Editor’s Note: The opinions expressed in this blog post are solely those of the author.

“In Poplar in 1960 the midwives of Nonnatus house were on perpetual duty. New life arrived with every season, at every time of day and in the midst of darkness of the autumn - birth sparked a little light into the gloom. Bringing mystery - and hope - the unknown - with the longed for….burning like a candle in the night.”

In Episode 7, Mr. and Mrs. Mills (Tommy and Gert), an elderly couple, help each other through health challenges with pride, grace and love. Sister Mary Cynthia mentors nurse Barbara Gilbert with maturity, insight and wisdom and Barbara shares recent research into bedsore care. Fred and Violet take the next step and he proposes. And Sister Evangeline has a tragic moment when she realizes a mix up between two baby girls and the impact this will have on both families.

As a Modern Day Midwife, this episode made me think about best practices and evidence based care. I also liked that the research they talked about was instigated by a nurse - especially since this is Nurses Week and we celebrate the International Day of the Nurse on May 12th – which is Florence Nightingale’s Birthday. The show also made me think about patient safety and structures and processes that are put in place to improve capability and decrease errors.

A couple years ago, the American College of Nurse-Midwives (ACNM) sent a call out for nurse-midwifery leaders to apply and participate in the ACNM VIRTUAL QUALITY INSTITUTE, Institute for Healthcare Improvement (IHI), ACNM Chapter for the Leadership Open School. I was one of 31 participants involved. The program included virtual self-paced modules and quarterly perinatal improvement webinars. The modules focused on improvement capability, patient safety, leadership, person and family centered care, and quality /cost value. It was an excellent program and I learned so much and then and went on to weave that program and concepts into my courses as a professor at the University of Michigan and currently incorporate the information as the Director of the Detroit Nurse-Family Partnership.

In one of the modules from IHI they highlight information about a culture of safety and how to foster this. Below are 4 things they mentioned:

• Psychological safety. People know their concerns will be received openly and treated with respect.
• Active leadership. Leaders actively create an environment where all staff are comfortable expressing their concerns.
• Transparency. Patient safety problems aren’t swept under the rug. Team members have a high degree of confidence that the organization will learn from problems and use them to improve the system.
• Fairness. People know they will not be punished or blamed for system-based errors. There is a Fairness Algorithm to see if a mistake needs a system redesign or if it needs disciplinary action. It examines if the harm was intended; if the individual was drunk or impaired; was there knowledge that the actions were unsafe; in a similar situation would other peers also experience the same mistake; has the person been involved in similar events or is there a history of this occurring with the same individual?

There are structures and behaviors that can help promote a culture of safety and each person can really make an impact each and every day. One thing that the show did a good job of was really highlighting the need to discuss errors openly in order to learn from them. And within a culture of safety you need to also encourage others to do so as well. In one of the IHI modules they discuss four concrete actions healthcare providers can start practicing right away that can make a big difference for the staff and patients around them for safety and they include:

1. Actively set a positive tone when working with a team.
2. 
Routinely use structured types of communication such as briefings and debriefings. 

3. Learn how to differentiate between system error and unsafe behaviors.
4. Be respectful to all your colleagues and patients.

Check out the resources and sites below if you have more interest in this area. I have found them really helpful. And it is good to keep the 2020 Vision for high-quality, high-value maternity care in mind. That vision is for a maternity care system that delivers the highest quality and value to achieve optimal health outcomes and experiences for mothers and babies through the consistent provision of woman-centered care grounded in the best evidence of effectiveness with the least risk of harm and the best use of resources.

“Light will often pierce the darkness when we least expect it and if we are fortunate when we need it most. Science can pave the way but we need human hands to guide us and love to illuminate the path that lies ahead.”

Resources
Institute for Healthcare Improvement (IHI)
Agency for Healthcare Research and Quality (AHRQ)
Consumers Advancing Patient Safety
Leapfrog Group
National Quality Forum
Partnership for Patient Safety
Safety Leaders

Katie Moriarty (CNM, PhD, CAFCI, RN) is the Director of Nurse-Family Partnership at Detroit Wayne County Health Authority and currently serves on the regional board of directors for the American College of Nurse-Midwives. Prior to her current position, Katie served as the Associate Director of the Nurse-Midwifery Education Program at the University of Michigan.
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