Dr. Becher, how exactly would you define a perinatal team?
The perinatal team is an extensive, interconnected network of professionals from different specialties, backgrounds and even geographical locations who have roles which may be distinct but which commonly converge on achieving the best outcomes for women and their babies. However despite this common goal, differing priorities, management structures and professional responsibilities can impact the perinatal team culture.
In your symposium talk, the line that really stayed with attendees was: “Culture eats strategy for breakfast.”
Yes. This quote, attributed to the business guru Peter Drucker, means that the culture of an organization, the shared beliefs, values and behaviors, has a stronger influence on success than strategy alone.
What does this mean in the context of perinatal care?
The first step is to define the goals of the team you wish to build: what is your current performance, what do you want to achieve, how aspirational do you want to be? The answers to these questions will help to build your improvement strategy. It is also equally important to understand the culture within your team as this is crucial to success. This information can be gathered through staff culture surveys, trainee surveys, parent feedback, staff focus groups, learning from adverse events, and performance in perinatal optimization metrics.
Who are the key stakeholders, who needs to be on board first?
Optimizing preterm outcomes takes many members of staff across different teams and sometimes across different hospitals. While it is essential to have neonatologists, neonatal nurses, midwives, obstetricians and anesthetists working towards a shared goal, we must not forget the essential role that other staff can have in promoting a healthy culture. These staff may include domestic staff, ward administrative staff, allied health professionals. Having an inclusive culture in your improvement efforts helps all the team to get behind projects and support each other even where the work is challenging.
Everyone in perinatal care ultimately wants the same thing—healthy mothers and healthy babies. Why, in your view, is interdisciplinary or multidisciplinary teamwork still so challenging?
The goal of healthy mothers and healthy babies is undoubtedly one we all want to embrace. However, the realization of that goal can be months in the future and many frontline staff may never be aware if this goal is achieved or not. Instead, team members often require goals which are more immediate and meaningful. These often take the form of ‘process measures’ rather than higher level ‘outcome measures’. Process measures might include, for example, expressing within the first 2 hours after birth, or enabling delayed cord clamping for 2 minutes or more. Goals such as these are more tangible for frontline staff who may invest considerable time and energy to making them happen and are more rewarded by immediate results.
Not everyone works on the frontline in the same manner. How do you ensure each team member knows their role, in the bigger picture?
Indeed, having more specific goals can impact one staff group more compared to another. For example, expressing breast milk within the first two hours may not be a priority for community midwives, who may see their role in supporting mothers after discharge—this can lead to disengagement. A challenge is to make these staff groups understand their contribution, even where it is not obvious. For example midwives in the community can help in an early expressing goal by ensuring preparation of mothers before birth, such as providing information about the benefits of breast milk and demonstrating expressing techniques. In this way collaboration becomes more natural.
What is the greatest challenge when starting on this journey?
The greatest challenge is staying positive in the face of little or slow progress. Most professionals in the field of quality improvement are enthusiastic clinicians who have attributes of flexibility, adaptiveness to change and innovation. This has to be carefully balanced against teams who may have many justifiable reasons for not wishing to change. Understanding these reasons is key to engagement and progress. Those leading in culture change can find it supportive to share their difficulties with other leaders.
Changing a team’s culture takes time, yet quality improvement projects often demand visible results in the short or medium term. How can teams balance these two timelines?
It is important to realize that poor performance in a quality improvement metric is more frequently due to cultural issues than the change idea. All too often interventions are modified repeatedly in order to achieve compliance, when elements of poor culture are hindering success. Performance in our quality improvement goals can help to highlight where culture needs to be improved. For example, a unit may have a very high ‘early expressing rate’ but a very low ‘breast milk on discharge rate’. Knowing this, helps to focus efforts on improving the supportive culture within neonatal units and in the community, rather than in the delivery suite where it is likely that culture around early breast milk is good. Therefore cultural change can, and often does, occur in parallel to QI efforts.
How can leaders keep teams motivated when progress is not immediately visible?
Firstly, focus on small successes. This might be the fact that while 5 patients in one month did not receive antenatal magnesium, one patient did. Focus on the excellent practice that occurred in this case. Personal feedback helps to grow champions who spread the word through their peers. Secondly, actively seek the barriers to progress by speaking to teams on the frontline. As change scientists we often make the mistake of implementing change ideas that have not been seen or trialed by staff. Seek to understand these viewpoints, staff feel valued when their opinion is sought.
Join us on April 28 for an inspiring webinar with Julie‑Clare Becher!
Discover how effective teamwork, shared goals, and positive communication can transform perinatal optimization efforts.
📅 April 28
⏰ 9:00 AM (USA) | 3:00 PM (CEST)
👉 Register here
