Staff & Leadership Support is Critical to Building Hospital Environments to Support Breastfeeding

August 14, 2013
By Cindy Hutter

Texas Health Harris Methodist Southwest hospital has been steadily improving its environment to support a mother’s choice to breastfeed. While the hospital is tackling several aspects that encourage breastfeeding, including initiating skin-to-skin contact immediately post-delivery, its biggest coup lies in getting all levels of staff and leadership on board with the changes.

“Teri Wheat, our lactation consultant, got a lot of excited staff members to come together and we gathered a groundswell of support. There is a lot of energy from the educators and leaders who are all working together saying we want to make this happen,” says Mary Robinson, PhD, RN, chief nursing officer at Texas Health Harris Methodist Southwest and one of the initiators of the improvements. “To be successful, it can’t be a top-down initiative. You need to get buy-in from all sides.”

Texas Health Harris Methodist Southwest is one of dozens of hospitals participating in the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative. The project is a collaboration between the Texas Department of State Health Services (DSHS), Texas Woman, Infants and Children Program (WIC) and NICHQ. In this project, teams use quality improvement techniques to improve service delivery and create settings where a woman’s choice concerning breastfeeding can be best supported, with the goal of increasing exclusive breastfeeding.

Since the project started in January 2013, the Southwest team has seen the most progress in practicing skin-to-skin contact following a cesarean birth, an evidence-based process that more quickly regulates the baby’s body temperature, encourages breastfeeding, decreases newborn stress and crying, enhances infant homeostasis, stimulates the hormonal regulation of lactation and increases maternal milk production.

“It was a big deal to get one of the hospital’s C-section teams on board with testing the change, but once that happened, it was a big success,” recalls Robinson. “One mom, who had two other children previously at the hospital, commented that she didn’t know what she was missing with skin-to-skin contact.”

After the quality improvement team made changes with the first C-section team, it videotaped the whole process, from delivery, to skin-to-skin contact, to post delivery and recovery. The team shared the video with senior leadership and other staff to encourage adoption of the practice. The effort is working. In May 2013, skin-to-skin contact was practiced among 67 percent of cesarean births at the hospital, up from zero in January 2013.

Robinson credits the structure of the Texas breastfeeding collaborative with making the change process easier. The collaborative uses best practices developed by the DSHS Texas Ten Step ProgramExternal Link, NICHQ and Baby-Friendly USAExternal Link. Teams don’t have to worry about crafting policies and procedures from scratch; rather, participating hospitals are building on what others have shown to be successful and sharing information and ideas with other teams in the project.

One of the biggest challenges the team faces is getting staff to see that change can happen. “My response when I hear someone complaining is that yes, it’s hard, but not impossible and hard work is usually the most rewarding,” says Wheat, the team lead for Southwest.

The key to building support for the quality improvement team’s work at the hospital has been getting people to relate to the change on some level, says Wheat. For some staff that means seeing statistics about how breastfeeding reduces infant mortality rates. For others, it is hearing the personal story of a mother who experienced the benefits of breastfeeding.

“You can’t be radical. You have to have an open mind and listen to your staff,” says Wheat. “Also, have small goals and celebrate even the small success that you think may be trivial. They all lead up to the bigger goal.”

Gina Laborina-Lewis, the quality improvement team’s WIC representative, attests to the team’s success.

“At the first committee meeting, the group was small and there was hesitation. At the last meeting, the conference room was so packed people were standing,” says Laborina-Lewis. “I’m floored by the progress they have made and how they are working together. They went from an ember to a full fire.”

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