NHS FPX 8002 Assessment 1 Demonstrating Effective Leadership

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Capella University

NHS-FPX 8002 Collaboration, Communication, and Case Analysis for Doctoral Learners

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Date

Demonstrating Effective Leadership

The United States of America is confronted with one of the highest maternal morbidity and mortality rates among developed nations globally (Johnson, 2022). In 2021, the Centers for Disease Control (CDC) reported a 40% increase in maternal deaths, marking it as one of the worst years for maternal mortality in U.S. history (Hoyert, 2021). A particularly concerning aspect is the significant racial and ethnic disparity in maternal outcomes, with Black women being three to four times more likely to experience pregnancy-related deaths compared to white women (CDC, 2019).

In response to this crisis, the CDC established the Perinatal Quality Collaboratives (PQCs), a collaborative initiative between federal and state governments aimed at improving healthcare processes to prevent maternal deaths and reduce racial disparities. However, effective local implementation necessitates a leadership coalition. This paper focuses on strategies to improve Black maternal health in Palm Beach County, Florida, through the formation of a collaborative coalition, analyzing contributing factors, and proposing interventions.

Contributing Factors

The maternal death rate in the United States rose by nearly 20% in 2020, reaching the highest level among economically developed countries (Johnson, 2022). Maternal mortality, as defined by the CDC, includes deaths of women during pregnancy or within 42 days of termination, excluding accidental or incidental causes (CDC, 2019). Leading medical causes of maternal mortality in the U.S. include blood clots in the lung, hypertension, and blood loss (Johnson, 2022). Disturbingly, African American (AA) mothers face three to four times the risk of pregnancy-related death compared to white or Hispanic mothers (Collier & Molina, 2017). Southern states, particularly Florida, exhibit the highest maternal mortality rates and interval rate increases (Snyder et al., 2020).

Regional variations highlight the lowest per-population healthcare provider ratios in the South, especially for certified nurse-midwives and obstetricians (Snyder et al., 2020). Longitudinal studies emphasize higher maternal morbidity rates among AA mothers in the southern United States (Kramer et al., 2023). Despite Florida ranking 32nd in maternal mortality rates among U.S. states, racial disparities persist (Bravender, 2020). Leading causes of maternal death among Black women, including cardiomyopathy, eclampsia, and preeclampsia, occur at rates five times higher than in white women (MacDorman et al., 2021).

Disparities persist even when controlling for factors like education and socioeconomic status (Petersen et al., 2019). Black women often report poor continuity of care, communication gaps, and a perceived lack of attentiveness in their maternal experiences with the U.S. healthcare system (Wang et al., 2021). Maternal deaths among Black women, often preventable, result from issues such as cardiomyopathy with noticeable symptoms (MacDorman et al., 2021). Implicit bias, lack of access to quality healthcare, inadequate health insurance, and racism contribute to health disparities (Bravender, 2020).

Coalition to Address Maternal Morbidity

A coalition in Palm Beach County, Florida, consisting of healthcare professionals and community organizations, aims to analyze factors contributing to poor maternal outcomes for African-American women. The five-member coalition comprises an Obstetrician-Gynecologist, Certified Nurse Midwife, Labor & Delivery Registered Nurse, Doula, and a representative from the Healthy Mothers Healthy Babies Coalition of Palm Beach County, Inc. Their diverse expertise contributes to analyzing components leading to high rates of Black maternal deaths and implementing evidence-based strategies. The coalition focuses on improving patient safety, healthcare quality, and reducing racial disparities.

Issues Affecting Collaboration

Several potential issues may impact interprofessional collaboration, including communication gaps, time constraints, undefined roles and responsibilities, biases, differences of opinion, and ineffective leadership. Hierarchy conflicts may arise among team members, such as obstetricians and certified nurse midwives. Autonomy is crucial but could become a barrier without compromise, trust, or respect for all team members.

Strategies to Optimize Collaboration

Effective collaboration is essential for developing strategies to reduce health disparities and enhance patient safety. A shared mission, clearly defined roles and responsibilities, good communication, and a collaborative approach with other organizations addressing similar issues are crucial elements for success (Downey et al., 2018). The coalition’s mission to ensure optimal birth outcomes for AA mothers in Palm Beach County, Florida, requires shared values and responsibilities among team members. Clear role definitions and equal participation in decision-making foster effective teamwork. Collaboration with other organizations addressing maternal health issues enhances the coalition’s impact.

Ethical Considerations

The coalition’s goal of reducing racial disparities in birth outcomes necessitates adherence to ethical principles such as respect, justice, equity, and beneficence. Beneficence involves acting in the best interests of patients, emphasizing prevention of significant disparities in maternal outcomes among Black communities. Justice requires fair and equitable treatment, advocating for improved access to quality care for AA women during the preconception, pregnancy, and postpartum periods. Ethical considerations also include addressing racialized pregnancy stigma through anti-bias training for healthcare providers, fostering culturally sensitive interactions, and promoting positive healthcare experiences.

Collaboration, Diversity, and Inclusion

While Black women and their families are disproportionately affected by adverse maternal outcomes, this public health crisis impacts all Americans. Discrimination and ill treatment can harm the entire community’s health. Therefore, a diverse multidisciplinary coalition is essential to address this issue comprehensively. Coalition diversity is associated with higher success rates, and inclusivity promotes a collaborative atmosphere that respects diverse experiences and inputs.

Literature Review to Address Maternal Morbidity

Maternal outcomes in the U.S. lag behind other developed nations, with Black birthing communities experiencing the poorest outcomes. Community-informed models, focusing on social and structural determinants of health, have shown promise in addressing racial health equity and improving maternal outcomes for AA women. Diversifying the women’s health workforce, promoting cultural sensitivity in medical education, and broadening interprofessional training can be evidence-based interventions derived from current research.

References

Bravender, R. (2020). ‘It’s not fine.’ Black mothers and babies are dying in Florida. Florida Phoenix. https://floridaphoenix.com/2020/01/30/its-not-fine-black-mothers-and-babies-are-dying-in-florida/

Centers for Disease Control and Prevention. (2019). Pregnancy-related deaths. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm

Collier, A.Y., & Molina, R.L. (2021). Maternal mortality in the United States: Updates on trends, causes, and solutions. Neoreviews, 20(10), e561-e574. https://doi.org/10.1542/neo.20-10-e561

Downey, L.M., Ireson, C.L., Slavova, S., & McKee, G. (2018). Defining elements of success: A critical pathway of coalition development. Health Promotion Practice, 9(2), 130-139. https://doi.org/10.1177/1524839907311573

Hoyert, D.L. (2021). Maternal mortality rates in the United States, 2021. National Center for Health Statistics (NCHS) Health E-Stats. https://dx.doi.org/10.15620/cdc:124678

Johnson, S.R. (2022). The U.S. maternal mortality rate surged by nearly 20% in 2020. U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2022-02-23/u-s-maternal-mortality-rate-surged-in-2020

NHS FPX 8002 Assessment 1 Demonstrating Effective Leadership

Julian, Z., Robles, D., Whetstone, S., Perritt, J.B., Jackson, A.V., Hardeman, R.R., & Scott, K.A. (2020). Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Seminars in Perinatology, 44(5), 151267. https://doi.org/10.1016/j.semperi.2020.151267

Junk, W.M. (2019). When diversity works: The effects of coalition composition on the success of lobbying coalitions. American Journal of Political Science, 63(3), 660-674. https://doi.org/10.1111/ajps.12437

Kramer, M.R., Labgold, K., Zertuche, A.D., Runkle, J.D., Bryan, M., Freymann, G.R., Austin, D., Adams, E.K., & Dunlop, A.L. (2023). Severe maternal morbidity in Georgia, 2009-2020. Medical Care, 61(5), 258-267. https://doi.org/10.1097/MLR.0000000000001819

MacDorman, M.F., Thoma, M., Declcerq, E., & Howell, E.A. (2021). Racial and ethnic disparities in maternal mortality in the United States using Enhanced Vital Records, 2016‒2017. American Journal of Public Health, 111(9), 1673-1681. https://doi.org/10.2105/ajph.2021.306375

Mehra, R., Boyd, L.M., Magriples, U., Kershaw, T.S., Ickovics, J.R., & Keene, D.E. (2020). Black pregnant women “get the most judgment”: A qualitative study of the experiences of black women at the intersection of race, gender, and pregnancy. Women’sHealth Issues, 30(6), 484-492. https://doi.org/10.1016/j.whi.2020.08.001

Petersen, E.E., Davis, N.L., Goodman, D., Cox, S., Syverson, C., Seed, K., Shapiro-Mendoza, C., Callaghan, W.M., & Barfield, W. (2019). Racial/Ethnic disparities in pregnancy-related deaths — United States, 2007-2016. Morbidity and Mortality Weekly Report, 68(35), 762-765. https://doi.org/10.15585/mmwr.mm6835a3