How a Hospital Raised its Exclusive Breastfeeding Rates from 10 percent to 40 percent

The 2 essential hurdles they had to clear: leadership and staff buy-in

February 19, 2013
By Cindy Hutter

Stony Brook University Hosptial Run Chart

For years Kathy Van Deventer, RN, PNP, a clinical nurse specialist and lactation coordinator, kept statistics on breastfeeding rates at Stony Brook University Hospital. Data showed the hospital did a good job of helping mothers to initiate breastfeeding, but exclusive rates were declining. The trend, paradoxically, was the opposite of what they were hearing: that mothers wanted to exclusively breastfeed.

One day in early 2010, the head of the hospital’s Obstetrics department bumped into Van Deventer and asked her about the hospital’s breastfeeding rates. “When I let him know we have over 75 percent of total mothers breastfeeding but our exclusive rates were at 10 percent, he invited me to a leadership meeting to present the stats,” recalls Van Deventer. “They were knowledgeable about breastfeeding and cared about the topic, so after they heard the data the executive team decided to commit to improving the hospital’s exclusive breastfeeding rates. It was our first big success.”

Chart showing Stony Brook's increase in exclusive breastfeeding rates from June 2010 to January 2013
Click image for larger version. Chart showing Stony Brook's increase in exclusive breastfeeding rates from June 2010 to January 2013. Credit: Stony Brook University Hospital.

Hospital leadership suggested developing an internal quality improvement project to foster change. Coincidently, NICHQ had begun recruiting hospitals for the New York State Breastfeeding Quality Improvement in Hospitals Learning Collaborative. Stony Brook applied and was accepted into the quality improvement program that sought to increase breastfeeding rates by improving hospital breastfeeding policies and practices. The hospital is now continuing its work through NICHQ’s new national project called Best Fed Beginnings, which aims to help hospitals improve maternity care and increase the number of “Baby-Friendly”-designated hospitals in the United States.

“We really have a commitment from our senior leadership here, both in word and deed,” says Susan Little, RN, NP, the assistant director of nursing for Antepartum, Labor and Delivery, and the Mother-Baby Unit. “Having that support and buy-in really helps to bring our hospital together. In order to be successful you have to have the whole team, senior leaders through bedside staff, working together.”

With leadership committed, Little and Van Deventer tackled their second hurdle to improving exclusive breastfeeding rates — getting the unit staff on board. They took a bold stance showing they were serious about change. They stopped giving out discharge bags with free formula.

But that was just the beginning. The Stony Brook team got rid of freebies like mouse pads, pens and crib cards with formula product advertising. The team established a new protocol for formula representatives; gone were the days when they could come onto the floor, now they had to set up an appointment. The team also put a hold on any shipments with free or promotion items coming into the hospital’s loading dock to make sure the items would not make it to the labor and delivery floor.

“Getting rid of the discharge bags sent a loud message to staff here that we are changing things,” says Little. “I really saw things start to turnaround then because I think the staff thought something like this would never happen.”

The team also looked at all its materials, from discharge paperwork to educational literature, and removed anything that had an endorsement or logo from a formula company. The team shared what they were doing with other hospitals on Long Island, New York, where they are located, and as a result, nearly all of them have stopped giving out discharge bags.

“I never thought it would happen on Long Island in my lifetime,” says Van Deventer.

Since clearing those two initial hurdles, Stony Brook Hospital is seeing results. The hospital is now up to nearly 40 percent of mothers exclusively breastfeeding while in the hospital. And the overall breastfeeding rate in the hospital has risen to a consistent 93 percent, up from around 80 percent in 2010.

“When you look at quality improvement and change there really is never an end point. You set certain goals and you meet them, but you are not going to stop there,” says Little. “You are constantly and consistently moving forward using feedback from physicians and patients. You just keep striving for better and better.”

The hospital’s new goal is to reach 60 percent of mothers exclusively breastfeeding while in the hospital.