I’ll write much more about design for birth and death in coming months — I have a fellowship next year and will teach two new courses on this subject — but this story nicely details the ways that design processes can assist in some pretty big changes in health outcomes:
The U.S. C-section rate has hovered around one in three for the last decade, but with great variation across hospitals. Some hospitals deliver just 10% of infants via C-section; others, more than 40%.
These wide variations didn’t appear to be due to conventional explanations, the researchers found. It wasn’t the case that hospitals performing more C-sections had a higher number of complicated patients or patients who preferred the procedure. Nor was insurance a factor.
Instead, the researchers found, C-section rates were largely a product of how much pressure a labor and delivery ward faces. They deemed it the “pressure tank model”: high patient volumes, limited staff, and the volatility of labor and delivery create a complex, stressful, busy environment where communication is difficult and teamwork erodes. As a result, clinicians opt to perform C-sections, even when medically unnecessary, rather than letting patients continue to progress in labor. C-sections are faster, requiring fewer nursing hours at the bedside. And, once the procedure begins, clinicians no longer have to communicate back and forth as much to make decisions about a case.
“Research has demonstrated that the more dysfunctional a team is, and the more negative culture is within a labor and delivery unit, the more C-sections there are,” Weiseth said. “It makes sense, right? If people aren’t working well together, they’re going to use the release valve of a C-section more often.”
The team found other culprits driving too-high C-section rates, including financial pressures—obstetric care as a whole is poorly reimbursed and C-sections earn more money than vaginal deliveries—and inconveniently designed wards, with too many rooms placed too far away from each other, cutting off communication between clinicians.
