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Marg Seppelt, Director Patient Care Services
Julie de Salaberry, Programs Leader
HONOURING WOMEN’S
VOICES
BC WOMEN’S NICU
MOTHER BABY CARE
5th Annual Quality Forum BC Patient Safety & Quality Council
Understand how the mother’s voice drove the innovation
of Mother Baby Care.
Understand the Mother Baby Care model.
Outline the anticipated impacts on health outcomes,
family experience, and health care system cost.
Share strategies to support the culture shift.
Share one thing we are most proud of.
Share one significant lesson learned.
OBJECTIVES
BC WOMEN’S 1ST STRATEGIC AIM
Be recognized as a world class service
provider who strives for perfection in
delivering best care in response to the
needs of women, newborns, and their
families across the life continuum.
http://jenniferswriting.blogspot.ca/2009/07/history-of-human-
incubators.html
http://www.neonatology.org/classics/silverman/silverman1.f3.gif
It all began….
GUIDING PRINCIPLES
• Women/Patient & family-centered
• Integrating families as part of the care team
• Support a healing environment
• Give time back for patient care
• Line of Sight
• Form follows function
• Build “Tents not Castles”
“I knew what was best for me
was to be with my baby” “If I could stand up after my C-Section, I would drag my IV pole to go to be with my baby!” “Teach me how to take care of a premature baby before I am ready to go home!”
Mother’s Voices from multiple improvement and design events
From The Cardboard Hospital
70 single room NICU
“Mothers ON ALERT
provided instant response to new ideas as we were
designing”
• Mothers and babies will be cared for in the 12 room short stay MBC unit (currently Intermediate Nursery).
• Mothers and babies will be cared for in the same room by the same nurse to eliminate or minimize separation from time of birth in a combined care model.
LEADING PRACTICE
MOTHER BABY CARE
(MBC)
• Separation is minimized - mothers and families actively partner in their baby’s care…providing as much care as possible.
Grounded in a philosophy of Patient and Family Centered care characterized by mutual respect and shared decision-making between the parent and health care team.
LEADING PRACTICE
PARTNERS IN CARE
“Core Care Team” Parent
Nurse Physician
Mother Baby Care supports
Evidence Informed Best Outcomes
• Enhanced long term physiologic organization and cognitive control1
• Reduced risk of mortality and nosocomial infections and reduced severe sepsis2,4
• Supporting secure maternal infant attachment impacts brain maturity3,7
• Earlier and more sustained breastfeeding, weight gain, and enhanced growth4
• Reduced newborn length of stay 5,6
• Parents taking an active role in their baby’s care5,6,7
1Feldman, R., Rosenthal, Z., & Eidelman, A. I. (2014) 2 Conde-Agudelo, A., Diaz-Rossello, J., & Belizan, J. M. (2014) 3 Kaffashi et al. (2013); Smith et al. (2011); Milgrom et al., (2009); Scher et al. (2009); Schore,(2001) 4Lester et al. (2013) 5 Örtenstrand et al. (2010) 6 Heinemann et al. (2013) 7 Altimier et al. (2013)
Early Implementation Opportunity
24 Couplets cared for to date
Renovated 2 parent rooms in existing NICU space
(NOTE: Place holder for breastfeeding data in progress)
Improved Health Outcomes Anticipated Increased Breastfeeding
Reduced Neonatal Length of Stay
0
20
40
60
80
100
120
140
160
180
C/S Vag C/S Vag
Mothers with babies in NICU or IN Other Mothers
ALOS in hours of Mothers Discharged from BCW Postpartum Units FY 2014/2015 , 2015/2016 YTD
2014/2015 2015/2016 YTD
Improved Efficiency Anticipated Reduction Maternal LOS
Improved Experience Patient Experience Survey Results
“If you could change on or two things, what would you change?”
Feedback from
Intermediate Nursery Feedback from
Mother Baby Care
Awareness Desire Knowledge Ability Reinforcement
54.5% 30.6% 16.9% 30.5% 67.8%
26.4% 30.2% 18.0% 22.7% 30.1%
50.6% 8.0% 9.9% 14.4% 9.5%
-- 64.8% -- -- --
-- 72.7% -- -- --
43.8% 41.26 14.9% 22.5% 35.8%
Build Awareness through: • Clear Vision • Face to Face dialogue with direct supervisor • Share early patient feedback from first MBC patients • Share what might happen if these changes are not made • Variety of ways to exchange information
SUPPORTING OUR STAFF ADKAR CHANGE MANAGEMENT
• Living our BC Women’s values – honouring women’s voices.
• Our amazing nursing staff…who asked tough questions and helped transform the care for women and their newborns!
• Re-thinking our relationships…… all mothers are post partum.
• “Build tents not castles”
MOST PROUD OF ….
• Never under estimate the impact of change….
• Timing of sharing the vision aligning the best available evidence with the organization’s strategic aims to engage staff
• Cannot Communicate enough!
KEY LESSON …