JOGNN: Barriers and Facilitators to Implementation of a Multistate Collaborative to Reduce Maternal Mortality From Postpartum Hemorrhage

Objective: To describe the barriers and facilitators to implementing the Association of Women’s Health, Obstetric and Neonatal Nurses Postpartum Hemorrhage (AWHONN PPH) Project experienced by hospital leaders, project cham-pions, and staff.

Design: Qualitative descriptive study with a grounded theory approach.

Setting: Hospital leaders, champions, and staff from hospitals in New Jersey and Georgia.

Participants: A total of 21 nurses and physicians who worked at six hospitals shared their experiences with regard to implementation of the AWHONN PPH Project.

Methods: Interviews were recorded and transcribed verbatim. Analysis included open, selective, and theoretical coding with a constant comparative method of grounded theory. Analysis was complete when a central process emerged.

Results: Successful implementation of most or all of the program elements was facilitated by support from admin-istrators, positive attitudes, active nurse and physician champions, and an existing culture of safety. When these el-ements were in place, respondents reported that they believed they made a difference. Barriers to implementation included negative attitudes, lack of champions, poor staff buy in, lack of resources, and lack of support from admin-istrators. When barriers were encountered, respondents felt discouraged and disappointed.

Conclusion: Although the road to full participation and implementation was difficult for some, lessons were learned by all. Suggestions for future projects include a step-by-step approach that begins with education, the creation and celebration of milestones, and the formation of teams to facilitate buy in and empowerment.

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