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Applying a Quality Improvement Approach to Promoting Exclusive Breastfeeding In US Hospitals

Monday, October 22, 2012
Room 346-347 (Morial Convention Center)
Sarah Donohue-Rolfe1, Charles Homer, MD, MPH1, Patricia Heinrich, RN, MSN2 and Sue Butts-Dion3, (1)National Initiative for Children's Healthcare Quality, Boston, MA, (2)Heinrich LLC, Walthamm, MA, (3)Butts-Dion Consulting, Inc., Saco, ME

Case Report:

Breastfeeding has been proven to provide significant benefits both to infants and their mothers yet only 75% percent of US mothers initiated breastfeeding in 2010, and of those, only 13% were exclusively breastfeeding their infants at six months. These rates also reveal substantial geographic and racial and ethnic disparities which should be addressed. To increase the rates of exclusive breastfeeding and spread awareness of the benefits of breastfeeding for both the child and the mother, the World Health Organization identified and codified a set of practices—the Ten Steps to Successful Breastfeeding—through the Baby-Friendly Hospital Initiative that characterize hospital environments that promote breastfeeding. 

The National Initiative for Children's Healthcare Quality (NICHQ), with support from the Centers for Disease Control and Prevention and working closely Baby-Friendly USA, is leading Best Fed Beginnings, a nationwide effort to help hospitals to improve maternity care to better support mothers and babies to be able to breastfeed and increase the number of Baby-Friendly hospitals in the United States.  The primary component of the project is a Learning Collaborative in which up to 90 hospitals across the country will apply a Breakthrough Series quality improvement approach to fulfill the Ten Steps and work toward Baby-Friendly designation.  Building on lessons from prior quality improvement work with the New York State Department of Health and other models, this 22-month collaborative includes three learning session meetings interspersed with action periods (i.e., rapid-cycle testing and reporting data from interventions in individual hospitals). Teams meet in-person three times over the course of the 22-month period and receive support from national faculty with expertise in exclusive breastfeeding promotion, quality improvement methodology, and Baby-Friendly USA designation. Hospital teams utilize an online learning community web portal that allows them to upload and share monthly results, network with peers and mentor each other. Results are shared throughout the Collaborative across teams to promote learning. In addition, senior administrators from participating hospitals will participate in a concurrent Leadership Track, highlighting their critical role in enabling and supporting change, and reinforcing their connection to their hospitals’ project teams.


By sharing early lessons from the implementation of the Best Fed Beginnings Learning Collaborative, participants will learn how quality improvement methodology can be applied to accelerate implementation of the Ten Steps and increase exclusive breastfeeding rates.  The session will review promising and evidence-based strategies for changing maternity care practice and demonstrate how these changes can be implemented using quality improvement science.