About

Dr. Amber Weiseth, DNP, MSN, RNC-OB is a Research Scientist at Harvard T.H. Chan School of Public Health and the Director for the Delivery Decisions Initiative (DDI) at Ariadne Labs. In this role, she leads a research and advocacy portfolio focused on improving dignity and safety in childbirth and reducing racial and ethnic disparities. Amber has been an obstetric nurse for 20 years, specializing in maternal-child health, quality improvement, and systems innovation.

Background

Ariadne Labs is a center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Their goal is to improve healthcare by delivering the best possible care to every patient, everywhere by using science and design to make healthcare safer, more equitable, and integrated. Their work has been accessed in over 178 countries, impacting millions of lives.

The Delivery Decisions Initiative (DDI) is a program focused on transforming childbirth care globally. They collaborate with health systems and communities to develop safe, supportive, and empowering care. DDI creates innovative solutions like TeamBirth to promote quality, dignity, and equity in maternal care. 

Tell us about how the TeamBirth project was developed and has evolved over time? 

The Delivery Decisions Initiative set out on a mission back in 2017 to address the breakdowns in teamwork and communication that occur in labor and delivery, and too often result in preventable maternal and newborn morbidities and mortality. They identified the opportunity to improve safety and dignity of childbirth care through designing a model to promote transparency, reliability, and structured teamwork and communication - one that places the patient at the center of all decision-making. This model is now known as TeamBirth. 

What have you learned during the development of TeamBirth and what can others learn from your experience? 

We drew upon methods and tools from Quality Improvement (QI) and Design Thinking disciplines to structure our approach - applying QI’s “Model for Improvement” (Plan, Do, Study, Act) and Design Thinking’s “Double Diamond (Discover, Define, Develop, Deliver). During the “Discover Phase,” we conducted peer-reviewed literature reviews and researched professional guidelines to understand challenges present in intrapartum care and identify both the gaps and potential solutions in the space. During the “Define Phase,” we convened a multidisciplinary team of experts - clinicians, patients, and community members - to align on the problem we were aiming to solve and prioritize solution features. The “Develop Phase” focused on developing an initial prototype ready for small-scale implementation testing. Finally, in the “Deliver Phase,” we tested our solution in a registered clinical trial from 2018 to 2019 across 4 sites in Massachusetts, Oklahoma, and Washington. Through this rapid-cycle testing and iteration process, we produced a care model built upon shared principles and aimed to address a universal problem in healthcare - an adaptable solution primed for scale. 

What’s the impact you’re seeing in terms of improvement of the care experiences, and most importantly, health outcomes? 

In 2024, TeamBirth is being implemented in more than 150 hospitals in 15 states across 2 countries (U.S. and Sweden) with a combined impact on tens of thousands of clinicians and over 500,000 families. The program targets each facet of the quadruple aim - improved patient experience, improved population health, reduced per capita spending, and reduced provider burnout. 

Our data shows TeamBirth supports clinicians (nurses, obstetricians, midwives) and patients alike. Clinicians rate TeamBirth positively and report improved communication between caregivers. Those surveyed indicate improved patient care, increased teamwork and job satisfaction, and decision-making in not emergent situations. 

For patients, across all race/ethnicity groups, those who received TeamBirth report high autonomy, meaning they feel centered in decision-making and have the role they want in their care. Our data shows 93% of Black/African American patients reported high autonomy—this is a 19% increase compared to those who did not receive TeamBirth. Additionally, across all race/ethnicity groups, patients who received TeamBirth reported higher trust in their clinical team.  [unpublished data; analysis run February, 2024]. 

Many of our hospitals have also seen improvements in their healthcare outcomes, especially a reduction in cesarean birth rates. All 4 hospitals that participated in the TeamBirth pilot trial saw a meaningful decrease in those rates. More recently, Cleveland Clinic in Ohio shared these data which demonstrated they reduced their overall cesarean birth rate and most importantly, they eliminated the racial disparity. 

How important is communication and teamwork during the care process and what can be done to improve it?

According to the Joint Commission, patient-provider communication failures are responsible for 80-90% of obstetric sentinel events and are among the most frequently cited root causes in maternal morbidity and mortality reviews.

What we’ve realized repeatedly when implementing TeamBirth at each new site, is that most clinicians believe they are perfectly good communicators - and there is some truth to this. That said, we also repeatedly uncover discrepancies in patient-reported experiences of communication and teamwork across sites. Our data clearly shows that clinicians do not communicate well with every patient, every time - and that these inequities often lie along racial and ethnic lines. To address today’s widening disparities in childbirth outcomes and experiences, clinicians need a structure to improve the impact and reliability of patient-centered decision-making.  

How can simulation be used to enhance communication and teamwork?

To provide quality care, clinicians need to feel confident and competent in their skills and to trust the team around them. Teamwork and communication can be strengthened through scenario-based learning and in-situ simulation training, especially in providing a safe environment to learn and be coached in soft skill development.  

What is the role of frequent refresher training, also known as low-dose, high-frequency training? 

Low-dose, high-frequency training is essential for successful TeamBirth implementation because culture and behavior change doesn’t happen overnight. We understand that clinicians need to have enough exposure to the new model in order to have the “ah ha” moment, where they experience how TeamBirth is different from their old communication methods. Additionally, with the increased rates of healthcare staff turnover, we find that low-dose, high-frequency approaches provide a structure to ensure the model stays intact amidst a fluctuating staff. 

What are some projects you’re exploring that will integrate the innovations developed with the TeamBirth project with other established programs to amplify the impact? 

We are currently working with Laerdal Global Health and local stakeholders to co-design an adapted model of TeamBirth for hospitals and birthing units in Nepal. We began working on this project last fall when we joined forces with LGH to submit a proposal together for the initial design phase of this work. Mirroring the initial development of TeamBirth, we’re drawing upon the rapid cycle feedback approach. We recently had the opportunity to travel to Nepal to meet with government officials, professional societies, and other local stakeholders to discuss the project and get their feedback on how to best align with national health initiatives and priorities. We visited three hospitals where we got to interact with staff and patients, observe unit workflows, and begin envisioning how TeamBirth might look in this new setting. We are now focused on designing a testable prototype of the solution - conducting design sessions with LGH and eliciting feedback from local stakeholders, including Family Welfare Division, MIDSON, clinicians at our pilot sites, and others, to inform each iteration and reach a version ready for small-scale pilot testing.  

The next phase of work will focus on testing, rigorously evaluating, and refining our model. We are actively pursuing additional funding to support this work. 

How important is collaboration with partners? 

Developing and nurturing strong, collaborative partnerships is at the heart of our success as we look to develop solutions to address gaps and unravel challenges in our increasingly complex healthcare system. We can’t do this work alone. It requires bringing together diverse perspectives and experiences - patient, family, clinician, government official, community organization, and more - to develop a deep understanding of a problem and the context in which it is situated. 

What are the most important elements of a good partnership? 

• Mission alignment and shared goals
• Unique expertise - each partner brings something different to the table, including deep contextual knowledge
• Collaborative work ethic
• Trust 
   

Can you share a personal story where you’ve seen the direct impact of the project?

As a clinical nurse administrator, I am not usually at the bedside for huddles. However, one day I was walking through the unit and heard a doctor inquiring about the OR availability. This doctor had just come on shift and a TeamBirth huddle had not yet occurred. I requested a huddle and joined this doctor in the room with the patient, their partner, and the bedside nurse. We huddled about labor progress using the Assisted Delivery Discussion Guide. Here is a first-hand account from one of the nurses:

"As a team we identified that there were some labor positions that had not yet been utilized. We reviewed the fetal heart rate tracing and assessed that the baby was tolerating this long labor well, and the oxytocin could be increased. This reassured the patient and partner, who both requested to avoid a c-section if it was safe to continue labor. I noted this on the patient’s huddle board, and it seemed to keep the conversation on track. Everyone agreed on a plan for more time. The physician headed to the call room, and I asked the charge nurse to join the bedside nurse, who was still learning about various labor positioning techniques. When I came back the next day, I heard that they had another huddle a couple of hours later and again agreed on more time and the patient had an uncomplicated vaginal birth at some point in the night. This story keeps being told on this unit this week; everyone was pretty excited about how well it all worked." — Nurse manager, TeamBirth hospital in WA state

What is your hope for the future of maternal and newborn care?

My hope is that every woman would have access to care from a skilled provider, ideally a midwife, and that she could give birth in a safe environment, where she feels empowered and has autonomy over her body. I believe this can be accomplished through dedication to improving both safety and dignity.