In advanced countries like Japan or Iceland the infant mortality rate is as low as 0.2% (2 out of 1,000 births). Part of this is due to perfected medical workflows.
Note: This article is supposed to be impersonal — covering the bigger picture of a rather private experience. That is why I have intentionally omitted names, locations and personal details.
Our second baby, Olivia, was born 8 weeks ago. And since the Czech Republic has the 9th lowest infant mortality rate in the world, a mere 0.26%, I couldn’t help but observe how this astonishing result is supported throughout the health care system. My professional background is in business management rather than medicine, so I was paying particular attention to the operational and managerial aspects of the treatment.
For precautionary reasons, we visited two different maternity hospitals before the birth. As a result, we were able to talk to various members of each of their staff and even to some of their clients.
We also decided to hire a professional doula and midwife. Both of them gave us a great deal of advice and information about what our options were as far as where to give birth and what the pros and cons are of each particular maternity hospital in our area. They knew most of their respective senior staff by name and even directed us to those who are considered to be especially great in providing care.
As always, people and their attitude are what really matters, but my professional interest led me to observe how they worked, with us, and between themselves. You shouldn’t be surprised then (at least not on this blog) it was clear that all of them consistently relied on established, perfected and bullet-proof processes.
It began months before the date of birth during the regular monthly visits to the gynecologist, who is also our friend, so his approach was friendly and informal with some small talk during each visit. But his medical treatment wasn’t at all informal. Quite the opposite. Although he knew we were already well informed, he nevertheless suggested voluntary preventive tests and explained everything as if we were hearing about it for the first time. He was obviously following an established professional procedure, one that has even been noticeably improved since our first child was born 5 years ago.
As the expected due date got closer, we switched from visiting the gynecologist to a series of consultations in pre-selected maternity hospitals. Here again, all of the interviews were conducted meticulously according to a checklist or some process documented in their computer, presented in the form of a long list of seemingly unrelated questions. These covered both the individual health conditions of the mother, as well as our preferences, raising our awareness to various issues that may (or may not) occur, and other topics related to timing and the upcoming admission to the hospital.
On top of all this, the approach was really humane, with sincere interest and empathy displayed towards any potentially emotional topics. Time was not limited and we were regularly encouraged to ask about anything and everything we’d like to know. If we asked advanced questions, like for example the statistical risks of a birth defect measured by a particular test, we were given precise answers with the obvious aim of informing us to the fullest extent possible. All and all, we felt supported and well-informed at the same time.
Also, a mother’s birth plan (a type of written-down set of individual preferences and wishes) is now widely accepted as a basis for cooperation between the mother and the hospital staff. We had one, debated it at home, considered various options and then discussed it during our visits to the maternity hospital. On one occasion, the doctor went through it with us, point after point, suggesting minor improvements and giving her general approval to the plan as a whole.
What was really very cool and comforting, was that even though the frequency of our visits was becoming more frequent as the expected due date neared and all the staff members obviously followed established procedures, we were given nearly total freedom to diverge, based on informed decisions supported by that very system.
After Olivia was born on August 30, we stayed almost a week in the maternity hospital and here again, all staff were following an established routine regimen of checkups, measurements, instructions on how to care for our baby daughter and tend to her needs, always with a polite reminder to pay attention and remember what’s important. We should have known most of this, given that this wasn’t our first child, yet the whole system is driven by the idea that memory is unreliable and one can always use extra training.
It all went against the intuitive fallacy that each parent knows what is best for their child. Until they don’t. Under stress, we often forget things or make bad decisions, even grave mistakes, most of which can be avoided by creating a controlled environment that prevents risks and reinforces best practices.
I am sure that many lives are saved each year by hi-tech medical equipment and new treatments, yet we are often less aware of simple wonders like perfected workflows. Not only we have witnessed some improvements since the last time we were admitted to the same maternity hospital, but since we had also visited the other one, I couldn’t miss the obvious fact that their approaches were fundamentally the same. Although they strive to treat each mother or couple on an individual basis, the underlying process encompasses a growing body of medical knowledge that is used to achieve the best possible results.
We know we are extremely lucky to live in an advanced country like Czechia and having access to such a high standard of medical treatment (a fact that I’m even more keenly aware of thanks to books like Rosling’s Factfulness and Pinker’s Enlightenment Now). Yet it is also worth mentioning that great medical treatment and care is not only about expensive equipment, but about understanding the importance of having precise workflow management as well.