TABLE 1.

Primary Drivers of Improved Women’s Survival Around Birth and Associated Changes the Participating Hospitals Tested

Primary Driver (what to do)	Changes (how to do)
Create a reliable process to identify patients with suspected LTCs.	Use MEOWS in addition to the standard screening tool for all patients (MEOWS + screening tool).
	Add 2 questions for women with MEOWS (MEOWS ≥ 4 or a single parameter score of 3): Can the patient have an infection (suspicion of sepsis)? Can the patient have HDP?
	Create alert systems for the entire team when suspected LTC is identified through MEOWS ≥ 4 or a score of 3 on any parameter + yes in 1 of the 3 questions or blood loss ≥500 mL vaginal birth or ≥1,000 mL for cesarean delivery.
Provide safe, reliable, and equitable care for all patients at admission, antepartum, postpartum, and discharge.	Ensure the timely rescue of all patients with suspected LTC by competent and trained teams to apply the care bundles.
	Reassess all patients according to bundle recommendations using MEOWS.
	Ensure to escalate the care of all patients with any LTC.
	Train teams to adapt the care considering social and racial inequalities.
Develop engaged care teams with knowledge of how to deal with LTCs, considering social and racial inequalities.	Train teams from all departments to provide clinical assistance to patients with LTCs.
	Promote training in the Model for Improvement.
	Build capacity (process/people) in the organization to collect and publish measures disaggregated by race reliably.
Develop a culture of safety and continuous improvement.	Create highly effective interdisciplinary teams (huddles, SBAR for communication, adverse events analysis).
Develop a culture of safety and continuous improvement.	Engage leaders to promote transparency, fair culture, and quality of care as a high organizational priority.
Ensure that service is co-designed with patients, families, and community.	Engage patients/family/community to co-design care processes.
	Improve transparency in communication with patients/family/community.

Abbreviations: LTCs, life-threatening conditions; MEOWS, Modified Early Obstetric Warning Score; HDP, hypertensive disorders of pregnancy; SBAR: Situation, Background, Assessment, Recommendation.