An evidence-informed roadmap for hospital leaders
From rural hospitals like Baptist Health Hardin in Elizabethtown, Kentucky, to large health system hospitals like Banner Thunderbird Medical Center in Glendale, Arizona, administrators and OB/GYN service line leaders are turning to OB hospitalists to address at-risk programs and hiring shortages and physician burnout.
For hospital leaders at these locations and others across the United States, establishing an OB hospitalist program means more than keeping the doors to a critical service line open. It’s an opportunity to strengthen patient safety, support community clinicians and build a more sustainable, coordinated approach to obstetric care for years to come.
A 2024 peer-reviewed article published in Obstetrics and Gynecology Clinics of North America by Mark N. Simon, MD, MMM, chief medical officer of Ob Hospitalist Group (OBHG), and Amy VanBlaricom, MD, outlines how to organize and operationalize an effective OB hospitalist program.
Drawing on experience implementing and overseeing programs nationwide, the physician leaders describe how hospitals can organize clinical teams, build operational infrastructure and sustain quality improvement.
Their insights offer a practical roadmap hospital leaders can use to launch, run and sustain an excellent OB hospitalist program.
Begin: Customize an OB hospitalist program around your community’s needs
No two hospitals have identical obstetric needs. Patient volumes, clinical acuity, community needs and resources, staffing challenges and existing workflows all influence what a successful OB hospitalist program looks like.
That’s why effective program development begins with understanding your hospital and the community it serves.
Identify specific program goals
Before implementation, hospital administrators, departmental leaders, nursing representatives and community OB/GYN clinicians should agree on what your program needs to accomplish.
- Is your primary challenge inconsistent OB coverage?
- Are there opportunities to improve clinical quality, expand access to obstetric services or support community physicians?
- Does your hospital need stronger emergency response capabilities or additional support for its labor and delivery team?
The answers help determine the program’s structure, responsibilities and measures of success.
As the authors state, “Each group may have different definitions of success for the program, and it is critical that the OB hospitalist team understands these and how they all fit together.”
Design the right clinical and operational infrastructure
Once the goals are established, OBHG leaders help you evaluate how an OB hospitalist program will integrate into your existing clinical operations, such as:
- Patient flow
- Admissions
- EMR documentation
- Emergency response processes
- Billing
- IT systems
If you’re considering a dedicated obstetric emergency department (OBED), you must also evaluate the additional physical space, patient flow, documentation and regulatory requirements associated with providing emergency obstetric services.
Determining these operational details early helps OB hospitalists build momentum by providing timely, coordinated care without adding unnecessary workflow complications.
Recruit clinicians who fit your program needs
Selecting the right OB hospitalist is one of your most important decisions. Besides clinical experience, an ideal candidate has the communication skills, adaptability, sound clinical judgment and the ability to collaborate with nurses, midwives, community physicians and other specialists.
Effective OB hospitalists must serve as patient safety champions by maintaining awareness of activity across labor and delivery, identifying potential risks and speaking up when a patient’s care plan raises concerns. The authors state, “This requires that the OB hospitalist is comfortable engaging with patients they may have had limited interaction with as well as a willingness to challenge the current care plan if it is clear this path could lead to patient harm.”
Different hospitals, different program models
OBHG’s partnerships illustrate why hospitalist programs should be designed around local needs. Programs can include a combination of physicians, advanced practice providers and certified nurse midwives who provide round-the-clock coverage or work a specific number of monthly shifts.
For example, in 2026:
- Banner North Colorado Medical Center in Greeley, Colorado: OBHG launched a full coverage hospitalist program, including a 1.0 OB Triage model, with plans to establish an OB emergency department (OBED) program.
- Jersey Shore University Medical Center in Neptune City, New Jersey: OBHG introduced a 24/7 OB hospitalist model and OBED to advance safety, quality, and sustainability in obstetric care.
- Mercy Health – Anderson Hospital in Ohio: OBHG will operate as a full-time OB emergency department. Goals include providing 24/7 in-house L&D coverage for unassigned and emergent patients, allowing private physicians to focus on outpatient care and increasing surgical volume.
Operate: Create the conditions for excellent clinical care
Even a well-designed program encounters challenges without clear expectations, effective communication and ongoing clinical support. The following are ways to fully integrate OB hospitalists into your hospital’s care delivery system.
Establish clear roles, responsibilities and clinical protocols
OB hospitalists work alongside community OB/GYNs, certified nurse-midwives, nurses and maternal-fetal medicine specialists. A program’s successful launch and continued collaboration require a shared understanding of who’s responsible for patient assessments, admissions, consultations, emergencies, handoffs and transfers.
The authors recommend developing formal program guidelines that define these processes and explain how OB hospitalists fit into your existing clinical structure. “It is best to spell these expectations out in a formal guideline document. Doing so will provide the new OB hospitalist team with a reference document that can help them be successful during their daily work. At the same time, the document will provide clear communication to the existing nursing and clinical staff on the initial framework for the program.”
Invest in training and evidence-based care
OB hospitalists must be prepared to manage a broad range of obstetric conditions and respond effectively when emergencies arise.
The authors identify several essential areas for ongoing education, including fetal heart rate interpretation, hypertensive disorders of pregnancy, obstetric hemorrhage, shoulder dystocia, sepsis and standardized communication techniques.
Training should extend beyond clinical knowledge to include hospital-specific workflows, regulatory requirements, patient experience and quality improvement.
An effective onboarding process prepares clinicians not only for the medical responsibilities of their role but also for the relationships and operational processes that shape daily care.
From there, the site director plays a key leadership role, aligning the hospitalist team with hospital priorities, addressing concerns and maintaining a shared focus on patient safety.
Maintain: Measure performance, improve quality and adapt over time
Launching and integrating an OB hospitalist program are important milestones, but the program must also be designed to capture data on clinical outcomes and operational metrics.
Establish meaningful clinical and operational measures
Monitor nationally recognized obstetric quality indicators alongside measures tailored to your hospital’s specific needs, such as cesarean delivery rates among low-risk patients, obstetric complications and adherence to hypertension and hemorrhage protocols.
Plan to measure operational metrics too, like how frequently OB hospitalists provide care, the services they deliver, how they support community physicians and the effective use of existing resources.
Transparent reporting helps clinical leaders recognize strong performance, identify opportunities for additional support and establish quality improvement priorities. It also creates an ongoing dialogue between the hospital and the OB hospitalist team about what’s working, what needs attention and how the program can better serve patients and clinicians.
Update goals and metrics as needs change
An OB hospitalist program that meets your hospital’s needs today will need to adjust as patient volumes, staffing models and clinical services change. Regular program reviews help leaders determine whether coverage remains appropriate, workflows need refinement, and whether the program can provide additional support to community OB/GYNs or other care partners.
A successful OB hospitalist program is built on partnership
Excellent OB hospitalist programs don’t exist simply because an experienced physician is present on labor and delivery. They require deliberate planning, skilled clinicians, clear expectations, strong clinical partnerships and an ongoing commitment to quality improvement.
For hospital leaders, the roadmap begins with understanding your community’s needs, building a collaborative clinical environment and tracking performance transparently.
To summarize, the following are five steps to a successful OB hospitalist program:
- Define your purpose. Identify the clinical, staffing and operational challenges the OB hospitalist model should address.
- Engage the care team. Involve hospital leadership, nursing, community physicians and other stakeholders in developing shared goals.
- Build a strong clinical foundation. Prioritize clinician selection, onboarding, evidence-based protocols and effective leadership.
- Measure. Establish clinical and operational performance indicators aligned with the hospital’s goals.
- Commit to continuous improvement. Review performance regularly, communicate findings and adapt the program as your needs evolve.
With the right foundation and ongoing support, an OB hospitalist program does more than keep your maternity ward open. It can be an integral part of your hospital’s strategy to strengthen maternal care, support clinicians, improve obstetric services and improve your community’s overall health.
OBHG partners with hospitals nationwide to develop and manage OB hospitalist programs built around their clinical, operational and community needs. Learn how OBHG can help your hospital build and sustain a high-performing OB hospitalist program.
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Primary source: Simon MN, VanBlaricom A. Organizing and Operationalizing an Effective Obstetric and Gynecologic Hospitalist Program. Obstetrics and Gynecology Clinics of North America. 2024;51:475-484. https://doi.org/10.1016/j.ogc.2024.05.003