Aligning Stakeholders and Engaging Leaders: Strategic ... · Strategic Priorities with BFI Jennifer...
Transcript of Aligning Stakeholders and Engaging Leaders: Strategic ... · Strategic Priorities with BFI Jennifer...
Engaging Leaders:
Aligning Stakeholders and Strategic Priorities with BFI
Jennifer Ustianov MS BSN RN IBCLC
Baby Friendly Hospital InitiativeNational Symposium 2017
September 22, 2017
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Session Objectives
• Describe one framework for change that can be leverage in the BFI
• Outline two strategies for establishing and maintaining engagement of key leaders in the BFI
• Describe one uncommon partnership critical to improving breastfeeding outcomes
Declarations
Jennifer Ustianov has no actual or potential disclosures/declarations in relation to this program
Important Systems Principles
• Complexity of Systems Every system has an aim – Important that those aims are aligned
– All systems should be looked at critically
It takes everyone to do the work– Patient, client, family voice is vital
– Multidisciplinary staff involvement is essential
– Leadership support is key
– Teams are critical to the work
– Change is based on solid evidence
– External partnerships inform change
Variation Exists!!
• Simply recognizing and accepting that no two things (people, processes, systems) are a like will help you with your change efforts!
Systems
A Way to Learn
(Theory of Knowledge)
Psychology
Of Change
Data &
Knowledge
Of Variation
Processes
To Support
Exclusive
Breast milk
feeding
System of
Profound
Knowledge
W.E. Deming
New Economics (1994)
Formula for Change and Improvement
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Subject Matter
ExpertiseMaternity Care and
Breastfeeding Support
•Systems
•Data & Variation
•Psychology of
Change (teams)
•Knowledge (how
we learn)
•Many tools!
Content
Knowledge plus Improvement
Knowledge & Tools
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What exactly is Innovation?
InnovationNoun: the introduction of something new; a new idea, method, or device; a novelty
Merriam Webster Dictionary
Influencing Adoption of Innovation
5 characteristics that influence potential adopters:
• • Perceived Benefit of the change
• • Operability of the innovation
• • Compatibility of the change with the current culture and personal belief systems
• • Level of Simplicity
• • Trialability of the innovation Berwick, D. 2003
The Will to Change
Effected by:
• Need and urgency for change
• Life experiences
• Positive and negative experience
• Personality
• Resources and Support
Key Elements of Breakthrough Improvement
Will to do what it takes to change to a new system
Ideas on which to base the design of the new system
Execution of the ideas
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Breakthrough Series (BTS)
Vehicle for identifying, testing and spreading changes that are effective for improving care and outcomes for defined populations.
The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI
Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on www.IHI.org)
At a Glance
Best Fed Beginning (BFB)
• Funding CDC Cooperative
Agreement (2011-2015) #1U58DP003829-01
• Lead Organization National Institute for
Children’s Health Quality
• Partners Baby-Friendly USA
(BFUSA)
United State Breastfeeding Coalition (USBC)
Best Fed Beginnings Goals• Increase the
number of US Baby-Friendly designated facilities
• Increase exclusive breastfeeding initiation
LEARNING COLLABORATIVE
PROJECT CLOSEOUT
Project Closeout
September 2014 - March 2015
Baby Friendly USA DESIGNATIONConduct Baby Friendly USA Onsite Assessments
September 2013-March 2015
KICK OFF AND PLANNINGProject funding
October 2011
Expert Meeting
March 2012
Planning and Promoting
October-March 2012
ACTION PERIOD 1
Oct 2012-Jan 2013
LS 1
Aug-Sep
2012
Celebration
Aug 2014
ACTION PERIOD 3
Nov 2013- Aug 2014
PRE-WORKJun-Aug 2012
LS 2
Feb
2013
ACTION PERIOD 2
Mar-Sep 2013
LS 3
Oct
2013
RECRUITMENT
Apr–Jun 2012
Leadership Track
EVALUATION; WIDESPREAD ADOPTION
PARTNERSHIIP WITH USBC &
COMMUNITY ENGAGEMENT
Recruitment & Activities
Development
August 2012-September 2014
No Cost
Extension:
Additional TA
Aug 2014
Intervention/Data collection period: July 2012 to August 2014
Data on Baby Friendly designation
collected
after the end of the intervention, (2015-
2016)
Best Fed BeginningsProject Timeline
Outcome and Process Measurement
Outcome Measures
• Exclusive Breastfeeding Rate Among Breastfed Babies (Goal: 90%)
• Breastfeeding Babies Supplemented(Goal: 10%)
• Overall Breastfeeding Rate (Goal: 90%)
Process Measures
• Prenatal Information on Benefits and Management of Breastfeeding
• Assistance and Support with Breastfeeding
• Baby Skin-to-Skin (vaginal birth)
• Baby Skin-to-Skin (cesarean birth)
• Rooming In (all births)
• Feeding on Cue (all births)
• Discharge Support
BFB Words of ExperienceIdentify:
• How change impacts all levels of the system
• Small wins – CELEBRATE and advertise them
• This will change status quo
• Champions
• Ways to engage management and administration (make sure they know they are stakeholders in the effort!)
• Behavior/practice that changed an outcome
• The need to morn the old
• Barriers, Saboteurs
• Supports needed for planning team
• Change in culture and behavior…TAKES TIME!
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Who are our leaders?Where are our champions?
• National
• Provincial and Territorial
• Regional
• Community Racial and Ethic and Faith Leaders
Educators
Media and Retail
Families
Peers
5 P’s
• Purpose Why, creating a case for change
• Picture People remember visuals better than words
• Plan Short (people only remember short clusters of info,
forget 90% of what they hear within one hour)
• Performance Measures What does success look like?
• Part Give that person a specific task, recruit them as a helper, make
them feel valued.
Deborah Mackin, 2012
http://www.newdirectionsconsulting.com/leadership-
engagement/quality-management-building-an-elevator-speech-for-
quality-using-the-5ps-model/
A Breastfeeding Culture:effective, agile and sustainable
Partnerships
• Change happens over time
• Change begins with conversations, role models and opportunities
• Change needs a vision, leaders, a framework and ACTION
Don’t walk behind me;
I may not lead.
Don’t walk in from of me;
I may not follow.
Walk beside me that we may be friends .
Ne marche pas devant moi,
je ne te suivrai peut-être pas.
Ne marche pas derrière moi,
je ne te guiderai peut-être pas.
Marche à côté de moi et sois simplement
mon ami!.
- Albert Camus
Bibliography
• Breastfeeding Committee for Canada Baby-Friendly Initiative Integrated 10 Steps for
Hospitals and Community Health Services (the Interpretation for Canadian Practice)
http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php#a5.3 Accessed
April 22, 2017
• Brian D. Christens and Paula Tran Inzeo, “Widening the view: situating collective impact
among frameworks for community-led change,” Community Development 46, no. 4 (2015):
420–35.
• Coulibaly, R., Séguin, L., Zunzunegui, M. V., & Gauvin, L. (2006). Links between maternal
breast-feeding duration and Québec infants’ health: A population-based study. Are the
effects different for poor children? Maternal and Child Health Journal, 10, 537–543.
• Feldman-Winter L, Ustianov J. Lessons Learned from Hospital Leaders Who Participated in
a National Effort to Improve Maternity Care Practices and Breastfeeding. Breastfeed Med.
2016 May;11:166-72.doi:10.1089/bfm.2016.0003. Epub 2016 Apr 8
• Feldman-Winter L, Ustianov J, Anastasio J, et al. Best Fed Beginnings: A Nationwide
Quality Improvement Initiative to Increase Breastfeeding. Pediatrics.
2017;140(1):e20163121
• Gilbert, N. L., Auger, N., Wilkins, R., & Kramer, M. S. (2013). Neighbourhood income and
neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality in Canada,
1991–2005. Canadian Journal of Public Health, 104, e187–e192
• Heath, C., & Heath, D. (2010). Switch: How to change things when change is hard. New
York: Broadway Books.