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- [00:01]
A
Welcome to Advancing Health. Western Wisconsin Health recently put a lot of care planning and resources into expanding its maternal care services for the rural population it serves. Was it successful? Well, the hospital CEO jokes that she took on a little bit of market research herself by having her own child at the hospital and checking out the experience from a patient's point of view.
- [00:29]
B
Hi, I'm Julia Resnik, senior director of health outcomes and Care Transformation at the American Hospital Association. I'm so excited to be here today with Ailee Peterson, CEO of Western Wisconsin Health. Today we're going to discuss rural maternal health. As many rural hospitals are shutting their labor and delivery services, some are doubling down. Ailey's Hospital is one of the ones that's expanding their maternity care for their community and for their patients. And Ailey has a special connection to share, so let's get right into it. Ailey, thank you so much for joining me for this conversation. To kick things off, can you tell me more about your hospital and the community that you serve?
- [01:06]
C
Yes. Thank you, Julia, for having me. Thank you to the aha. My name is Ailey Peterson. I'm the CEO with Western Wisconsin Health, and we are a critical access hospital in Baldwin, Wisconsin. We serve a rural community and we serve as a safety net hospital to to both our community and to our region. We employ about 500 people and offer a full breadth of service, focusing on the holistic approach to healthcare and meeting patients where they are.
- [01:35]
B
Fantastic. And tell me more about your family and raising your family in Baldwin.
- [01:40]
C
So now I have four kids. Very excited to share my pregnancy journey with you. With my most recent baby, she was the latest addition to four kids, two boys, two girls, and. And I absolutely love raising a family in Baldwin. I think there's nothing better than raising your children in a rural community, having an opportunity to really get to deeply know people, both people with whom you're raising children at the same time, but also meeting and getting to know people who use and benefit from your hospital services. I personally love that opportunity to meet patients in the grocery store, at the local football game, for my family, at our hockey games or big hockey players. And so that opportunity to get to know people outside of just when they're sick and when they're in the hospital, but when they're feeling their best out in the community, I think is the absolute best thing about serving as a leader in a rural hospital and living in a rural community.
- [02:38]
B
That's so special that you get to see your patients when they're healthy and out of the hospital and back to their day to day lives.
- [02:44]
C
Yes, yes. I think it also was really what contributes to the quality of medicine in rural communities. There's nowhere to hide if something doesn't go well, if there is displeasure about a service, you're going to hear about it again at the grocery store, at the football game, at church, at the hockey game. And that high level of accountability translates into quality outcomes. So it makes a difference too, to live and work in the same community.
- [03:13]
B
Absolutely. So tell me about what maternity care is like in your community. All the way from prenatal care through postpartum care.
- [03:21]
C
So all things encompassing maternal and child health are really a staple in our hospital. We've made a conscious decision that these are foundational programs to us. So we offer prenatal care through midwives, certified nurse midwives, obstetricians and family medicine physicians with obstetrical care as part of their training and their service. So the prenatal journey starts there. Patients have an option to see any of those providers. It's their choice. Part of our very focused approach to medicine here. Patients are in control, they lead their own show. We're here to support and care for them. So the prenatal care journey starts there. There. We see patients through antepartum visits, we see for them through their ultrasound needs. All of their lab work is done within our hospital. And then there's the birth experience that happens in our labor and delivery unit. We are now a seven bed obstetrical care unit where we deliver patients either vaginally or through C section. And then once those patients are born, we're there to be service their medical home. So on the pediatric side we have two pediatricians. One specializes in developmental pediatrics. So for our patients who have developmental needs, we have on site pediatric care. For patients in need of those services, we have a pediatric nurse practitioner and then we have family medicine providers who also meet the needs of our pediatric patients. And we really want to be that wraparound service for a patient's lifespan. So through the birthday, through childhood, and all the way throughout all stages of life, we wanna be here for our patients.
- [05:01]
B
And it's one thing to talk about pregnancy care in the abstract, it's another when you are the hospital CEO who is getting your pregnancy care at your own hospital. So can you talk about that experience?
- [05:11]
C
Oh, it is just an absolute joy to have my own child at this hospital. One of the things that we do here for all patients is we sign kind of a quasi birth certificate. It's not an official birth certificate, but but it's a welcome to the world. We put the baby's footprint on it. It's one of my favorite parts of the job is I get to personally sign all of those welcome to the world through our hospital. And so it was really special and fun to. I had my own baby, and I got my own certificate that I signed. Welcoming my baby into the world, being able to experience prenatal care here. I went the midwifery route and had an absolute wonderful experience through prenatal care, sharing in the joys of practice with that personalized approach of a nurse, midwife, then through the labor experience too. Again, nurse, midwife by my side. We expanded our hospital a year and a half ago, and to be able to be in a room that we worked hard to bring on site for patients in need was great to see every aspect of that design come to life as a patient, to. To see firsthand why we built it that way, all the funds that we raised to bring that to life again, just to experience that firsthand was great. And nothing beats the joy of welcoming a child into the world. And to get to do it in my hospital was beyond words. How special that was.
- [06:38]
B
Being a patient in your hospital, how did it make you think about care differently?
- [06:43]
C
You know, you have a vision as an administrator on what you think that care journey should look like. Of course, you who do that in partnership with physicians, providers, nurses, all of the caretakers who are closest to the work. And that vision, you hope, you plan, you prepare, that that aligns with reality. And so I joke that this was one way to do market research to determine, okay, did all of that planning go according to plan in a real life experience? And I will say for the most part, it did. It went exactly as we planned and prepared that it should, with few exceptions. And I'm happy to share those exceptions. But it was great to see that vision that we had, that plan of care come to life and to experience that as a patient. I'm thinking, you know, okay, this is what should happen next. This is what we plan for. This is what it should look like. And really, in every aspect, it basically did. Which was wonderful to experience firsthand as a patient.
- [07:42]
B
Yeah, what were those exceptions? And how are you thinking about changing things based on those?
- [07:47]
C
You know, you can't predict some of these things, but I was glad to see how it played out. So this was a unique birth experience in that there was a storm coming when I went into labor, and my midwife, who is as great of a midwife as she Is storm tracker said, okay, Ailey, I need you to be prepared. There's a storm coming. I think it's going to hit about 10pm and. And that's right around the time when your baby is going to be born. And I said, sarah, how do you know this? I know you're a great midwife, but how do you also track storms? And she said, in my spare time, I track the weather and I know there's a storm coming, and so we need to prepare you. Sure enough, I was ready to push at 10pm right at that time, all of the power went out in the hospital. We had a huge storm indeed. Power went out. We were on backup generator power. And so it was this dual thought of, I need to have this baby right now. And I'm also very curious to see how our emergency preparedness planning is going to work in this moment. Minutes before the power went out, the team moved everything to the red outlets, which are the outlets that make sure that when generator power comes on, all of the monitors and equipment still works the way that it should. They did this quietly, discreetly. I, of course, knew what they were doing. My husband had no idea, which is what you want. It happened seamlessly. It was clear that our emergency preparedness planning went the way that it should. Everything functioned. Indeed, when the power went out a few minutes later and was able to safely and healthily deliver my baby girl in the midst of a storm with no power, only operating on generator power, the team knew the emergency preparedness policies. Their training was effective. The power was out until the next morning at 7am so we had a full evening without regular power. The hospital was still able to deliver many babies that night. The other unique thing about the experience that I thought about differently as a patient is when our OB rooms are full, which they often are, because of the need in the community, we have to move patients to either a triage room or to a postpartum care room. And we do this routinely. And as we plan for this, you know, I thought, okay, well, this won't be a big deal to families. They'll understand we've got a patient coming in who needs a labor and delivery room. But as I experienced that as a patient, I saw firsthand the challenges of moving everything. You know, the new baby, the partner, all of the mountains of things you have. And doing that at 3am was not an ideal time. And so I saw firsthand that we can probably do that in a better way. So the market research continued with, how do we interact with our patients better when those needs arise.
- [10:41]
B
That is such a helpful learning that I think you can only realize by being in it. So I want to talk about rural maternal health generally. So many rural hospitals are being forced to close their labor and delivery services while you all seem to be expanding. How do you do that?
- [10:57]
C
We've made an investment and a commitment to sustaining rural obstetrical care despite all odds. We've really taken it as our personal mission that when others close, we have to be there for those communities in need. How do we do that? Number one, quality of care. That's the foundational aspect of this training. Making sure that we know our patients needs because of that relationship to be there to deliver the best care possible. We have a 4% C section rate, so clearly that foundational level of quality care rings true. Number two is workforce. Making sure that we have a diverse, sustainable workforce to meet the varied needs of our patients. And that's why we employ certified nurse midwives, obstetricians, family medicine, physicians with OB surgery, so we can have a variety and enough caregivers to meet the needs of our patients. And then number three is advocacy work that needs to continue so that our government partners, our community partners, know the challenges that we endure and know how they best can support rural hospitals to stay open in our minds. Those are the keys to success. And that's our daily mantra on how do we do this? How do we keep our doors open and do it well?
- [12:19]
B
And as labor and delivery departments around you are closing their services, how are you adapting to meet not just the needs of patients in Baldwin, but in the communities that are around you?
- [12:28]
C
The thoughts that we have as we work to adapt to the changing landscape and the ever growing needs goes back to what I shared earlier. Number one, workforce, we need more caregivers and providers to do this work. And then number two, is increasing our space. Just a year and a half ago, we doubled the size of our labor and delivery unit and we're already pushing up against those limits. I personally had to move as a patient because we had more patients coming in to deliver. We need more space. And that's why as part of our five year strategic plan in this hospital, we intend to add yet again more space, more clinical space to meet the needs of our growing region. I think we do this and can do this well because we're local, we're independent, we're very accountable to our community. And it highlights why it's so important for rural independent hospitals to stay open because they keep these things at the heart of their work keeping labor and delivery open.
- [13:29]
B
Absolutely. And it's just such a powerful story for how you can have rural medicine really serving the needs of the community and providing high quality care that even the CEO would be willing to have her baby at. And listeners, I've met that baby and she is adorable. So congratulations on your new little one. Thank you so much for the work that you do every day for your community and just really appreciate you sharing your story with our listeners.
- [13:55]
C
My pleasure. Thank you for having me.
- [13:57]
A
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.