Guest post by Ariel Herrlich, MA, Executive Assistant at Childbirth Connection.
The movie Moneyball has been a recent box office hit, inspired by the true story of how Oakland Athletics General Manager Billy Beane went against baseball orthodoxy to create a winning baseball team. Facing baseball’s elite teams on a fraction of their budgets, Beane realized that the A’s couldn’t compete if they played the same old ballgame. When I saw the movie recently I was startled to see a considerable amount of thematic overlap with the issues currently facing maternity care.
In the movie Billy Beane turns to a young Yale-educated economist to help him draft players that can win games without huge salary demands. Instead of valuing the qualities traditionally upheld by baseball scouts and management, they rely on statistical analysis, much to the chagrin of scouts, the head coach, and sports commentators around the country. But at the end of the season the underdogs from Oakland demonstrate just how successful this tactic can be.
So how exactly does this relate to maternity care? First, disclaimer: I recognize that the differences between major league baseball and maternity care are vastly more numerous than are any similarities. But in this country baseball metaphors permeate every facet of society. Why should maternity care be any different? A few lessons to take from Moneyball:
- If you can get the same results for less, do it. In 2002 the Oakland Athletics and the New York Yankees both won 103 games. The Yankees spent over $125 million on player salaries while the Athletics only spent $41 million. This comparison forces one to wonder is the $84 million differential pure waste? Efficiency is important in any system, major league baseball and maternity care alike. In maternity care, the literature shows that overuse of medical intervention drives up costs without improving outcomes, and sometimes even makes women and babies sicker. Effective strategies to rein in such overuse can improve quality and value simultaneously.
- Numbers matter. In baseball, players may be overlooked because of their personality, age, injuries, or other considerations, but Moneyball tells us that statistics are the strongest predictors of winning games. In maternity care, women can overlook high quality care because of appealing advertising or overlook a provider because of the degrees after her name, but the recent performance of a hospital or provider is a much stronger predictor of the quality of care a she can expect. That is why performance measurement is crucial to ensure high quality and value in maternity care. The Leapfrog Group is keeping tabs on hospitals by publicly reporting their data on early elective deliveries. We need more performance measures to be collected and leveraged in this way.
- Change is hard. Resistance is to be expected when any perceived outsider makes new claims that could threaten the authority and autonomy of seasoned veterans. At the end of Moneyball, the owner of the Boston Red Sox approaches Billy Beane and, having seen the backlash to his unorthodox methods, explains, “In their minds, this is threatening the game. It’s threatening the way that they do things.” It is important to keep this in mind when thinking about maternity care. Even when reform is needed and change is good, it can cause those who are comfortably entrenched in the status quo to be wary. One of many examples is the highly sensitive controversy over home birth, a growing trend. Some of those who oppose home birth do so because it looks nothing like the hospital based medical model for maternity care. The willingness to meet women’s demand for safe, integrated home birth services requires courage and conviction on behalf of all stakeholders to come together and build solutions. The recent home birth summit was a historic step in the right direction.
Quality improvements in maternity care are so very needed and important, and working to achieve these improvements can be all consuming. But if we don’t take off the blinders from time to time, we won’t be able to learn from the struggles that others have overcome in their respective fields. As long as we keep our eyes on the ball, long-lasting meaningful maternity care reform will be achieved.
Ariel Herrlich, MA, provides administrative and project management support to Childbirth Connection’s Executive Director and senior program staff. She graduated in 2010 from the George Washington University with a combined undergraduate and graduate degree in women’s studies and public policy.