A Multi-institutional Approach to Improving Maternal and Fetal Health


The Challenge

The Grey Bruce region in Ontario was achieving poor marks in certain aspects of prenatal healthcare for women as compared to the Ontario average. Data indicated specific challenges like teenage pregnancy rates, antenatal smoking, and a lack of support for postpartum depression. Smoking rates in particular were twice as high as the provincial average, especially within the under 20 age group. Smoking is a significant and modifiable risk factor for pregnant women, with serious consequences to the pregnancy as well as to the healthcare system.

The Improvement Project

With the support of the Canadian Foundation for Healthcare Improvement’s (CFHI) EXTRA program, Dr. May Elhajj, Chief, Obstetrics & Gynecology at Grey Bruce Health Services, Dr. Hazel Lynn, Medical Officer of Health, Grey Bruce Health Unit and Christie Webster a Nurse Practitioner with the Owen Sound Family Health Team, focused their improvement project on smoking cessation. Their main objective was to urge obstetrical care providers to discuss the issue with their patients and referthem to a trained pharmacist to help them quit smoking. Using a cooperative model, the improvement project brought together people from a variety of backgrounds and sectors to create a dynamic multi-institutional model that would help improve maternal and fetal health. Working with the Grey Bruce Health Services, the Grey Bruce Public Health Unit, and the Owen Sound Family Health Team, the EXTRA team collaborated to reduce smoking rates using simple tools such as smoking status reminders and electronic medical record messages.

Key Results and Impact

The EXTRA improvement project has placed women at the centre of the care process. As a direct result, there has been an increase in identified pregnant smokers, and an increase in patients who were referred to a pharmacist for smoking cessation aid. Smoking cessation became a priority in Grey Bruce Health System’s strategic plan, which would roll-out over time. Long-term partnerships have formed between groups such as a midwives association and a smoker’s helpline. Healthcare providers became more aware that smoking during pregnancy is a significant issue in the region. These changes are expected to lead to improvements in maternal and fetal health.

Data will continue to be collected from the improvement project to inform outcomes. The new way of thinking introduced through this improvement project created a change of culture within the Owen Sound Family Health Team. It has also helped healthcare providers renew their commitment to smoking cessation efforts, leading to further improvements for the region as a whole. This includes the initiation of new smoking cessation programs in other family services organizations.


Lynn, Hazel_forWebHazel Lynn, MD, FCFP, MHSc
Medical Officer of Health
Grey Bruce Health Unit
Owen Sound, Ontario


Webster, Christie_forWebChristie Webster, RN, NP
Owen Sound Family Health Team
Owen Sound, Ontario


Elhajj, May_forWebMay Elhajj, MD, FRCSC
Chief Grey Bruce Health Services
Owen Sound, Ontario


To learn more about this project or the EXTRA program, visit cfhi-fcass.ca/EXTRA or email us at info@cfhi-fcass.ca.