Quality Management Program
Engaging in activities which strive to encourage continuous quality improvement is a public demonstration of the midwifery profession’s commitment to reflective self and peer evaluation with the goal of providing safe responsible family-centered maternity care. The Quality Management Program (QMP) is a state sanctioned and legally protected program, established by MAWS in 2003 and administered by the QMP committee, whereby midwives can, in confidence, freely discuss and be supportively evaluated by a group of their peer midwives, safe from subpoena or legal inquiry. The protected safe space of Peer Review and Incident Review enables midwives to freely discuss clinical cases with their peers providing them with an opportunity to improve their practice and future outcomes.
Two branches of the QMP program provide mechanisms for quality improvement:
- a) Peer Review which each midwife must complete on a regular basis every 2 years with at least 3 other professional MAWS members (ie midwives practicing legally in Washington state), and
- b) Incident Review which is organized by the QMP committee and is conducted by a specially convened panel whenever an outcome occurs which meets “Sentinel Event” criteria.
The Peer Review Process is a routine retrospective educational review of 5 clinical cases, every two years, by at least 3 other professional MAWS members, to provide peer feedback, identify areas of practice needing improvement, and maintain a high standard for the midwifery model of care and the profession. Peer Reviews may be initiated and organized by any MAWS member after contacting a MAWS Regional Representative or MAWS staff member or they may be conducted at the regional level, coordinated by a Regional Representative. In addition, statewide “All Region Peer Reviews” are generally held twice a year in conjunction with MAWS conferences. Strict confidentiality must be maintained at and regarding Peer Review.
MAWS members must complete Peer Review on a regular basis every 2 years with at least 3 other professional MAWS members (ie midwives practicing legally in Washington state) to maintain their MAWS membership. MAWS Peer Reviews also qualify to meet the requirements for JUA liability insurance held by many LMs practicing in WA state.
The Incident Review Process (IRP) is a procedure by which the process of care leading to a particular outcome (“sentinel event”) is reviewed. The IRP is designed to be a supportive process through which midwives hear constructive feedback regarding their own protocols, procedures and practice guidelines and the general standards of care in the community. The Quality Management Program (QMP) committee determines if a self-report or a complaint meets criteria and warrants review.
If a self-report or a complaint meets criteria and warrants review, the QMP committee organizes a panel to review the case and report their findings and recommendations to the committee. The committee then interprets and summarizes those findings to the midwife, and in some cases asks the midwife to submit recommended revisions of policies or practice guidelines, attend continuing education on particular topics, and/or organize additional peer reviews beyond what is required by MAWS (or the JUA). Rarely, the committee may be obligated to report certain situations to the Department of Health, according to guidelines in the QMP document submitted to the state. This document accepted by the DOH is what enables Incident Review to be protected space safe from subpoena or legal inquiry. The protected safe process of Incident Review enables midwives to freely discuss clinical cases with their peers providing them with an opportunity to improve their practice and future outcomes.
The QMP committee is a volunteer group of professional MAWS members, which meets regularly to track peer review reports, via a summary submitted with ideas for continuing education, and to review midwives’ self-reported incidents and /or complaints from clients, providers, family members, or the general public.
As a MAWS professional member, each midwife agrees to: 1) participate as a panelist on an Incident Review Panel when called upon to do so, 2) maintain strict confidentiality whenever participating in Peer Review or on an Incident Review Panel, 3) turn in a self-report within 14 days if any of the “sentinel events” occur.