Transforming Maternal Health Through Relational Coordination
Dr. Lester Fitzgerald Bussey's vision for revolutionizing OB/GYN residency education to address maternal health inequities through relational coordination and community partnership.
The Maternal Health Crisis
26.4
Maternal Mortality Rate
Per 100,000 in Oneida County, significantly exceeding the prevention agenda goal of 16.0
3x
Higher Risk
Black and indigenous expectant parents face disproportionately higher mortality rates
1
County Priority
Maternal child health identified as a top countywide health concern
Beyond Competency: A New Educational Paradigm
Champions of Justice
Advocating for systemic change
Collaborators
Building relationships across systems
Healers
Providing compassionate care
Dr. Bussey believes education must be "transformative, not transactional," forming identities where professionals "do not just do medicine but become medicine." Traditional competency-based education alone leads to "indifference," which he identifies as "a quiet killer."
Root Causes of Maternal Health Inequities
Systemic Barriers
Obstacles in decision-making processes that limit access to quality care
Relational Breakdowns
Failures in communication and respect between providers and patients
Structural Factors
Poverty, housing instability, and racism affecting health outcomes
Community Context
Refugee resettlement and fractured communication across healthcare settings
Dr. Bussey: Catalyst for Radical Change
Seeker of Radical Truth
Questions limitations of traditional medical education and believes education can heal systems
Visionary Philosopher
Emphasizes moving beyond "sterile walls of tradition" into "the boundless space of possibility"
Action-Oriented Leader
Challenges others with his core question: "What are you going to do about it?"
Social Constructivist Approach
Relationships
Knowledge and equity constructed through meaningful connections
Lived Experiences
Valuing diverse perspectives and personal narratives
Systems Design
Intentionally creating structures that promote equity
Pragmatic Solutions
Implementing practical approaches informed by theory
Relational Coordination: The Core Framework
Shared Goals
Aligning objectives across team members and patients
Mutual Respect
Valuing each person's contribution and perspective
Timely Communication
Ensuring information flows efficiently and effectively
Team Effectiveness
Achieving better outcomes through coordinated efforts
Relational Map of Clinical Learning in OB-GYN ResidencyIn this diagram, each node represents the quality of intra-role relationships and communication (e.g., among PGY-I residents, among nurses, among faculty), while each tie represents the inter-role relational context (e.g., collaboration between nurses and PGY-IVs, or between leadership and faculty). All paths converge at the Patient, symbolizing the central purpose of both care and education. This visual reflects the principles of Relational Coordination and the MICRS framework, while aligning with MVHS values of Respect, Teamwork, and Safety.
The Blended Learning Ecosystem
Morning Reports
Integrating equity discussions into daily clinical workflows
Peer Coaching
Residents supporting each other's growth in relational skills
Digital Content
Accessible resources aligned with CREOG objectives and ACGME milestones
Community Forums
Engaging local voices in co-creating educational experiences
Comprehensive Evaluation Framework
Context
Assessing the environment and needs
Input
Evaluating resources and strategies
Process
Monitoring implementation
Product
Measuring outcomes and impact
The CIPP model guides evaluation using mixed methods to track clinical metrics, educational outcomes, and changes in "motivation, inclusion practices, and relational maturity, disaggregated by role and race."
The MICRS Framework
Motivation
Driving engagement and commitment to equity
Identity Integration
Embracing diverse perspectives and backgrounds
Collaboration
Working together across boundaries
Respect
Valuing each person's contribution
Safety Climate
Creating psychological safety for all
"Without these elements, DEI remains performative. With them, teams become truly inclusive, resilient, and high functioning."
Co-Leadership and Shared Accountability
Traditional Hierarchy
- Top-down decision making
- Faculty as experts, residents as learners
- Community as recipients of care
- Siloed responsibilities
Co-Led Ecosystem
- Mutual accountability
- Community members as co-leaders
- Faculty as co-learners
- Shared stake in equitable outcomes
Theory of Change: Building a National Model
1
Short-Term
Building psychological safety and shared understanding across teams
2
Intermediate
Strengthening team dynamics and relational coordination in clinical settings
3
Long-Term
Creating a sustainable relational learning ecosystem that reduces disparities and serves as a national model
"If we center relational coordination, equity-driven leadership, and community co-design, then we cultivate a culture of belonging that improves both training and maternal outcomes."