After a deliberate effort to be more responsive to patients giving birth, The Birthplace at Baystate Franklin Medical Center in Greenfield saw a positive change in feedback about the hospital’s ability to understand their needs. 

While engaged in TeamBirth, an approach designed by Ariadne Labs to improve communication, teamwork and shared decision-making, The Birthplace had become aware of a cohort of patients who felt misunderstood by caregivers. The problem was first recognized by a nurse manager and confirmed through data analysis.  

Helping patients feel understood by addressing health-related social needs 

In 2022, The Birthplace joined eight other Massachusetts birthing facilities in a TeamBirth pilot, which included structured huddles for birthing patients, their partners and care team members. Each patient was provided with a whiteboard where the parents and care team outlined the patient’s preferences for labor and birth, desired comfort measures, and the ongoing care plan for mother and baby. After delivery and prior to discharge, they were asked to complete a 12-question survey about their experience. 

Shirley Hamill, M.S.N., R.N., who became the Nurse Manager at The Birthplace in 2018 after more than 20 years in neonatal intensive care and lactation services at Baystate Medical Center in Springfield, reviewed survey data from TeamBirth facilities across the country. She saw evidence of disparities in patient experience based on racial and ethnic backgrounds. But while entering data from surveys at The Birthplace, Hamill noted that variations in patient responses seemed more likely to be based on socioeconomic status than race and ethnicity.  

“We noticed that most TeamBirth institutions stratify the data by race,” says Hamill. “But we have a predominantly white community here in Greenfield, Massachusetts, so we did not see a huge discrepancy in data based on race.” 

Hamill asked the Betsy Lehman Center, which provides data analysis to TeamBirth sites in Massachusetts, to stratify the survey data by payer—Mass Health and private-pay insurance—beginning in July 2023. 

The results showed a dramatic and previously hidden discrepancy: among a cohort of MassHealth patients who did not receive the TeamBirth intervention, only 33% reported their health care team “understood my background, home life and health history.” In contrast, 71% of patients with private insurance who also did not receive the intervention felt understood by their care team. “We were shocked because we don't know what a patient’s insurance is when we walk into their room,” says Hamill. “Nurses care for all patients in the same way. We wondered, ‘How is it that this population feels like we don't know their home life, health history and background?” 

Hamill was aware of a survey used in the NICU at Baystate Medical Center in Springfield to assess families’ health-related social needs, including food, transportation and housing, which she thought might help The Birthplace to better understand its patients. One goal of the NICU survey was to provide families with resource guides tailored to their needs. Hamill reached out to her former colleagues in Springfield, who shared the survey and resource guides.  

Hamill and a small team at The Birthplace adapted the health-related social needs assessment, which is offered to all patients as soon as possible on arrival at The Birthplace, and a student intern from UMass created new guides based on local resources in Franklin County tailored to the young, childbearing population. The resource guides include a QR code for smartphone access and a link to further information online. 

Results from the TeamBirth survey question about feeling understood improved soon after the social needs assessment went live in February 2024, and the number of patients who have asked for resource guides is growing.  

Baystate Greenfield now requires that all patients be offered the health-related social needs questionnaire, which staff can access in patients’ electronic medical records.  

The Birthplace’s experience with TeamBirth is part of a larger effort to improve maternal health and reduce inequities in care. The Betsy Lehman Center provided data analytics support to Massachusetts hospitals participating in the pilot, encouraging use of the data to drive measurable improvement in patients’ birthing experience and outcomes.