Leveraging partnerships to support large scale adoption of quality and safety best practices

Elizabeth Brandeis – Association of Ontario Midwives
Allyson Booth – Association of Ontario Midwives
Joanna Noble – Healthcare Insurance Reciprocal of Canada

The session opened with a discussion about effective partnerships. Collaboration, shared goals, commitment and respect were some of the responses from the audience about what is required for an effective partnership. The Association of Ontario Midwives (AOM) and Healthcare Insurance Reciprocal of Canada (HIROC) discussed their unique, long-term and mutually beneficial partnership.

The AOM is the professional association and advocacy body that represents midwives in Ontario. Midwifery has been regulated as a health profession in Ontario since 1994; the only province without regulatory status for midwifery is Prince Edward Island. The AOM has a very robust risk management process, and is supported by HIROC. The AOM supports out of hospital births, including at a birth centre or in homes, and these births are covered by HIROC. AOM’s provincial government funding is linked to midwifery birth data and healthy outcomes for home births.

HIROC is a not-for-profit reciprocal owned and governed by the organizations they ensure. They partner with their organizations (large health regions, long-term care centres and midwives), and insure over 1,000 midwives.

Prior to being regulated in 1994, midwives sought insurance due to a sense of responsibility to compensate families who had suffered a loss. The AOM engaged HIROC in 2003, and they have had a very positive relationship over the past 16 years. The AOM submits incident reports and claims to HIROC for critical incidents; this information is useful for assigning a dollar value as well as a base of knowledge. Midwives are diligent about reporting data. HIROC and AOM’s relationship extends far beyond insurance coverage; it has led to risk management collaboration activities that are at the heart of the AOM-HIROC partnership.

According to research from the AOM, key elements of collaborative partnerships include a shared vision, a clear relationship between partners, working as learning organizations and thinking about the complex healthcare system using a lens of shared thinking. HIROC believes in partnering with organizations they insure, and working together to develop a shared vision. HIROC has a deep understanding of midwifery, and can provide a national perspective on healthcare issues. Midwives advocate for giving clients choices; clients are placed at the centre to promote the highest and safest quality of care, and are fully supported by HIROC to facilitate this model of care.

HIROC’s risk assessment checklist ranks data by claims cost to provided evidence-based information for the top 30 hospitals and the top 10 list of patients (for midwifery data). A risk reference sheet is created for each case to summarize case examples, literature and mitigation strategies for the future. These most impactful mitigation strategies rooted in evidence-based strategies are vetted and uploaded into the risk assessment checklist tool. The AOM was the first group of midwives to participate in this program.

The AOM and HIROC’s relationship has evolved over time due to committed individuals, collaboration on risk management activities (i.e. co-creating tools together) and working toward shared goals. Both organizations are committed to being great organizations; this common ground has resulted in a partnership because key stakeholders are willing to learn, collaborate and foster trust. For example, HIROC’s first iteration of risk management sheets required many revisions by the AOM to reflect the values that midwives hold.

HIROC has a great deal of respect for midwives; HIROC respects the concept of informed choices, birth location and that midwifery will continue to grow and evolve.

The AOM changed its constitution to include Indigenous midwives in 2017 to have Indigenous midwifery programs funded and supported by the Ontario Ministry of Health. There were insurance implications related to this change, and one of the distinct differences of midwives regulated by the College of Midwives and Indigenous midwives (practicing under an exception to these regulations) was the level of regulatory oversight. The AOM was pleased that HIROC undertook the challenge to create a new model to provide coverage for Indigenous midwives.

HIROC is pleased to provide adequate insurance for the AOM as midwifery practice needs change and continue to evolve. Hospitals and midwives are insured differently; midwives are insured as independent practitioners. The AOM sees data as “their friend” because funding and best practices are tied to data collection. Due to the AOM’s collaborative relationship with HIROC, they do not fear sharing data with HIROC because it benefits both organizations.

Data is also used to drive quality improvement in the practice of midwifery. HIROC presented the top 10 risks in midwifery to AOM annually. This information aided HIROC in developing resources, including facilitating nine regional workshops across Canada. The AOM had over 90 midwives participate in nine regional workshops dedicated to increasing safety, mitigating risks and sharing best practices last year.

The strength of the partnership has been fortified by working together through growth and ambiguity. HIROC and AOM consult regularly to ensure they are making sound decisions based on facts instead of assumptions. The reciprocal support for each organization is evident. For example, a leader within HIROC is an AOM board member. 

The financial barriers of the HIROC-AOM partnership works very closely together to mitigate challenges. Roles and responsibilities are clearly defined, and both organizations are transparent about how funds and resources are allocated.

In the early days of the partnership, AOM respected the fact that HIROC was willing to learn about midwifery as a profession, regulated midwives, Indigenous midwives and informed choice beyond providing insurance coverage. HIROC approached the learning curve with humility with a genuine desire to learn about and support AOM. HIROC has been the platinum sponsor of the AOM’s annual conference, and midwives can clearly see that the AOM and HIROC have a supportive, reciprocal partnership. Prior to midwives graduating into the profession, there is a presentation about insurance and HIROC’s coverage and support for midwives in Ontario.

HIROC and AOM’s partnership is an excellent example of how two organizations willing to work together respectfully and collaboratively in the healthcare sector has improved the overall quality of care, risk mitigation and safety in midwifery. 





Report written by: Julie Ferlisi, The Write Approach Professional Services

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