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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How Lucky Are We?

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

Change, Innovation

and

Improvement

Change

Noun: the act or instance of making or becoming different

Merriam-Webster Dictionary

Change: A Personal Experience

Stand strong…against the winds of change

You’re between a rock and a hard place

Leading and flourishing amongst dead wood

Change: A Systems Approach

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

18

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

+

You don’t have to see the whole staircase. Just take the first step.

-Martin Luther King, Jr.

20

Eight Steps

To Change

The Heart of Change, Harvard Business School Press, 2002

What exactly is Innovation?

InnovationNoun: the introduction of something new; a new idea, method, or device; a novelty

Merriam Webster Dictionary

Population distribution over time

Rogers Innovation Adoption Curve

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

26

Model for Improvement

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

Exclusive Breastfeeding Initiation

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!

35

Influences, Leaders and

Champions

• Who do we serve?

• Who are their influencers

• How do we partner?

Data…Beautiful Data

Before…(Baseline)

During…(Interim)

Ongoing…(the only thing constant…)

Leaders

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/

The Power

of a

Question

Improved Breastfeeding Outcomes

Conversations

Relationships Partnerships

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

Questions & Discussion

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.