Episode 5 - Partnership in Action: The Patient Safety Toolbox

Emily: 0:26

Hello and welcome to today's episode from MoMMA's Voices. My name is Emily Taylor and I am in charge of engagement and outreach. One of the things I enjoy most about working for MoMMA's Voices is our matchmaking process for pairing certified patient family partners with providers. Every third podcast, we will talk about different matchmaking success stories. We hope this can give our PFPs more information about the types of engagements out there and give insight to providers and organizations of how to include patients with lived experience into their work. I'm super pleased to introduce our two guests today. Trashaun Powell is a maternal health advocate and patient family partner based in New Jersey. She survived a near death pregnancy experience related to the diagnosis of HELLP syndrome, which resulted in the birth and death of her first child at 23 weeks, resulting in a near-miss liver hemorrhage requiring multiple blood transfusions, surgery, and admission to the ICU. Trashaun now shares her compelling childbirth story of hope and tragedy to raise awareness about the need for education, about the maternal mortality health crisis, and funding for a cure for preeclampsia. She serves as a volunteer with the Preeclampsia Foundation and MoMMA's Voices patient advocate. And now I'm going to let Dr. Christina Davidson

Dr Davidson: 1:56

introduce herself. Hi everyone. I'm Christina Davidson and I'm a maternal fetal medicine physician in Houston, Texas. I hold several quality and safety and health equity roles and at Baylor, I am the Department of OBGYN's Vice Chair for quality patient safety and health equity. and I have been a part of our Texas State Perinatal Quality Collaborative since it started about 10 years ago, I was the one of the co-chairs of the OB committee for many years and had an opportunity to work with MoMMA's Voices a lot within that. And I'm currently the chair of the Society for Maternal Fetal Medicines Patient Safety and Quality Committee, and have also had an opportunity to work with MoMMA's Voices through that. Even within my own hospital we have a patient advisory committee and I've had an opportunity to work with patients with lived experiences on some of our QI projects. So I'm very excited to be here and get to share my experiences in

Emily: 2:48

this realm. Thank you. We appreciate it too. I know that you've done multiple things for us, so thank you for your willingness to continue to collaborate. So today we're here to talk about the Patient Safety Toolbox course. Dr. Davidson, if you don't mind, can you start by telling us what that exactly is?

Dr Davidson: 3:07

Yeah, sure. The Patient Safety Toolbox is a course that comes from the Society for Maternal Fetal Medicines Patient Safety and Quality Committee, which I've been a member of for about the last five years. And now I'm currently the chair of, and this was actually I think our third. Toolbox course where, you know, kind of as a, a toolbox, we would have different courses on helping hospitals with, you know, a variety of things related to patient safety and, and quality. So one year we even did something on how to implement the alliance for innovation on maternal health or AIM patient safety bundles on hemorrhage and hypertension. This time last year, we felt that we wanted to come together. And put together a toolbox on how to incorporate health equity into all quality and patient safety projects and how to apply quality and patient safety with a health equity lens. And so that was and we wanted to do this broadly. So this is not just a, a maternal fetal medicine issue. This is an obstetrics issue. This is an every person who takes care of a pregnant patient. We all need to come together and so we had the opportunity to offer this toolbox course to anyone who wanted to attend. And we had speakers across all disciplines of obstetrics. So we had obstetrics and gynecology physicians, maternal fetal medicine physicians. We had nurses, we had midwives we had nurse practitioners and we had MoMMA's voices. And so the purpose of this toolbox was to really be able to equip people with some tools to take back to their institutions and work in a multidisciplinary fashion, to identify disparities in their hospitals, identify the inequities or the root causes of those disparities, and work together through a health equity lens. And along with patients and, their lived experiences in terms of eliminating these disparities and the barriers and inequities.

Emily: 5:01

Thank you so much. I'm just so impressed with how many different players you allow to be a part of this project. Why did you really want to include patients with lived experience on, this project, and what valuable insights do you think that they were able to give?

Dr Davidson: 5:18

You know, I've learned so much more about it over the years. I mean, this is something, you know, I've been, when you include my residency, I've been a practicing physician for over 20 years, and I would say it's really just been in the last five years, at least for me, where we really have partnered with our patients more from a standpoint of, you know, well, what was this like for you? What was this experience like for you? And, we may think that we're medically, you know, giving all of the correct information and, and clinical expertise, but it's so important to understand, you know, if we try to implement this new project, what is it gonna look like from that, the perspective of the patient and I, I think we really started to learn more about that as we started to, to hear more of these stories. and I know through the work that Texas has done implementing the AIM patient safety bundles, we started on hemorrhage back in late 2018, early 2019 and it was something that the Texas Department of State Health Services implemented as a statewide patient safety initiative and invited all birthing hospitals to volunteer. And as we did the in-person learning sessions, there were, there was always a panel of patients with lived experiences, and I always found that to be one of the most impactful components of the, the entire session because medically I've been taught how to treat hemorrhage and I've medically been taught how to manage hypertension, but I didn't necessarily get that teaching on, you know, what this means for the patient, what her understanding is of it when she wants to receive that information. In terms of when do you wanna hear my whole spiel? You know, I've got a spiel for everything But instead of going on a 20 minute spiel and then saying, do you have any questions? You know, we've, we've learned how, you know, better ways, to connect with the patient and talk with the patient. And I think that's so important for everyone to be able to hear. Because I think as the, the healthcare team We're just thinking medically, what do we need to do? And I think this has really opened our eyes and, and broadened the perspective of, you know, medically, we know we need to discharge you with this information, but you need to tell me how you wanna receive this information. Do you want me to give you a, a 50 page book to take home after you've delivered a baby? Do you want me to give you a one page, little infographic, do you want me to send something to you via My Chart? And so that's what we need to hear and better understand from the patients with lived experiences.

Emily: 7:42

Thank you so much Trashaun, now I would love to hear from you of course, in my introduction of you. We heard a little bit about your story. If you don't mind kind of expanding and talking about your story a little bit further and what made you wanna get involved in advocacy work? Yes. So

Trashaun: 8:02

prior to joining the community of MoMMA's Voices, I led a team of family, friends, some of my sorority sisters and colleagues to raise awareness about the dangers of preeclampsia at the Preeclampsia Foundation's signature event, the Promise Walk. So using my mom voice was really a natural part of who I became after losing Mia. Being diagnosed with HELLP syndrome at 23 weeks. Losing Mia a two days after birth, it really changed us. It, it changed me. I knew I had two options. I could either stay silent and grieve alone, or face my fear advocate and become a member of a community of survivors.

Emily: 8:40

Thank you for sharing. I think it's important to note that not everyone has to go on this advocacy journey especially with you having to deal with a loss. I think it's just so many other levels of emotion and, detail that you have to relive every time. So, thank you for doing the work that you do. I know that you've done several engagements for us but I just really appreciate your willingness to share your story. Can you tell me a little bit what it was like to be a part of this engagement?

Trashaun: 9:09

To be a part of this engagement? It's really powerful. It really is. It's connection, it's resources, it's friendship, it's community. To our listeners, if you've ever had something happen to you and you wanna share it with someone, whether it was,a good experience, or just not what you hope for, that is what the MoMMA's Voices community is. It's a network of survivors engaging together to create the change that we wanna see, and to aid providers in the value of having patients at the very core of their work and becoming further connected in grassroots advocacy.

Emily: 9:45

Thank you so much. For this particular project. I think when I saw I, it was so impressive when it was finished. So was that a really neat experience for you to see? I know sometimes the speaking engagements are a wonderful opportunity as well, but when you're able to be a part of something that, you know, there's a physical document afterwards and, and you're hoping changes the lives of other birthing people and mothers. What was that feeling like for you? So for me,

Trashaun: 10:18

if I had to share with other patients that wanna get in this work, I would really stress to them that advocating for change and every facet takes a part of you that you may never have known was there. It's passion, yes. But it really goes beyond passion. It's, it's more of a roar inside of you that wants to change for the next person, family, community, birthing people, et cetera. And it's, it's really larger than life. And when you really think about all of the struggles that we have faced and overcome, it all started because someone advocated and I always remember that in every opportunity that I get, every platform that I'm on is that I'm using my voice for change. I'm using my voice for advocacy, and it continuously keeps Mia's memory alive.

Emily: 11:06

Thank you. Dr. Davidson, what was it like for you to work with patients? I know you mentioned that this was a, a new avenue for you, and what would your recommendations be to other organizations? Thinking about including other voices in

Dr Davidson: 11:22

their work? Yeah. You know, I think I was fortunate to be at a hospital that already had a patient advisory committee and so, you know, I was able to go to them and, you know, there was already a system set up where we could go to meetings where they were in attendance and kind of talk through, you know, some of our project ideas and get their feedback. But I found, you know, that I, I can get the same information from talking to patients I'm taking care of too. So I've really tried to kind of use every opportunity I can to better understand, you know, just really listening to the patients and asking them. You may not have, so my hospital has a system where, you know, people have been vetted to be able to get onto this committee. There's a process and so I could even include them on my quality and safety committee if I wanted to. I haven't gotten to that point yet. We've got them included on work groups. haven't gotten to a point where I've invited them on to the actual quality and patient safety committee, but because my hospital has that process, that is something that the patients on this advisory council can do. However, I work at another hospital that doesn't have that process set up yet, and so there it's kind of more a matter of, you know, just talking with my patients and learning from them. I had one very recent experience just last week in ultrasound. Where I was doing an ultrasound for fetal growth restriction and the sonographer came to get me before she had even started the ultrasound to let me know that the patient's heart rate was very high. And so I went into her chart to see, you know, what's been going on with her, what is her medical history? And I saw where she'd had about a dozen trips to our triage and in each one, there were, you know, there were, there was always documentation of asking if the patient felt safe at home because we're kind of trained to look for those warning signs of, you know, is somebody coming in to triage as their cry for help? And, you know, if they have multiple visits to triages or something that were missing. and they kept documenting that she felt safe at home, but I thought, well, I'm gonna ask her again. You know, I feel like it's my medical duty as a physician to go in and ask her this. So I go into her room as she's being, getting her ultrasound, and I ask her this, and she was just the sweetest, cutest thing, but she was like, yes, I feel safe at home and I am so tired of you all asking me this. And we went on for 20 minutes about like how she was just like, you know, I'm coming to triage for things you all told me to come in for. You told me if my baby doesn't move, well come in. You told me if this come in. She has a history of a miscarriage of twins followed by a cesarean delivery at 25 weeks because she went into early labor broke her bag of water, and the baby was not positioned for a vaginal delivery. And then that baby died after delivery. And so she, she said, you know I'm gonna come in, if anything just doesn't seem quite right. And that's what y'all are telling me to do. But every time I come in here, y'all wanna know if I'm safe at home. And it gave me such a different perspective. And I had this great conversation with her and I said, do you want me to put in your chart to stop asking you if you feel safe at home? And she was like, yes, would you please? And I was like, and you can blame it on me if the next person who sees you But I, I put it in a form where like, as soon as you open her chart, it can pop up. And I, I described my conversation with her and said, you know, we can stop asking the patient if she feels safe at home, basically. Mm-hmm. And so I, I found that to be a very valuable experience just from being able to sit and listen and talk to a patient, even though she's not part of a committee, so to speak. Mm-hmm.

Emily: 14:48

Thank you so much. I, I'm just blown away by your ability to treat patients as individuals and be able to really listen to what they're trying to say. I know there are protocols in, in place, you know, for a reason and kind of finding out about why she kept going to triage, was very interesting. And I just so appreciate that there are healthcare providers like you out there. It gives us a lot of hope into the future of maternal health.

Dr Davidson: 15:17

But I'll say this has been a learned process for me too. Yeah. And so I think, you know, it's something that we're trying to pass on now to our residents and students, but this was not part of my training. And so I think it's, you know, it's gonna take some time to change the culture. But give us, be patient with us please. And, and and know that we're, we're trying

Emily: 15:38

I appreciate that. And Treyshawn, I don't know how you feel, but when you talk to other moms you know, one of my biggest pieces of, of advice is you have to push back a little bit more than, than you think you should. You know, nothing to to be rude, but you know your body more than than anyone else. So I don't know if, you know, given your experience in the work that you do any advice that you would have to, to give to moms out there right now?

Trashaun: 16:06

Absolutely. We are our biggest advocate. We know our bodies best, and so if there is something that you are not sure of or something that just doesn't feel right, be able to communicate that in whatever way you can. Right? We, there is no script to say something doesn't feel right. There is no code words to say something doesn't feel right. You should be able to message that to your doctors and or providers that something doesn't feel right and don't stop until you get an answer.

Emily: 16:35

Mm-hmm. absolutely. Well, thank you both so much for your time. Is there anything else that, that you'd like to say? I would love, definitely love to, to give you the microphone, if there's any ending words that you'd like to say. I was gonna

Dr Davidson: 16:49

ask you a question, Trashaun because something that people ask me sometimes, and I, I don't really feel like I'm in a position to answer this, but just exactly to what you said, you know, you know your own body and you know, and you know if, what if the, the healthcare team isn't listening to you. And so people have asked me, What, what do you tell patients to help make them advocate for themselves? And I'm like, you know, I shouldn't really have to tell a patient that she's telling us, but, and we're not listening. So I think what people wanna know sometimes is what is your next step If you are saying these things and you don't feel like you're getting the response? I tell patients, if you feel that you're not being listened to, we have a patient advocacy, you know, committee or, a family advocacy. A group that can come visit you. I was like, you keep escalating. If you feel that you're not being listened to, ask for that person. Ask for the, you know, attending, ask for the chief of quality or something. But I just don't want patients to feel like it's their fault or their responsibility. Any, any tips that you can share so that I can learn from them too, to pass them on to my patient.

Trashaun: 17:52

Yeah, my, I always share with patients is that if something doesn't feel right, communicate that with your doctor. If you don't feel that you're getting the answer that you deserve, you can utilize your community support or your, or your support person that comes to the hospital with you to maybe message it different. If you both feel that you're still not being heard, ask for another doctor. Ask for a resident, ask for a nurse, ask for someone else. And if the doctor is telling you something that still doesn't sit right with you, ask that doctor to unpack those for you because sometimes I think in at hospitals and, and, and provider agencies is that we're so used to speaking in our own language that we just assume that all patients know what we're talking about. And sometimes when we're communicating with patients, we may nod our heads. To say yes. You understand what I mean? And sometimes our patients may nod their heads back to say, I don't really understand what you mean, but I know you're rushing and I know I have to get out of here cause I only have a 30-minute appointment. So yes, I'm gonna nod my head as well in agreement, but really is not, they're really not aware of what you just said, or they're really not able to comprehend what you said. And so we're always advocating for our patients to ask the doctors to explain why they took this approach, or explain why you gave me this information to go home with. Or once you give me this packet, what does this mean? What should I do? And so make sure that you stay there in order for you to understand what they're giving you and what they stated to you. Because what happens is once that doctor leaves the room, then you're left with all these questions, and so we wanna make sure that we get all that information communicated at the time that you're there. I love that. Thank

Dr Davidson: 19:34

you.

Trashaun: 19:36

And so, one more shameless plug that I might have to add is to any of our listeners who are in New Jersey or in, in the surrounding New Jersey areas, we are having our Somerset Promise Walk for Preeclampsia on Saturday May 6th at 9:00 AM. At Colonial Park in Somerset, New Jersey. You can follow us on Instagram, Facebook, and Twitter at expecting dot excellence and we hope to see you there. Thank you.