kaleidoscope perinatal neonatal women’s...

Kaleidoscope Perinatal Neonatal & Women’s

Symposium

February 21, 2014Susan M. Distefano

CEO

The Leadership Challenge:Our World is Changing….

2

What is Going On In Healthcare?

3

Medicaid Expansion

Risk Pool

Bronze Plan

Three simple but bold “triple aims”»Better Care»Better Health»Lower Cost

4

Institute for HealthcareImprovement

Flipping U.S. Healthcare to Prevention….

5

Leadership

Essential to any solution: Leadership

6

Galvanizing LeadersPope Francis ‐ embraces the world

7

Galvanizing LeadersNelson Mandela – dared to insist on equality

8

Galvanizing Leaders

Oprah Winfrey – not about “me”

9

Galvanizing LeadersTEAM USA Olympics………Lindsey Vonn

…I’m still a winner

10

• What does this have to do with me?

• Do you have to be famous to be effective?

12

If healthcare changes are going to work we need leaders at all levels

But I’m just a:

ManagerBedside ClinicianEducator

13

Video

• Leadership at an early age…..

Young boy who made a cardboard amusement park

• http://vimeo.com/40000072

14

Leadership QualitiesInspireActGet someone to follow!

15

Video

Leadership:Single person dancing in the field• W:\HER\HER ‐ Customer Experience\Videos\First Follower‐

Leadership Lessons from Dancing Guy.wmv

16

Closer to home…..

New CMS Perinatal Core Measures:•PC01 Elective delivery <39 weeks

•PC02 CD rate for nulliparous women; team; singleton; vertex

•PC03 Antenatal steroid >24 wks and <32 wks

•PC04 Healthcare associated bacterial infection rate in neonates

•PC05 Exclusive breast feeding

17

Perinatal Care Core Measure PC‐01

18

CMHH PC-01 Elective Delivery Less Than 39 Completed WeeksPerinatal Care

(Lower is Better)

Source fi le date: 1/14/2014Generated: 1/14/2014 3:08:45 PM Reporting Months

p ro du ced by System Qu a l i t y a nd Pa t i en t Sa fe ty

Mean = 11.5

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 11.5


2013 2014

0

10

20

30

40

50

60

70

80

90

100

Strategic Actions:Perinatal Core Measures:

All PC‐01, PC‐02, PC‐04 cases reviewed by Dr. Blackwell

Physicians and nurses attending Best Fed Beginnings as part of 10 step Baby Friendly designation

Leaders working on “scripting tool” for physicians and nurses re Best Fed initiative

Dr. Blackwell is working with physician groups to assure reason for C/S (PC‐2) documentation is appropriate

A physician template for documentation of “mother’s choice” is being developed

Focus to assure “mother’s choice” is documented prior to first feed to meet requirements

Removing availability of formula from nursery

Dr. Blackwell is developing a monthly score card for physicians related to PC measures

Kirsten Benjamin met with Dr. Blackwell 12/19/13 to discuss implementing a “hard stop” for H&Ps on scheduled deliveries

Perinatal Care Core MeasurePC‐02a ‐ 05

19

CMHH PC-05 Exclusive Breast Milk FeedingPerinatal Care

(Higher is Better)

Source file date: 1/14/2014Generated: 1/14/2014 3:08:49 PM Reporting Months

p ro d u ce d b y Syste m Qu a l i ty a n d Pa t i e n t Sa fe ty

Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 25.17


2013 2014

0

10

20

30

40

50

60

70

80

90

100

CMHH PC-02a Cesarean Section - OverallPerinatal Care

(Lower is Better)


p ro d u ce d b y Syste m Qu a l i t y a n d Pa t i e n t Sa fe ty

Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 32.05


2013 2014

0

10

20

30

40

50

60

70

80

90

100

CMHH PC-03 Preterm Delivery Antenatal SteroidsPerinatal Care

(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Higher is Better)



Mean = 97.73


2013 2014

0

10

20

30

40

50

60

70

80

90

100

CMHH PC-04 Bacteremia in High-Risk NewbornsPerinatal Care

(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100


(Lower is Better)



Mean = 3.68


2013 2014

0

10

20

30

40

50

60

70

80

90

100

Leadership…at the Corporate level

Memorial Hermann Health System

• Safety is a core value• Leaders “own” safe outcomes

• System Goal: Become a High Reliability Organization (HRO)

20

High Reliability 2011‐12Certified Zero Awards

21

1. Zero Events2. 12 Consecutive Months3. Certified Zero Category

High Reliability Organization

9 Certified Zero Awards at MH-TMC1. TMC Adult: Retained Foreign Bodies (12 months)2. CMHH: Iatrogenic Pneumothorax (12 months)3. CMHH: Iatrogenic Pneumothorax (24 months)4. CMHH: Pressure Ulcers (12 months)5. CMHH: Pressure Ulcers (12 months)6. CMHH: Retained Foreign Bodies (12 months)7. CMHH: Retained Foreign Bodies (24 months)8. CMHH: Ventilator Associated Pneumonias (24 months)9. CMHH: Ventilator Associated Pneumonias (36 months)

Do No HarmPICU VAPs, CLABSIs NICU/PICU/Floor, Pedi SSIs, PICU CAUTI Counts

22

13-Jul 13-Aug 13-Sep 13-Oct 13-Nov 13-Dec 14-Jan 14-Feb 14-Mar 14-Apr 14-May 14-Jun FY14 Total

0 0 0 0 0 0 0

3 1 3 1 3 3 14

0 0 2 0 2 0 4

1 1 0 0 0 0 2

0 0 0 0 0 0 0

0

0

0 3 0 0 0 3

36.95 49.78 63.22 49.24 52.80 50.40

`

C. Difficile (LabID)

Pedi SSI

Surgeon Query Compliance (%)

PICU CLABSI

CAUTI PICU

CAUTI Floor

MRSA (LabID)

NICU CLABSI

MH-CMHH Infection Counts

CLABSI Floor

Surgeon Query Compliance (%)

Distinguished Target Threshold Concern

> 70.00% > 60.00% > 50.00% < 50.00%

HAI Infection Counts

Zero Cases Any Cases

0 > 0

Leadership in the Unit level

23

NICU Practice Changes to decrease infection:2008 Line Team Started ‐

(Surgical line management dressing change, blood draws, meds)

2009 Annual validations staff/line team competenciesDaily assessment re: line necessity

2011 Ethanol lock introduced

2012 “Press & Seal” for Ostomy patients with CL

2010‐12 Administered flu vaccine to staff, patients and family member

NICU Central Line Associated Blood Stream Infections (CLABSI)

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays

Memorial Hermann Healthcare SystemNICU Central Line Associated Blood Stream Infections

Source file date: 7/14/2012Generated: 7/14/2012 9:43:21 AM Reporting Months

produced by System Quality and Pat ient Safety

UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

CLA

BS

I Rat

e pe

r 1K

Lin

e D

ays




UCL = 19.19

Mean = 11.96

LCL = 4.74

UCL = 8.62

Mean = 3.45

UCL = 4.44

Mean = 1.62

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

18

20

24

Leadership at the unit level…• NICUGoal: Zero bacterial catheter related infections.

(insert trend graph over last 3 years)

25

CLA

BSI R

ate

per 1K

Lin

e Day

s

CMHH NICU CLABSIDo No Harm

Central Line Associated Blood Stream Infections

Source fi le date:1/14/2014Generated: 1/14/2014 3:09:02 PM Reporting Months

p ro du ced b y System Qu a l i t y a nd Pa t i en t Sa fe ty

UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

CLA

BSI R

ate

per 1K

Lin

e Day

s





UCL = 6.28

Mean = 1.83

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May Ju

n

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar Ap

r

May

2012 2013 2014

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

Baby Meets WorldGoal:• Implement “Baby Meets World” in Women’s Services at CMHH with a go live date of June 4th 2013. • 90% of healthy infants will go skin to skin (vaginal and C/S) within the first 5 minutes

• 100% of breastfeeding mothers will receive assistance and support with breastfeeding

• 90% percent of infants will room‐in with mothers and feed on cue

26

“Baby Meets World”

o Skin to skin within first 5 minuteso Breastfeeding within 1st hour of lifeo In room transition of the newborno Bedside hand offo Couplet careo Rooming‐ino Newborn bath in the roomo Single caregiver for mother and baby

Baby Meets World

Pre‐data collection

Skin to skin PDSA #1

Skin to skinPDSA # 2

Pre‐data collection

Checklist pilot

Bundle intervention

Increase room temperature to 77-80 degrees pre-delivery

Pre-warm warmers to 100% for 20 min. prior to delivery

At delivery, place baby skin to skin (≥ 36 weeks) or receive baby in WARM blanket and keep covered on way to warmer

Immediately remove wet blanket and place ISC probe

Take and record baseline temperature

Focus on the Baby

Thermoregulation Bundle

NICHQ Best Fed Beginnings

Vermont Oxford

VHAIHI

Perinatal Community

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Pre‐intervention Post‐intervention

Readiness to Perform Newborn Assessment

Scale 1‐5 (1= not ready, 5= ready)

12345

N=26 (40% in progress)N=33 (52%)

0%

10%

20%

30%

40%

50%

60%

Pre‐intervention Post‐intervention

D StronglyD SlightlyNeutralA SlightlyA Strongly

BMW Best Possible Care Model

N = 40 (63% N = 31 (47% in progress)

Rooming In Baby Meets World Go Live

One mother’s voice….• “I was very delighted to find out that they are encouraging mothers to bond with their baby. They placed my baby on my chest right after delivery and that’s exactly what I wanted. “

• …our newborn son’s temperature went a little bit lowand rather than taking him into the nursery and puttinghim under the lamp they had him lay on me skin‐to skinfor 30 minute intervals. They came back to check and his temperature rose back and remained normal.”

Our plans for the next phase of the Journey…..

• Provide all in‐room care for the newborn including pediatric exam and labs

• Expand the Mother Baby RN knowledge of transitional care of the newborn, thermoregulation

• Provide skin‐to‐skin in the OR• Improving exclusive breastfeeding rate• Decrease C/S rate through improved labor practices

35

Leaders :• Inspire, tell why, tell why again, and don’t dictate solutions.

• Start Staff meetings with Patient Story• Remember to focus on what is going well

Team Members :• Be engaged!• Give constructive input!• It doesn’t have to be perfect to try it out

36

“Losers assemble in little groups and complain about the coaches and players in other little groups. Winners assemble as a team.”

Caution:

38

Everyday we have the option to lead, follow or be a loser! Our communities, colleagues, families and patients are counting on us to lead the way.

Path Forward…

What is your role?•Leader•First Follower•Team Member•All the above

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