Ariadne Labs

Ariadne Labs is a joint center for health systems innovation at Brigham & Women’s Hospital and the Harvard T.H. Chan School of Public Health. With a mission to save lives and reduce suffering, our vision is that health systems equitably deliver the best possible care for every patient, everywhere, every time. We use human centered design, health systems implementation science, public health expertise, and frontline clinical care experience to design, test and spread scalable systems-level solutions to some of health care’s biggest problems. From developing checklists and conversation guides to fostering international collaborations and establishing global standards of measurement, our work has been accessed in more than 165 countries, touching hundreds of millions of lives.

TeamBirth

TeamBirth is a care model that helps ensure people who are giving birth are informed about the care they are receiving, have the role they want in care decisions, and feel their input makes a difference in what happens. How does this build trustworthiness? This approach builds patients’ trust by embracing their lived experience as a key form of expertise, emphasizing clear communication among the care team and patient, alongside clinicians’ complementary knowledge and skills.

How It Works

We use a dry-erase planning board affixed to the wall that is large enough for everyone on the team to clearly see and understand–particularly the mother.

The board has four fields and any member of the team is empowered to write down:

Name and role of every team member (ie: mom, partner, nurse, obstetrician or midwife)
Mom’s preferences
Care plan
When the next assessment will occur

The board is used to organize and structure a team “huddle” or “check-in” during labor assessments. It is designed to foster psychological safety for everyone and prominently assert the preferences of the mother. Structuring the communication helps align expectations about the care being given and received.

While the process is intuitive, the actual practice makes communication more intentional and requires competency to be effective at producing trustworthy care. We train clinicians prior to implementation and provide ongoing coaching and support. We also feedback data on both clinician and patient experiences of care, as well as outcomes.

Skills and Competencies

This approach asserts their lived and embodied experience as a key form of expertise alongside the complementary knowledge and skills of the clinicians.

Origins

We originally developed TeamBirth as a way of addressing unreliable care during labor and inappropriately high cesarean rates. We invited leaders from the professions (obstetrics, maternal-fetal medicine, anesthesia, midwifery, nursing, doulas) as well as birthing people and experts in public health and design to co-produce the solution. We discovered through this process that the root cause of cesarean overuse was also the root cause of maternal morbidity and mortality, including the stark racial inequities in a broad set of maternal outcomes. This root cause is communication and teamwork, which according to the Joint Commission is a source of 80-90 percent of sentinel events.

Effectiveness

In a clinical trial, 3,924 eligible birthing people and 375 clinicians responded to surveys on their experiences receiving or providing care with TeamBirth. 95 percent of birthing people felt comfortable sharing their preferences and opinions with both their nurse and provider, and 90 percent felt that their preferences made a difference in the care they received. We observed with statistical significance that the more TeamBirth huddles a person experienced, the most likely they were to hold these beliefs.

In clinician surveys completed eight months post-launch, 90 percent of nurses, midwives, and obstetricians would definitely or probably recommend TeamBirth for use in other labor and delivery units. 93 percent of clinicians reported that the project definitely or somewhat improves care for laboring people.

Over time we have seen sustained improvements in cesarean delivery rates, unexpected newborn complications and severe maternal morbidity.

Scalability

TeamBirth is intentionally designed for scale with defined “core” components that are necessary for fidelity in any setting and “flexible” components that are necessarily adapted to local context. The feasibility of implementation was demonstrated in a Federally registered clinical trial among hundreds of clinicians and tens of thousands of birthing people at community hospitals that were thousands of miles apart on both coasts and in the heartland. TeamBirth is currently being implemented at hospitals across Washington State, Oklahoma, Massachusetts and Michigan.