In a recently released article in Pediatrics, Ward et al (10.1542/peds.2016-0344 and colleagues from Cincinnati Children’s Hospital Medical Center beautifully present their quality improvement work done through participation in the “Best Fed Beginnings” project, which ultimately resulted in successful “Baby-Friendly” designation for their institution. The article truly does as advertised, and provides methods, techniques and materials that other hospitals can use to facilitate their own “journey” to Baby-Friendly designation (www.babyfriendlyusa.org)for more information).
For those less familiar, Best Fed Beginnings was a national initiative sponsored by the NICHQ (National Initiative for Children’s Healthcare Quality) in collaboration with the CDC (Centers for Disease Control and Prevention), whose purpose was to provide technical assistance and support for selected birthing hospitals to implement those maternity care practices outlined by the Baby Friendly Hospital Initiative. Of 235 applicants, 90 hospitals, including 6 in Ohio, were chosen for the 22 month learning, support and technical assistance collaborative. Maternity hospitals had to be located in states and regions with low breastfeeding rates, and have high rates of formula supplementation, and had to provide in their application clear reasons why they sought to participate. The Learning Collaborative Model, in which representatives from similar health care systems worked together as teams, and shared ideas and supported each other, was described as both helpful and powerful by participants. Additional techniques for success that the Best Fed Beginnings collaborative offered included webinars with direct coaching, and a series of written goals and objectives that kept each hospital team moving forward. The importance of this excellent support is appropriately emphasized in the article.
Dr. Ward and colleagues also clearly identify the critical importance of achieving Baby-Friendly designation through hospital organizational and administrative leadership that is fully aligned and in complete support. They give us several ways in which hospital leadership was able to literally and figuratively “buy in.” Baby-Friendly designation was “…strategically associated … with the hospital mission…” and “…aligned with the Joint Commission Perinatal Core Measures…a publicly reported accountability measure…” and “…coincide[d] with public health efforts…” This is essential because pragmatically, a major financial commitment is needed. Additional costs of Baby-Friendly designation include nursing education, online modules, and increased nursing staffing, even when physician training and time is contributed. The largest commitment, however, may be the need to negotiate and then pay fair market price for formula, which is a requirement for designation. The World Health Organization (WHO) International Code of Marketing of Breastmilk Substitutes, which protects against the marketing and free provision of formula and breast milk substitutes was voted on and adopted May 1981 by WHO, and is often called the “11th Step” of Baby-Friendly designation.
A final key point that Dr. Ward and colleagues share is the collaborative nature of their entire project. The stakeholders included staff from Pediatrics and Obstetrics, were not limited to physicians and nurses, and included trainees, administrators, and all staff. Without a designation team that crosses disciplines and areas of expertise, progress would have been even more difficult. It is sometimes said that a birthing hospital has truly succeeded in achieving the spirit of Baby-Friendly designation when the environmental staff person who comes in to clean and the ward secretary on the floor also ask a mother how her breastfeeding is going and what they can do to help: indeed this is the goal – all for one and one for all—and everyone for breastfeeding!