it's United States most of I want I want is global but at the same time this is the what we focus on within the the lower 48 50 states that we have they they give you you know these recommendations the most upto-date research this is where you're finding your evidence-based practice and then you're trying to bring that information so you don't have to go searching all over the place you can bring that same knowledge back and maybe start the ball ruling with the providers and knowing what they have and what they see and what they're doing and what they look what what they're seeing when they have have those postpartum or the pr the Pediatric well child checkups what are you seeing how can we do a better job when it comes to our patients as a whole really great advice that's important and so we talked about how having The Interpreter Services is essential monitoring for postpartum depression and then it comes to kind of the question surrounding patient experience so we know a lot of people are looking to have elevated patient experiences especially during that extremely stressful time uh and so how do we what strategies are you implementing or have you seen that as successful to try to really Elevate that that experience that kind of fit in with a lot of the technologies that we're implementing today yeah so technology wise I mean we'll be honest I'll be honest everybody that and anybody probably who's listening is Healthcare wise everything changed with covid right everything changed um the way we see Healthcare the way we deliver Healthcare all of that technology um that we didn't always use on a regular basis became very um important during covid because we had a lot of people that did not want to go to the hospital we had people that did not want to go to you know their doctor's appointments because they were too scared of what that would look like right and what they would be exposing themselves and as a pregnant mother what what are you exposing yourself to you know when you're going to the doctor you know you don't you're not really sure so with covid um it brought about a lot of different changes you know we are looking at how are we using and and using our technology to um reach some really remote places people you know are able to usually you have your cell phones most people have a cell phone now so using that technology or a computer whatever they have to have those doctor's visits you don't that tella health is huge across the board you know how can we um how can we keep in contact with our patients when they need to be seen so it's not a barrier it's not a hindrance to getting prenatal care or postpartum Pediatric Care down the road what does that look like the other part of that is you have this tele medicine if you've got somebody who is very high risk You' got you know severe hypertension you've got um gestational diabetes you have all of those kinds of um Specialists that the the per the patient may or may not be able to get to all of those appointments you know because of different reasons social determinance that they have whatever that looks like so how can we bring that patient in contact with them and that's where our tella Health you know we have lots of times um technology is is wonderful where we have gestational diabetes that can be monitored from afar and a central like location can see that a mom has taken a blood sugar um a gestational diabetic mom can have a blood sugar that is way out of range high or low and that person immediately knows that that in that Center in that centralized um call center that something is going on and so they the you know their policy maybe to to recheck a blood sugar and you know take and eat something and recheck or recheck your blood sugar after you've you know given yourself some insulin and follow back if it's still out of range then there's a contact there's a phone call there's a like how are you doing do we need to have you go to the doctor do we need to have you go the emergency room where do we need to stand but that technology has allowed people to have exponentially different experiences with different providers to make sure that they're getting the best care across the board it's also with that same thing with electronic field not field monitoring but um the medical record different providers can actually see and doent so there's not that gap of I need to get my medical record from physician a to take it to physician B who then may send me to physician C you're not trying as a as a patient to to collect all of that and take it in as long as we're able to share and if they have the similar um medical records they can see each other's you know their notes so that this patient who who's probably highrisk like I said seeing different Physicians they don't have one more thing to take and remember or to take care of that's so important because there's a lot of people that are you're dealing with when you're pregnant right it's not just you're one doctor you now you have a ton of people well and then when you come into the hospital there's other I mean we have you know it used to be back in the day when I first started we had you were hooked up to the monitors and you were connected to a machine right you you were connected to that you're watching contractions you're walking watching the fetal monitoring um the the heart rate and when a patient had to get up to go to use the bathroom if they had they were sitting to get an epidural you fighting with the cords nowadays they have wireless ones on that you can walk patients can walk around the room with this great technology and the baby can be monitored as they're doing they're sitting on a birthing ball you know rocking in a chair um Walking The Halls if they have enough technology that gets it Wireless throughout the the hallways those kinds of things so we're not losing data knowing if our baby is doing okay and how Mom's doing but we it it but you're not worried about the cords and you're not worried about all of what the interaction and the the the barriers to having that patient have the experience of they want to have right and so that clearly would create a much kind of elevated patient experience compared to to the traditional you know the wiring and also that flows into the tele medicine you know being able to access the Specialists really high quality Care being able to not have to worry as much about your blood sugar because it's being monitored I mean those things are are excellent one of the concerns that might be presented though is when it comes to to budgeting and prioritization and this also goes into best practices so when we're looking at some of these rural hospitals or Hospital who um might have had some some financial problems they haven't been advancing at the same rate when it comes to choosing what to invest in what are some of the priorities as far as best practices go that really need to be emphasized when caring for you know these these new parents um I always I always go back to patient safety you know that's where you you know when you're looking at different Technologies you're looking at different systems how can we deliver the best care the safe evidence-based practice care that is the safest and you are absolutely correct these things technology is not cheap right you know everything comes down to that bottom line and hospitals after covid have struggled we've heard about them um the struggle you know meeting the expectations doing more the the staff and you know Physicians and providers clinical team doing more with less right we're we're trying to make sure that we're and and so it's it's a challenge and so I always take take try to take a step back especially with Consulting and saying Hey listen what do our budget look like and and these are the top safety things like we have you know can can you continue to fetal monitor without having Wireless absolutely um can you you know your medical record do you need to update it maybe get by the latest version so that we have more Universal generalized across the board within that whatever Health System organization that they have the same medical record so that we can do that maybe just that again comes down to the numbers um but then it is tele medicine is huge I would say that's probably where I would start just because if you can connect the patients with the not only the prenatal your OBGYN but you've got any other um Consulting aspects that this patient may need um that's going to be able to deliver quality high quality patient care patient safety and you're going to have a mom who while they may be rural will'll have a better experience we'll come in with better prenatal records so that we can then take and know the bigger picture when we're delivering them and taking care of them postpartum does that increase the catchment area a lot then by enabling that that tele medicine service yeah yeah I think that it it gives you I mean you can reach a lot of me I'm in a hospital right now that is very small but it it's servicing the whole you know the whole County and Beyond so having to drive you know an hour and a half to two hours for a 30 minute doctor's appointment is or 45 minute doctor's appointment what that's a lot to ask a mom even a firsttime mom mom with children are even it's even more of a struggle because you're trying to Wrangle all those little ones and get them in the car and get to the doctor and if you have the ability to have a conversation like we are right now it makes it so much better um the patient feels like they're getting that care that they need and they want all moms want to do what's best for their babies you know they want a healthy baby and so taking that off of their plate is huge I appreciate that advice because it I also think about how that could impact um social determinance of Health right because transits an issue um you know a lot of these these you know student to be mothers are still working right um and so that's also thing have you seen in your experience where the tele medicine has has of course increased catchment but has also reduced some of those kind of mortality you know factors in terms of sdoh yeah absolutely I will tell you though um social determinance of Health in general they it is obviously something that we are monitoring and every hospital should be looking at when people arrive to the is it done 100% of the time no it but it is increasing and so getting everybody on the same page and making sure that we're addressing all of those social determinant right that are going to impact this patient as a whole and trying to to handle all of that and help them manage that is is is it's not new but it's evolving it's continuing to evolve and what that looks like um now repeat the question cool because I was like going down another rabbit hole with with social determinant do I see that it's the catch like the the net that we're throwing is capturing and it's it's giving us better outcomes yeah is is the kind of the tele medicine approach you know we know that it's increasing the catchment area it's capturing rural areas it's capturing individuals who might not have been Capt which is great at the same time though is it also helping us to reduce some of these barriers yeah and what we're seeing um hospitals are obviously looking at different kind of um metrics and benchmarks right across the board um we're looking at you know are we seeing any kind of different um shift with our newborns you know are we having more complications that is causing these rural hospitals who maybe have an a nursery level one that they're not having to um transfer um or transport pay that is not that because of moms having this tele medicine being able to have those consults being able to have that connection with a provider or again like we were talking about with gational diabetes having a call center who can actually relay and say Hey listen what's going on with your blood sugar kind of thing in the moment you're seeing that we're having healthier pregnancies we're having less transports out we're having Le you know those little hospitals are able to keep mom and baby together so that we're not having one in one hospital and one in another um it's again evolving and it's still like trying to be or trying to capture that data as it continues to to to it's like a moving Target right things are changing so fast when sometimes with technology that you can't always keep up as to what's causing what to be a better outcome and so obviously addressing these um in the moment is huge and as as giving us better outcomes as a whole on the note of moving targets I'll ask you the final question um and that's comes down to policy right so we have these technologies that we're having to adjust like you just mentioned um so we always are keeping an eye on the mentality rates on the complication rates but then you have this kind of added Financial business layer which is government policy that then changes how the finances work but in some instances we've seen it can actually impact doctors and how they practice how are you able to prepare for policy changes any tips in that area um again I think that for me um in the experience that I've had is it really is opening up communication right and and having being transparent looking at providers and and I mean I work very closely um in my practice as with Revenue Integrity I'm looking at Finance I'm looking at providers and having that conversation open discussions about the what they're seeing and what we're doing and how we can marry that together with the care that we're giving I'm also I'm very transparent with my staff um no matter where I'm at because I want want them to understand that you know hospitals are a business right providers there's a business there there's that the bottom line I should say the bottom line patient safe patient care is really where our bottom line but money does rule the world and money does Drive hospitals and organizations in general so how do we open up that communication to be transparent and to be able to say this is what we're seeing whether it comes to insurance companies um H you know federal state all of those those um policies that come down how is all of that impacting this and everybody's an individual so what I get and what you get and what whoever is listening to this get it's all individualized to a certain extent and so when somebody comes in for labor and delivery we have we have a range of which how we're doing this and handling that I really look at and it's one of the first things I do is Hospital productivity within the women Services area and see where we're at like I said reaching out to our Revenue Integrity what what are we able to do how are we what's going on behind the scenes so that I can understand the bigger picture of what the unit what the hospitals is facing when it comes to these policies it can be tricky I'll be honest every state has a little bit of different stuff right even things are coming down you have to be able to move and adjust um that's probably one of the biggest struggles I would say just because it's not Universal every every state has something different so diving into that State's issues and and that state policies and there and what the standard of care is and what the scope of practice is and and what does that all Impact and how does different insurances impact that state um it it can be a moving again a moving Target but again it's opening up the conversation you know there's a lot of people that are going home since covid I would say the beginning of it was in covid most of our maternal um patients our our postpartum patients are going home at that 24hour Mark because when Co nobody want again nobody wanted to be in the hospital and now they're finding that you know going home at 24 hours if everybody is is healthy and it's a good idea to discharge and it's not you know 11:30 at night we're trying to send a new mom home that might that's you know you have to look at that and see what that looks like obviously you know the the the goal is always safe patient care so you know getting those patients who want to go home they don't want to be in the hospital you know even a new mom she's getting the care that she needs but she doesn't want want to stay there she's more comfortable in her own environment with her family and her friends around right so she so having that and having that conversation we're trying to do what's best for everybody involved and making sure that we're doing that with safe discharges with both mom and baby that does help the bottom line you know doing it if if that means in one state that it's a bucket of money and it doesn't matter if you discharge at 24 hours or you know three days later basically what does that look like and how much revenue is coming in there's other you know states that I've been in where it's not it's a you know the patient comes home is there and they're um one day and if they stay the next day and it's it's that's the way that that needs to be that they don't want to be discharged right away and insurance is going to pay for two days for a vaginal delivery and potentially three days for a C-section then what what's the best there you know I mean it's not just always a bucket it's a sometimes it's day by day you know posttop post day delivery One Two Three or is it a bucket kind of thing which is nice because you know I I obviously we talked about earlier I'm married and my husband was a insurance attorney so I have lots of conversations that he we and we talk about the different nuances of that which is I will say credit to myself because I get to have that knowledge right there so when I come home asking questions about different Insurance things and what that looks like it's huge for me to be able to to bounce things off of him with that aspect so that's something that that's you know not not everybody has but I I am very thankful that I do absolutely and we can tell from this conversation that you're extremely knowledgeable in this area and also that does make sense on the policy end too where you get some of that added information from because it it's complicated and so we've we' kind of you've done well I think we've discussed the technology implementation and how that works and then also that last piece on um you know the the kind of the big challenges of the way that different states you know organize their their budgeting I think that overall one of the biggest themes though and correct me if I'm wrong is that communication and collaboration throughout the entire organization is the most important thing uh probably just below patient safety yeah I mean and honestly it goes almost hand in hand because if you are opening communication right across the board and everybody has the same focus of safe patient care and the patient's best experience um then it drives that patient safety you know you and and so having that and as a leader one of the things is I don't have to always be right it's not always my idea it's not I know I always think that the Moree heads are better the Moree heads that are thinking about a certain project policy whatever it happens to be you got different areas of specialty that come into that and so then you're focusing on everybody coming together for that to to to provide the best policy that's going to bring in all of those aspects right and then you put forth what addresses all of those things and so having that yeah communication and transparency is is really really key I believe um and it's something that I've used everywhere that I go um to be transparent and and there's nothing wrong with saying you know I I that was my idea didn't work very well let's try that one again kind of thing let's let's reorganize and you know what part of this went well what part of it do did we need to you know make shift on whether it's a complete shift or or you know just a a Moder minor little week to something absolutely yeah they kind of go hand inand very very good advice Cassandra thank you so much for coming on the podcast we hope we can have you on again in the future uh of course we're going to have the links in the description and whatnot but uh yeah please uh you know you're our do is always open to have you very knowledgeable and great amount of information so thank you again well thank you for having me at any time</p>