Leaders can be literal life savers

Lan Bentsen tells the story of how a group of leaders with close relationships came together for an incredibly important project: reducing infant mortality in Houston hospitals.

During the mid 1980s, the infant mortality rate in their community—12.5 per 1000 live births—was about thirty percent above the national average, and almost twice the Surgeon General’s Year 2000 goal of 6.5.

Bentsen knew that his community could do better. From his time as a March of Dimes volunteer he understood that the failure of responsible agencies to coordinate their services was a major cause of the problem. He describes how mundane missteps often led to terrible outcomes:

A high-risk pregnancy patient diagnosed at a city clinic would be handed her records and told to go make an appointment with the county hospital. If she were, say, a 15-year-old, she would likely never get there for any number of reasons—fear, loss of records, inability to get an appointment after working hours, lack of bilingual operators, lack of a “hot line”—all manageable circumstances, assuming cooperation. Left alone, her high-risk conditions prevailed until she went into labor, too often with disastrous results.

ALF Houston Class 3 offered to intervene. We felt a community-wide effort would be required to overcome the inertia of the two agencies. Because the subject of prenatal care in those days had become linked with extenuating social issues, we knew all parties that could “veto” the effort had to be involved. In particular, the March of Dimes and the faith community had to come to the table.

To broaden the collaboration, the ALF class members recruited thirty other community organizations with a range of views on health issues. A mission statement was defined, step by laborious step. Our ALF training had taught us that no step could be taken unless all parties agreed. Confidence grew. Respect for values was developed. Misconceptions were identified and clarified. The ALF collaboration approached the city and the county with a request to implement the changes. All leaders agreed that the steps and recommendations were reasonable and desirable.

But somehow nothing seemed to change.

The ALF collaboration then turned to the media, which was suitably impressed with the breadth and depth of the collaboration and its mission. Media cameras entered the clinics asking to see the (nonexistent) multilingual hot-lines for making appointments. The newspaper tracked on the front page how long it took to get an appointment with the county system for high-risk city pregnancies. The television stations visited the “baby cemetery.” The public pressure was unrelenting.

Things changed fast at that point. Systems were integrated quickly, because they had already been designed and funded. Clinics opened on evenings and weekends. Patient records were hand-delivered and appointment reminders were sent to patients. The bus system offered free passes. And the high-risk city pregnancies began to get first-trimester care.

Within three years, infant deaths dropped from six hundred to three hundred per year in the city and county, even as the local birthrate continued to increase dramatically. Houston achieved its year 2000 Surgeon General goal of 6.5 infant deaths per 1000 live births in five years, ten years ahead of schedule.

As it happened, the lieutenant governor of Texas was a Houston resident and saw this unfold. He convened the Select Committee on Medicaid and Family Services and recruited ALF class members to serve on it and make recommendations to the state. The Maternal Infant Health Improvement Act was subsequently submitted to the Texas Legislature.

Over the next five years infant mortality incidence in Texas declined from 3,000 to 2,000 deaths. The state’s infant mortality ranking improved from 49th to 26th, a ranking it continues to hold more than twenty years later.

Leave a Reply