The impact of delivery hospital organizational structure and culture on perinatal outcomes

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PROJECT SUMMARY Adverse outcomes for pregnant patients and infants associated with the hospitalization for childbirth are frequent and vary across hospitals in the United States. Organizational factors, such as organizational structure and culture, in birth hospitals are potential drivers of variation in care and outcomes. Maternal and neonatal levels of care, an organizational structure, are the risk-based services available at a hospital for mothers and infants, respectively. Organizational culture refers to the beliefs, perceptions, and values on obstetric and neonatal units in a hospital, a key component of which is the culture of patient-centered care. The care and health of the mother and infant are interrelated, yet studies have not formally assessed perinatal organizational factors, those created by the intersection of maternal and neonatal care at the hospital level. The overall objective of this study is to determine how organizational factors of obstetric and neonatal units, formalized by this proposal as perinatal profiles of organizational structure and culture, impact perinatal outcomes of mothers and infants and drive hospital variation. Dr. Handley will achieve this objective by 1) assessing the impact of perinatal level of care profiles, 2) assessing the impact of perinatal patient-centered care culture profiles, and 3) examining the interaction of perinatal structure and culture profiles on perinatal outcomes. Her analysis will leverage a nine-state, retrospective cohort of mother-infant pairs as well as primary data from her organizational culture survey of California birth hospitals, which will be linked with state data to produce a novel dataset. This proposal was designed to prepare Dr. Handley to become an independent investigator, specifically focused on integrating health services research and organizational science in order to understand how organizational factors on obstetric and neonatal units affect perinatal outcomes. Her research will be complemented by training in advanced statistical methods for observational data and primary organizational culture survey data as well as acquiring in-depth knowledge of organizational behavior, dynamics, and change. Working with a multidisciplinary team of mentors and advisors with experts from neonatology, health care management, obstetrics, and biostatistics will provide her valuable guidance in the completion of this work and planning of future studies. Understanding the implications of perinatal organizational structure and culture profiles on perinatal outcomes is critical to improving perinatal care. Through better understanding of drivers of outcome variation across hospitals and identification of organizational factors amenable to change, this work has the potential to shape perinatal level of care policies, inform initiatives to improve organizational culture and coordination of maternal and neonatal care, and guide future change at the hospital, state, and national levels, which are actionable strategies to improve outcomes of the mother-infant dyad.