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Join us as we dive deeper into the rising severe maternal morbidity and maternal mortality rates in the United States through a data-driven, quality improvement lens. Each episode will foster discussion with those committed to improving maternal health outcomes and saving lives.
Christie - 00:00:05:
Welcome to Aim for Safer Birth. I'm your host, Christie Allen, Senior Director of Quality Improvement and Programs at the American College of Obstetricians and Gynecologists, or ACOG. On this podcast, we dive deeper into the rising severe maternal morbidity and maternal mortality rates in the United States through a data-driven and quality improvement lens. In this episode, I'm talking with Audra Summers and Ashley Rainey about how they're using the AIM patient safety bundles to sustain change and quality improvement in Indiana. Audra Summers' passion is to improve healthcare quality. Audra served in both state and private sector roles, including maternal child health clinical coordinator for the Indiana Department of Health, quality improvement manager for state Medicaid, and quality improvement associate director for a state Medicaid health plan. Audra specializes in employing data-driven quality improvement methodology and interventions with a strong commitment to promoting equitable healthcare for all. Ashley Rainey attained her associate science and nursing degree in 2011. She subsequently began her labor and delivery nursing profession in Indiana, and throughout the years, Ashley has developed a deep-seated passion for perinatal care, which has led to her serve in her current role as a maternal child health clinical director for the state of Indiana. In this capacity, she performs various functions to promote the clinical practice of the 77 delivery facilities in the state. She remains involved with the A1, or the Association of Women's Health Obstetric and Neonatal Nurses nationally and locally, and is currently seeking her PhD in nursing research at the University of Wisconsin-Milwaukee. You are two busy, busy folks, and it's such a pleasure to have you today. Thanks for joining.
Ashley - 00:01:37:
Thank you for having us.
Audra - 00:01:38:
Thank you.
Christie - 00:01:39:
I think first, we're talking about sustainability today, and that can mean a lot of different things to a lot of different people. So I'm wondering if we could start with sort of your experience with the inpatient safety bundles, and then we'll get more into sustaining the work. Most of our audience is somewhat familiar. They're listening to an AIM podcast. They may have some history with AIM and they may have some basic understanding of the bundles. But it's a little different the way we do bundles in every different setting. So Ashley, if you could tell our listeners a little bit about your work with the AIM patient safety bundles being implemented in Indiana, I think that would give us some great context.
Ashley - 00:02:14:
Sure. Thank you so much, Christie, for that. So Indiana is very unique in the way that we, one, develop our bundles and implement our bundles. We use a three-legged stool approach. I work for the Indiana Department of Health, and we fund our Indiana Perinatal Quality Improvement Collaborative. And then we also partner with our Indiana Hospital Association, where we then allow and work with IPQIC, is who our Indiana Perinatal Quality acronym is. They really foster the different subject matter experts who leverage the bundles, look at them, analyze them, and then work to develop the different processes for each R. The Indiana Hospital Association helps us with the discharge data to support the different initiatives, as well as help to identify certain components when we're talking about the blood loss and severe morbidities. And so we really leverage all three to be able to make the bundles possible once they're developed. The maternal and child health team, we then work with the hospitals to implement those bundles. And so we then host webinars. We look at the data. We do a lot more partnership with the hospitals at that point in time. And then it continues to allow us to be able to identify areas of improvement to have quality outcomes.
Christie - 00:03:36:
Got it. So you all are really putting the collaboration and collaborative. It sounds like, you know, we talk a lot on this podcast about what it takes to drive change and quality. And we know it takes, I always joke about a village and beyond the village, and it takes all hands on deck, right? So I love hearing that you are doing that in Indiana. So that's amazing. Audra, I think we'll move to you. I'm wondering if you can talk about why sustainability and sustainment of the inpatient safety bundle. Has become a priority in Indiana specifically.
Audra - 00:04:07:
Sure. Sustainability has been a hot topic. We actually implemented the OB hemorrhage patient safety bundle in 2019 and the severe hypertension in pregnancy patient safety bundle in 2021. So teams have done an amazing job through the pandemic and those challenges to demonstrate process changes. They've been implementing structure measures and now they're coming back and saying, Hey Audra, some of us are wanting to move on, right? And also, with all of the requirements for implementation, it makes it hard to move on to other patient safety bundles. So. What we're hearing from the hospitals is now sustainability feels like it's starting to be reflected in unit DNAs. So by that, I mean that these processes are part of the way they do business. They're part of the structure and the flow of the unit. So now we're moving from implementation to sustainability. And what does that look like?
Christie - 00:05:15:
Okay. So I'm going to talk a little bit about some of our broader focus outside of Indiana, because what you're talking about is what I think everyone's dealing with. The point of the bundles is not to do a bundle, check it off and move on. And I talked about this with Dr. Elliot Main this season. I've talked with other folks that we've had through. The goal is to have this be continuous quality, but continuous quality doesn't mean that the bundle is continuously being implemented at the level it is when you first start, right? Like all quality improvement, we kind of start up here, like way up, and then we ratchet down as it, you said the unit DNA. I love that expression, but it's like integrated into just best practice. And it's just accepted as best practice. And I think I've used the example before of hemorrhage carts. When I was practicing in labor and delivery, we didn't have hemorrhage carts. And now it's very odd if you go somewhere and they don't have some sort of combined area where the hemorrhage supplies are. It's just accepted as the norm. So that's sort of what I think you mean by DNA. Am I right?
Audra - 00:06:13:
Correct. And you're right. How do we go from implementing all of our PDSA cycles, gathering all that data? Evaluating if we've met our goals, and how do we sustain those goals? Because often what happens is if you let off the gas pedal, then the risk is that we're going to go backwards. So I think that's where you're going, Christie, too, as far as part of that quality control cycle that naturally follows quality improvement. And how do hospitals make that change? Knowing that quality control doesn't mean we stop all quality improvement activities. It means that we're monitoring and we might have to do some mini quality improvement activities to maintain our gains if we see that something is slipping. So we're always monitoring. We don't say, okay, checkbox, on to our next project. But we are also looking to see, are we maintaining the gains? Did something change? Maybe we move to a new EMR system. How does that impact what we're doing with our patient safety bundle? So staying current and making sure that we're monitoring internally.
Christie - 00:07:31:
So what I'm hearing is external factors and internal factors, right? Like we know we've seen some of this, and I'm sure you guys can build on this. But the advent of COVID, as you mentioned, the COVID pandemic, a new EMR, staffing turnover. You have a wonderful batch of new and enthusiastic nurses come in, but they weren't there with the initial quality improvement change. I think, Ashley, you're nodding, and I know you're at the bedside. You know, nursing is a great champion for this, but if you don't have the grounding and context, how do you maintain that? Because we can't just run quality on passion, right?
Audra - 00:08:05:
I wish we could.
Christie - 00:08:07:
Wouldn't that be nice? Wouldn't it be nice if you cared enough, things automatically got better? It's a piece of it.
Audra - 00:08:12:
I think a lot of that goes down to unit culture as well. And do you have the support? Are the frontline staff empowered to make recommendations, say, hey, this isn't working the way it's supposed to? Are those frontline managers monitoring to help ensure new staff have the training that they need? Are we doing simulation to help ensure people are keeping their skills up? So there's a lot of things that we can do just from a cultural perspective and helping sure that people have a voice in the process and they stay engaged.
Christie - 00:08:48:
I love that. The engagement is always a struggle, right? We all have different reasons, internal and external drivers, right? I'm always going to go to the quality pieces, but that we stay engaged or not. You know, not everyone shows up to work every night being ready to do QI. Sometimes you didn't sleep well, or you have family considerations, or, I mean, there's so many reasons. I think we're seeing some of that with climate change emergencies outside of hospitals, evacuations, those, I mean, talk about something that's going to disrupt sustainability and process improvement, but it can be something as simple as a new attending joins, or there's a new, you know, clinician working with that night that you're building teamwork with. Ashley, how have you seen sustainability be addressed specifically across hospitals and other care settings, sort of at the bedside in Indiana?
Ashley - 00:09:36:
So I'm actually really unique because although I have a history of working at the bedside, I'm currently working at the Department of Health. And so what I really do is I oversee some public health nurse consultants who really do the work with our perinatal levels of care. And so what we have identified is the opportunities where we're able to look and see, OK, who is doing QBL? How many of their deliveries is having QBL conducted? Where is it taking place? Is it solely in vaginal deliveries? Is it in the OR? Is it in both? Also, how timely are they treating severe hypertension in pregnancy? Are they utilizing the protocols? Are they taking the initiative and utilizing that protocol of, hey, this individual's blood pressure is 160 over 120, right? And instead of me delaying care, I am following that protocol and then following up with the provider. I can tell you that we've seen the modifications particularly during the time of COVID, right? Where. People were worried. They didn't know, you know, how soon are patients going to be able to stay in here? The objective is to get them home. And so we've seen unique advances where many providers were trying to go to that more independent practice in implementing those different call orders of when to call me, when to be able to get those labs drawn if we're seeing some sustainability with their blood pressures. And so what we've identified is, as you stated and as Audra stated, the numerical value in our hospitals with that timeframe of submitting timely data and to support them if they couldn't do simulation, then my team and I took a point of offer education so we can still identify those areas so they could be able to maintain that adequate steps of doing QBL and doing risk assessments and identifying the gaps if they didn't have the capacity, right, to do that on their own because now it's all hands on deck situation and even with us doing that to assist them, it has assisted us as a state to be able to look and go, we are continuously ranking in that 85, 95% when it's talking about QBL or risk assessments. And that alone has allowed us to look and say, okay, IHA, are you seeing the same thing? And the reason why I say that is because IHA also has an Inspire Award. And so they also support us by looking at the different areas of the AIM data and saying who's reporting at least 85 to 95% of the time on this metric in timely data and timely entry. And then they're recognized at the end of the year too. So I feel that that sort of recognition also has helped push our hospitals to ensure that they are meeting that sustainability. And this has been a woven aspect of their culture.
Christie - 00:12:24:
Amazing. So many pieces that I would love to go down a rabbit hole with you on there. So I want to talk, Audra, about data and the role that it plays in just a minute. But I'm actually hearing something you're talking about, Ashley. And we had another episode this season where we talked to two folks who had implemented maternal early warning system in the hospitals across their state. And one of the core components of that was when they had a nurse available within the clinical setting, those nurses were watching to see if that was being run. And I joked at the time that it was like a true rapid, rapid cycle process improvement because we were doing it in real time. But you're kind of talking about the same. And I think that human component to QI of getting eyes on and having folks take leadership is a theme that I'm hearing in a lot of different implementation settings, which is incredibly interesting to me and is something that has got my brain going. I also hear you saying QBL, and I want to be clear because not everyone listening might know what that is. We're talking about quantitative blood loss. So that is instead of eyeballing blood loss at a delivery or during a surgery, which is the traditional practice. And we've done that for many years, but it's somewhat subjective. Instead, we're quantifying it. So we're measuring it somehow. So just to make sure we're all on the same page with that. Okay, Audra, back to data. So we know that data plays an important role in sustaining gains, right? And data is a lot to stay on top of. We just heard Ashley describing sort of different checks and balances in the data from like real time to the Department of Health to Hospital Association. And I love that, that sort of safety net of observation of the data. But what role do you feel like it plays in sustaining gains from quality improvement? Can you talk about why that data is so critical to the work?
Audra - 00:14:07:
You won't know if you're sustaining your gains if you don't have data. It's the bottom line. When we're doing quality improvement work, we can't make assumptions. We have to use data. What you'll find is if you have four people and you ask them the same question, Everyone will come up with a different answer if they're not looking at the data. So you want to make sure that you're measuring so you can inform your senior leadership team so that you can give feedback to your frontline staff who are doing the work. And the other thing we haven't talked about, but what I feel is very important, is that we start putting some emphasis on using formal QI methodology when working with the hospitals and the units and really providing them or encouraging them to obtain some QI methodology background so that we're all speaking the same language so that when we're working and doing our TA calls, that we all have that foundational language of quality improvement. Because what I've heard is that some of the folks doing the work in the hospitals are nurses and they do a great job. But I didn't have a lot of QI in my training when even in graduate school. Did not have a big QI class. I think now some of the programs are getting a little bit better and including that. But we need to arm this generation of nurses with the skills to do this work and do it well. And when we do that, then they'll see the importance. They'll understand more about what we're showing them. And they'll be able to carry this forward. Without data, we won't be able to do any of that.
Christie - 00:16:04:
So real intentionality around the frameworks that we use to generate that data. Absolutely. No, I've definitely talked about that in the past that I don't think most of us get trained in QI methodology. We're just like, oh, we're doing this thing. Okay, we're doing the thing. And you might not even be told it's QI. Ashley, go ahead.
Ashley - 00:16:25:
I was just going to add to what Audra stated. One of our hospital leaders, we just had a perinatal center retreat. And that was time where we brought together our big sister facilities to discuss data and areas of improvement. And one of the leaders made a really great point. And it was a statement. And she said, without data, you're just another person with an opinion. And that's so true, right? And we are eyes open. We're like, that's so true. And so data tells a lot. It tells a lot about what's taking place on the unit. It tells a lot about what is the issue with adopting best practice. Is it a cultural thing? Is it a lack of education? The why behind it, right? And so we really are trying to utilize data to tell a better story about each individual hospital. And Audra has done a great job since joining the team of being able to look at the data individually, that data individually, and find those areas that says, hey, you are doing a great job in this area. So I feel we can sustain, put this area in sustainability. But yet there's still this area that we need to focus on. So when we talk about sustainability here. In Indiana, it doesn't mean that every part of the OB hemorrhage or severe hypertension is in sustainability. That means there are areas that you have demonstrated competency and that you're doing really well. So let's put that focus, not only maintain it there, but let's drive that energy to this other area within this work that you can also be doing really well or doing a lot better.
Christie - 00:17:59:
You're describing data-driven, right? And I'm kind of laughing as you do that because we use these buzzwords and we throw them around, evidence-based, evidence-informed, data-driven. We all love that. But real data-driven isn't always pretty. It's constantly looking. And Audra, I heard you mention giving senior leaders the data so that they can inform frontline staff with feedback. But it isn't just when things aren't going well. No, it's to check that next step in there, to look at your next step for that methodology, right, where you go forward using that data.
Audra - 00:18:32:
Yeah. So I think it's important to keep senior leaders abreast of your QI project implementation. And there's a couple of reasons. One is obviously these projects were put in place to address a concern. Right. So we want to make sure that we're giving feedback on that. And then it's also important to keep them informed on what additional resources or what barriers are the teams running into so that your leaders can help address those problems. They can help with those sorts of things. If it's additional training, if it's something specific the teams need, they can help to remove some of those challenges and barriers. And some of the best QI work comes from sharing, we tried X and it didn't work. And we learned from that though, right? And we're flipping that around. We're trying something different. And now we'll come back in two weeks and tell you how this new change happened. But I don't look at PDSA cycles that did not result in what we thought they would result in as a failure. I look at that as, oh, we learned something else about the problem. And if you look at it and stay curious and try to understand what's driving those changes, what's driving the results. Then it's just another data point. And then that almost takes some of the pressure off the team to be perfect. And really get into that curiosity and learning mindset.
Christie - 00:20:09:
So you're describing a little bit there of a just culture, this idea that it's systems and structures that lead to the breakdown, which we know in QI and quality improvement, it isn't individuals that are bad actors the majority of the time. It's the process, the structure, the barriers. We know that's also true around some of the bias and the inequities leading to disparities that we see in outcomes as well. And I do want to talk about that in just a moment. The other thing I want to highlight is that what you're describing has data behind it. There's a wonderful article that I think we'll link to with this episode about engagement with leadership driving rates of severe maternal morbidity down. I believe that's Dr. Howell who did that work. And it shows that that engagement with senior leaders, and I'm not talking about your chair of your department. I'm talking about the advocates at the top, the CNO, the chief nursing officer, the CEO of the hospital. They don't need to have a clinical background to support the resources and making things available and to really drive that change. And I do think that's a critical component that we don't think of in the sustainability. We think about sometimes like the initial engagement when you're trying to sell people on doing this. But then I think there is a tendency, especially for folks that aren't in QI and don't think of it as continuous quality improvement. We did the thing. We did a hemorrhage bundle. The unit's good. And I think this really highlights for me the importance of engaging them in the knowledge that sustainability is. It's forever, not at the same intensity, but it's going to keep going, right? I see you both nodding. I want to, though, circle back because I just mentioned inequities leading to disparities. And I want to ask, maybe this is both of you. Y'all are welcome to decide who answers. But how do you think that respectful, equitable, and supportive care can continue to be addressed or uplifted through sustainability practice? We know this is fundamental to quality. We know there is no quality without equity, and there is no equity without high-quality care, right? Those are fundamental. We're going to agree on as a group. How do you see the role of sustainability and also sustaining that open to any thoughts you have.
Ashley - 00:22:16:
I can kick us off. So for us, one of the big things that we have done in Indiana, as I stated, we are continuing to collaborate with the Indiana Hospital Association. And they recently developed a new dashboard where we're able to look at our data, discharge data at a closer lens. And so that gives us, you know, pay source, it gives us race and ethnicity, it gives us jurisdiction, so many key components when you're talking about respectful, equitable care. We're also looking at the AIM data to look and say, okay, where are, you know, where are our areas within our state that may be impacted more by a different culture, right? And so how do we give more targeted education so that they have the resources they need when they're managing an individual who may be impacted by severe hypertension, particularly if you have a culture who's not receptive to medication or coming to follow up. Indiana has a very large Amish population. And so we're trying to identify how do we provide that ongoing education so that they know when to have timely follow-up or to come and see their provider. Additionally with us, Indiana is a part of the preeclampsia blood pressure program and trying to ensure that we get blood pressures in many different educational resources and tools based on the individual diagnosis and needs as well. So Audra, I'm not sure if you want to add additionally to that, but we're really trying to highlight those areas of opportunity that meets our community needs.
Audra - 00:23:53:
Yeah, Actually, those are great examples. And one of the things I always go back to is we've been awesome about implementing these blanket interventions across populations. What we haven't been so good at is drilling down to the community level, to the zip code, to wherever, to really understand. What do folks need? What's driving some of these things in these communities? And then work to address those. Because these blanket interventions, I think folks will agree, will only take us so far. And until we drill down and really understand what the data is telling us, we're not going to move the needle where we want it to go. So it's looking at those subpopulations, working with those communities, understanding the lived experience of individuals in those communities. Those are some of the ways we can move this project forward. Otherwise, if we keep throwing blanket interventions, all we're going to do is throw paint against the wall and try and get a fly. We're not going to be targeted. So. Drilling down is important.
Christie - 00:25:11:
I think that makes me think of something that I know Dr. Gillespie Bell, Veronica Gillespie Bell from Louisiana, says a lot of times when we're talking. I believe she said on the podcast when she talks with me. And it's about, you know, we're standardizing care, but it isn't that we're doing the same care for everyone. It's we're doing the same high quality standard of care. And that means. One of my favorite things to say, meeting people where they're at, right? And whether that means trying to figure out how to run a piece of equipment on a farm that does not have electricity. And I've done that as a nurse trying to figure out how we're going to have a breast pump working on a farm that doesn't have electricity for a number of weeks or something like that. But we can do that. None of these are insurmountable, but it does take some thoughtfulness and outside the box thinking, which isn't always the major genre in QI. We do like standardization and I do think it's that mental shift from standardizing blanket, as you say, interventions to the blanket intervention is we need to give everybody that high level of care with the same expectations of what people should be able to achieve. And that's closing those disparity gaps by truly drilling down. I really like the way that you're talking about approaching that in Indiana. I'm wondering, you know, Audra, in your view, what the next steps are for PQCs or perinatal quality collaboratives and anyone else who's implementing AIM in sustainability. Y'all are talking about how you're doing it, and I love how Indiana's approaching it. And we have some really good key concepts in that. First is the understanding that we need to sustain change. I mean, that is tricky for some folks and not just checking boxes. But are there any core concepts that you would encourage a PQC or a group of folks to really lean into as they're trying to create sustainability in their work?
Audra - 00:26:57:
Sustainability doesn't just happen. You have to plan for it. So. Having facilities think about their plan. Whether it's using a tool like IHI's MoCA sustainability worksheet or helping folks build their bench strength with QI methodology, helping people transition through maybe less frequent data submission, but still monitoring to help ensure that they're maintaining that high quality care. But have a plan and think through who's going to be responsible for this. What are you going to continue measuring? Those are things that need to be planned up front. And who is going to do the work? How does this impact your current workload? How do you make it easy for people to do the right thing and make it hard to do the wrong thing? What systems changes still need to be implemented? Because... We continue to learn, science continues to evolve. So how are you going to keep up with all this? So I think those are the key things that as I think about sustainability, it's... Planning for the future, making sure folks have the skills needed to do many QI cycles, because we all know things are going to backslide. Just make that assumption. So make a plan for that and then understand what you're going to measure.
Christie - 00:28:31:
I love the idea of equipping people to run their own. QI cycles. I think I did some of that as a nurse myself without having much knowledge of QI. I'm being a little facetious, but I did like, okay, why don't we try this to see if the patient gets better sleep tonight? We all do stuff like this in our practice at the bedside. Ooh, I had that patient last night and we dimmed the lights at about nine, but they really never got to sleep. It took a while. Why don't we go a little earlier tonight? I do this, I joke that I do QI cycles in like every aspect of my life, whether it's pet care, childcare, running my house, running my life. But I think empowering people with the understanding that it is a framework is a really simple, but maybe revolutionary thought versus us telling people it's us giving them the tools and then supporting them. And Ashley, I don't know if you have anything you want to add to that.
Ashley - 00:29:19:
Yeah, I was just going to add, echo what Audra said. And I think for me, it's really important to have the right people at the table, right? When you're talking about sustainability, it's not one particular group of individuals' responsibility. It is everyone. And so I'm thinking about even your CEOs, your CFOs, those individuals. It's really important because that plays a big factor in the buy-in because you have to understand when you've had a culture so much of we're going to do this. And then when they stop, the focus is no longer there. As Audra said, people want to go back to their same behavior because they feel, well, no one's watching, right? And so what does that look like? And then I think the other thing is making sure that if you're going to look into QI, you're equipping the people with the same knowledge. As Audra and I both say, it wasn't until really we attended the IHI Breakthrough Series that it allowed us to be able to move forward even as a team because we were speaking the same language. We were able to come into meetings and say certain acronyms and knew exactly what we all were talking about. So when you're talking about sustainability, you have to ensure that your entire team has bought in to that and that they're speaking the same language. And if you have changes in team members, understanding where their level of knowledge is and then getting them up to speed to be able to move the project forward.
Christie - 00:30:44:
I know that a guest that I talked to earlier this season talked about resident training as residents were coming into academic settings and that they have a quality and safety sort of onboarding. And I love that. I love also, I know in Oklahoma, the Oklahoma PQC does some really amazing work at onboarding perinatal nurses across the state. And those are states that do some really robust, impressive QI work. And I think that gets overlooked. We don't always equip everyone. We have the QI specialist and we forget that like the nurse is the person doing the element or the physician leader or the midwife, or sometimes it's environmental services that are helping us move things forward in a hospital and are critical, but we're not telling them what we're doing. So between the communication and the education, there's some kind of synergy there. I think I'm hearing.
Ashley - 00:31:32:
Absolutely.
Christie - 00:31:32:
All right. So with that, this season, we've been asking people about the one thing. So I want to ask both of you. I'll start with you, Audra. Is there one thing that you would want to leave our listeners with about the work you're doing in maternal care in general or about sustainability? If there was one takeaway for folks today.
Audra - 00:31:52:
Don't assume. Don't make any assumptions. Ask questions. That curiosity factor is going to be key to move this work forward. And if you come at a problem with a mindset of curiosity and understanding all the drivers and what's inputting into that problem. Your work will be so much more robust and meaningful. And I think for folks maybe new on their QI journey or new to AIM, just stay curious. I think that's the advice I would give.
Christie - 00:32:32:
That's great advice. I think curiosity, we say it gets people in trouble, but I think it's actually gotten me out of trouble more often than not. Ashley, what's the one thing you would want to leave folks with?
Ashley - 00:32:44:
For me, I say start with your most quietest person first. They are typically... Filled with amazing ideas, but we often go to the loudest people first, instead of going to those who don't typically say much because they're usually examining and seeing areas of opportunity that has never been spoken. So don't be afraid to tap on those quiet people and look and say, hey, you want to lead this project or assist with this project? You may be amazed how far you get.
Christie - 00:33:11:
I love that. It's that sort of stepping up, stepping back thing we talk about sometimes as we lead work, even in equity circles. You want to make sure that everybody has space to be heard. I think that is another core concept that it takes. Everyone. And it's not always the person that's at the front of the room doing the chit-chatting like we are today. Well, thank you both so much for joining me here today to share your important work. I really appreciate your time.
Ashley - 00:33:37:
Thank you for having us.
Audra - 00:33:38:
Thank you. It's been a pleasure.
Christie - 00:33:44:
Thanks for tuning in to Aim for Safer Birth. If you like the show, be sure to follow wherever you get your podcasts so you don't miss an episode. To get involved in work related to addressing maternal mortality, be sure to check out the Alliance for Innovation on Maternal Health at saferbirth.org. Together, we can work towards safer births and healthier outcomes for all families. I'm Christie Allen, and I'll talk with you next time on Aim for Safer Birth.