Physician Breastfeeding Education Leads to Practice Changes and Improved Clinical Outcomes

Alison Volpe Holmes,1,2 Angela Yerdon McLeod,2-5 Claire Thesing,6 Stephanie Kramer,7 and Cynthia R. Howard 8,9

BREASTFEEDING MEDICINE Volume 0, Number 0, 2012

Background and Objectives: Lack of physician knowledge about breastfeeding is associated with decreased initiation and continuation of breastfeeding by patients. We evaluated the effects of a breastfeeding education program on physicians' breastfeeding knowledge, attitudes, and beliefs, measured changes in clinical practice, and examined breastfeeding rates of patients of participating physicians.

Conclusions: A breastfeeding education program at a semirural residency program improved physicians' breastfeeding knowledge. Implementation of practice changes was fair. Two years into the intervention, breastfeeding rates improved for patients of the physicians with high levels of participation in the program.

Organizations that make a decision to embark on cultural transformation journeys stand on the threshold and choose a path into the unknown. The process used or created to move forward on the path has a number of steps:

Assessing current reality, defining a desired state, guiding change, engaging the workforce, leadership commitment and support, involvement and ownership at all levels.

Leadership Commitment and Support: Leadership must articulate the vision, over the windows of possibility, and actively invite all the people in the organization to engage in the "call to adventure". This invitation to join signals the leader's commitment and is a step towards building trust. When leaders visibly model value-driven behaviors, others naturally follow, and what begins to emerge is a culture of discipline evidenced by value-driven behavior. Communities of disciplines people require less hierarchy, bureaucracy and controls.

Involvement and Ownership at all levels: Organizations that enjoy involvement and ownership at all levels understand that culture is a highly valued community asset. By not only including management and employees but also patients and families, physicians, and board members in the planning and implementation process a diverse set of stakeholders is at the table. It changes the conversation. It recognizes competence, which helps build trust. Organizations that take a broad based inclusive approach find that it helps to hold individuals accountable. Everyone was at the table. Once empowered, the frontline staff-not-managers lead the revolution.

(Kimball, 2005)

• Does you unit have leadership commitment and support?
• Do they know what initiative you are working on and what your outcomes are?
• Did you include a diverse population in the planning and implementation of the initiative?
• Is the initiative staff led or management led?

Our ability to understand variation in data helps us learn from patterns. We encounter variation constantly and make decisions based in part on our interpretations of that variation. Walter Shewhart developed the concept that variation in data should be viewed in one of two ways: either as variation that indicates something has changed or as random variation. Data that varies randomly exhibits patterns similar to those seen in the past.   That is, the values are predictable within certain limits. Shewhart's concepts is that one should not react to each observation. One should plot data over time and observe the patterns.

What kind of charts do you use to show patterns over time or do you react to each observation?

Langley, Gerald J.; Moen, Ronald D.; Nolan, Kevin M.; Nolan, Thomas W.; Norman, Clifford L.; Provost, Lloyd P. (2009-06-03). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (JOSSEY-BASS BUSINESS & MANAGEMENT SERIES) (Kindle Locations 896-897). Wiley Publishing. Kindle Edition.

The next webinar will be Wednesday, November 28th, 2:00 - 3:00 PM.  Please plan to have at least one person from your team on the call so we can hear your 'voice'.

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Contact

Tammy.Haithcox@pqcnc.org