"We found we had a 15.3% elective delivery rate and a 31.3% C-section rate," he says. "That was way too high. So we put up barriers for doctors to schedule these, and if there was no clinical indication, we said, 'We're sorry. You'll have to wait.' "
There, too, Sutter got pushback. "Patients had come to their doctors saying, 'Oh, why can't you deliver me early? I'm tired. My feet are swollen. Can't we get this over?' "
It was, he says, "like drawing a line in the sand."
But last year, the numbers dropped. Early elective deliveries without medical indication are down to 2.3% at Sutter Medical Center in Sacramento, which performs 5,500 deliveries a year, and C-sections are down to 24.7%. Similar policies have been or are being pushed out to the other four hospitals.
And like at Rush-Copley, doctors get to see all obstetrical rates by practitioner. Sutter has moved on, improving physician rates for other measures soon to be reported to The Joint Commission, such as increasing use of antenatal steroids prior to a preterm delivery and enabling the mother to exclusively breast feed during the newborn's entire hospitalization.
"We post in the doctor's lounge everybody's elective delivery rate, which is now zero," Gilbert says. "We also post everybody's C-section and episiotomy rates and I email them to the entire department."
There are exceptions, he says. Sometimes the patients live far away, they tend to have fast labors, and they're three or four centimeters dilated.
But Sutter is in an especially competitive market. "If the patient doesn't like what the doctor tells them, they may leave and go to somebody else," Gilbert says. "So physicians have to really work with their patients."
Gilbert says Sutter is poised to improve other measures of prenatal care quality as well. "We need to make sure our data is accurate and clean. We want to look good so insurers will say, 'Wow. Your C-section rate is lower than your competition's. That means my bill is going to be lower. And your outcomes are better. I am going to maybe pay you more.'
"My focus was, improve the quality and the business will follow."
This article appears in the September issue of HealthLeaders magazine.