J Hum Lact 2010 26: 130 originally published online 28 January Abstract 

This was a nurse-driven, hospital-based, prospective cohort study of data collected in 19 hospitals in San Bernardino and Riverside counties by California Perinatal Services Network on all mothers (n = 21 842) who delivered a singleton infant (37-40 weeks gestation) between July 2005 through June 2006. Multivariate ordinal logistic regression showed that maternal infant-feeding method intention (measured prior to birth), sociodemographic characteristics, intrapartum variables, and early skin-to-skin mother-infant contact during the first 3 hours following birth (controlling for delivery hospital) were correlated with exclusive breastfeeding during the maternity hospitalization. 

Compared with mothers with no early skin-to-skin contact, exclusive breastfeeding was higher in mothers who experienced skin-to-skin contact for 1 to 15 minutes (odds ratio [OR] 1.376; 95% confidence interval [CI], 1.189-1.593), 16 to 30 minutes (OR 1.665; 95% CI, 1.468-1.888), 31 to 59 minutes (OR 2.357; 95% CI, 2.061-2.695), and more than 1 hour (OR 3.145; 95% CI, 2.905-3.405). 

The results demonstrate a dose-response relationship between early skin-to-skin contact and breastfeeding exclusivity. 

As the journey unfolds, the road is filled with trials and obstacles. These can be viewed as a series of tests, tasks, or ordeals that the organization must undergo in order to carry on. Failure of a task is not uncommon and may be considered a test of resolve or a learning experience. For each stage of the journey, there is a corresponding pitfall. The pitfalls generally represent an attempt to accelerate the process by skipping or shortcutting required steps, or a failure to appreciate the length of time required for transformation. 

A failure to remove obstacles is a commonly observed pitfall that includes policies and procedures or leadership behaviors that are incongruent with the vision and values. Inability to address simple systems issues in a timely manner creates frustration and breed's negativity. There are also trust-breaking behaviors. Lack of readiness is illustrated by not having made a convincing case for change or not developing or communicating a clear and concise vision. Sometimes a state or readiness is assumed, but there is an inherent lack of understanding at a deeper level, of the potential for betrayal and lack of trust. The most common obstacle is resistance to moving forward.

(Kimball, 2005)

What pitfalls has your unit experienced? 

Do you have a well spelled out communication plan? 

Are you willing to remove barriers that hamper change efforts? 

If data are available from both before and after a planned change, a plot of data over time can be used to see if the change resulted in improvement. If the data depicts a random pattern within a predictable range, we should not infer that a change in performance has occurred.

Shewhart's concept of variation can also be used to help develop a change-that is, help to answer the fundamental question of the Model for Improvement, "What changes can we make that will result in improvement?" Plotting data over time can reveal when the variation in the data no longer follows a predictable pattern. The chart may show an isolated observation or two that are outside the predictable range, or show a new trend. 

If the random variation in the data is disturbed by some specific circumstance, improvements can be developed by understanding what these special causes are. People can make changes to remove or overcome these causes if performance is worse, or continue them if performance is better. 

If the pattern of variation seen in the data is random within a predictable range, more fundamental changes are usually needed to bring about an improvement. If you don't have baseline data, don't wait to begin testing a change. It often takes time for a change to affect performance. Start collecting data when you start testing, and use the beginning data to understand the current level of performance. 

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 904-909). 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'.

Over the next 5 months we will focus our attention as a collaborative on specific process measures for improvements. So you and your team can begin to think about these areas the schedule will be as follows: 

• Oct/Nov: Skin-to-Skin 
• Jan: Separation 
• Feb: Breastfeeding support 
• Mar: Hand Expression 

If any team would be willing to present on any of these topics on the monthly webinars please contact me or I will be contacting you.

 Click here for webinar information.

Contact

Tammy.Haithcox@pqcnc.org