A national collaborative to prevent preterm birth, using Life QI

Since 2019, Women’s Healthcare Australasia (WHA), along with their sister organisation Children’s Healthcare Australia (CHA), have successfully run several collaboratives in Life QI. Topics have tackled some of the key issues in women’s and children’s healthcare in Australia, including bronchiolitis care improvement and perineal tear reduction. 

Together, the organisations themselves form a vibrant and diverse non-profit community of more than 160 women’s hospitals and maternity units, as well as 90 children’s hospitals and paediatric units across Australia and New Zealand. They are the peak bodies for hospitals providing paediatric, maternity and women’s healthcare in Australia.

In October 2021, WHA along with their partners, the Australian Preterm Birth Prevention Alliance (the Alliance) and the Institute for Healthcare Improvement (IHI), commenced their largest collaborative yet in Life QI – the Every Week Counts National Preterm Birth Prevention Collaborative.

The problem and aim

It is well recognised that preterm birth (birth before 37 weeks gestation) is the single greatest cause of perinatal mortality and morbidity with potential lifelong consequences (1).  It is also now understood that the 14-day period between 37 weeks and 39 weeks gestation, known as ‘early term’ is also critically important. In recent years, 1 in 3 Australian children were born in this 14-day window resulting in increased pressures on maternity services and potential future impacts to children in the Australian education system.

Previous, more localised, work by the project partners demonstrated successful improvement and helped confirm the seven key strategies for success (Figure 1). Whilst the signs were positive, it was recognised that a systematic and more structured approach was needed to achieve and sustain improvements of this scale, nationally.

Figure 1: The seven clinical strategies included in the Every Week Counts National Collaborative.

The Every Week Counts National Preterm Birth Prevention Collaborative was designed to build on these successes and spread improvements nationwide. The aim?

“To safely lower the rate of preterm and early term birth across the 63 participating maternity services by 20% by March 2024”

Scaling improvements

To ensure the initiative’s national reach, WHA, the Alliance and IHI partnered with the eight jurisdictional Health Departments across Australia along with other bodies and organisations with common objectives and complimentary skills. A total of 63 hospitals, spanning 49 health care services and all states and territories took part in the collaborative.

Figure 2: The names and locations of the 63 maternity hospitals participating in the Every Week Counts National Collaborative.

The institute for Healthcare Improvement (IHI) Breakthrough Series Collaborative model was chosen to provide the necessary structure to the work. This model works toward a central aim using a team-based approach grounded in improvement science. Coordination, such as the provision of change packages and support are facilitated centrally to the project teams. The model is a tried and tested approach to delivering rapid and sustained improvement and is one that is championed and facilitated by Life QI.

Life QI - the chosen solution

Coordinating a national collaborative across 63 hospitals required a technology solution to collate and share data and learnings from across the participants. Life QI was chosen to support the collaborative, primarily for the following reasons:

• Cloud access: Teams from each hospital can easily access and collaborate from wherever they are located.
• Sharing and collaboration: Data and learnings can be easily shared, whilst successes can be identified, celebrated and spread to other sites.
• Data analysis: Data can be aggregated from across all the sites and analysed using Statistical Process Control (SPC)
• Consistency in approach: The IHI Breakthrough Series Collaborative model requires each team to work with flexibility and independence but grounded in a common approach.

“Life QI supports teams to understand and use improvement methodology bringing improvement tools together into one place,  Life QI  made it possible for teams from across the country to collaborate, to share data and learning. ” - Barb Vernon WHA CEO 

Hospitals and project teams

Through the course of the work, teams in each hospital undertook their own tests of change, based on the seven defined strategies. Within Life QI, the Programme function was used to provide the central hub for the collaborative. The programme was used to define a common logic model for the work using a Driver Diagram and define key aspects such as measurement plan and project templates.

On commencement of the Collaborative, each participating hospital had its own project team. Teams were responsible for implementing any changes in their hospital, and also for documenting the impact and reporting data into Life QI. Each hospital had its own ‘local’ project in Life QI, which sits under the programme.

"Life QI allowed us to support hospital teams across the country, providing a central place to collect and visualise data. It also supported the spread of improvements between hospitals through the sharing of learning, resources and facilitating collaboration during Action Periods." - Adele Kelly, WHA Improvement Program Manager

Hospital teams were principally involved with conducting iterative tests of change using the Plan-Do-Study-Act (PDSA) methodology. In total, a staggering 900 PDSA cycles were run across the project teams – all recorded and tracked using Life QI.

Teams were also responsible for recording key Outcome Measures on a monthly basis and selected Process Measures on a weekly cycle. Run charts and control charts were used to demonstrate the immediate impact of PDSA cycles to the teams, whilst all data was automatically aggregated to allow visualisation of the progress and impact on a national scale. 823 Run or Control charts were generated in Life QI through the course of the collaborative.

Results

Whilst the collaborative largely concluded in March 2024, national results are still being analysed. As it stands, over 80% of the 49 health systems have demonstrated improvement in their projects on Life QI (based on scoring 3 or above on the IHI project progress score) which acts as an early indication of the collaborative being a great success!

As a result of this work, Australia is on track to become the world’s first country to strategically and safely lower its rate of untimely birth. This would be a fantastic achievement for the WHA team, their partners, participating hospitals and the nation as a whole.

You can read more about the collaborative in the O&G Magazine article here: https://www.ogmagazine.org.au/25/4-25/the-australian-national-preterm-birth-prevention-collaborative/

References

1.  Newnham JP, White SW, Lee HS, Arrese CA, Watts JC, Pedretti MK, Dickinson JE, Doherty DA. The elements of success in a comprehensive state-wide program to safely reduce the rate of preterm birth. PLoS One. 2020 Jun 4;15(6):e0234033. doi: 10.1371/journal.pone.0234033. PMID: 32497072; PMCID: PMC7272053.

2.  Newnham JP, Morris J, Vernon B and Mckenzie L. The Sutralian National preterm Birth Prevention Collaborative. O&G Magazine. Vol 25 No. 4 Summer 2023.