Introducing our new Quality Improvement page, with lots of resources to aid you in implementation of the Recommendations in your NICU!
How do you get from here to there, when “here” is having a set of recommendations for providing comprehensive family support embedded in six different articles (see our Supplement to the December issue of Journal of Perinatology), and “there” is actually implementing the recommendations in your own NICU? How can you become a change agent, and move forward from theory to practice? And how can you improve care for the parents of the tiny babies in your charge on a daily basis, so that they can hopefully get through the traumatic NICU experience intact, although certainly changed?
We recommend that whatever your position is in the NICU—whether neonatologist, bedside nurse, nurse practitioner, charge nurse, nurse manager, clinical educator, social worker, psychologist, occupational, physical or speech therapist, or even chaplain or former NICU parent—that you start talking about the recommendations with your colleagues, expressing your own interest, enthusiasm, passion and commitment to the ideals of comprehensive family support. Hopefully your enthusiasm will be infectious, and you will gain support for the NICU staff to engage in a self-assessment process. If your personal enthusiasm isn’t enough to get the process going, consider giving a copy of the articles in the Supplement to your NICU Medical Director and/or Head Nurse. Hopefully, once they see that the Recommendations represent current “best practice” as compiled by our interdisciplinary workgroup, they will jump on board. Then, using the NICU Self-Assessment Tool that we have created, staff can be queried about how well they think your NICU is doing on a variety of different measures that reflect the Recommendations.
A Task Force on Comprehensive Family Support can then be created (or, this could be a first step). The Task Force should be interdisciplinary and should involve staff along the continuum of care in perinatal service delivery areas, including the High Risk OB team, the antenatal ward, Labor and Delivery, the NICU, and community-based post-discharge follow-up services. This working group will be most successful if it has the backing of the both the medical and nursing administrators of the NICU (e.g., NICU Medical Director and Head Nurse) and the obstetrical team. The first job of the Task Force can be to review results of the self-assessment. Where there is a consensus that the NICU is already doing certain things well, these should be acknowledged and celebrated. Where there is an indication that things could be done better, that area can be flagged and later considered for a Quality Improvement project.
The Task Force can collaborate to develop an overarching comprehensive family support policy, including Mission and Vision statements. The working group can then break up into smaller groups, and projects can be selected for improvement. “Low-hanging fruit,” or things that can easily be changed/improved, can be identified as starting points, so the group can get a sense of accomplishment and forward progress quickly. You can consider our Top Ten Recommendations as a stating point, the ones we feel are most critical to improving family support. Our Quality Improvement Strategy Worksheet can be used to outline what it is that will be changed, how change will be measured, where the specific opportunities for improvement are as well as what barriers could stand in the way of achieving positive change, and what resources need to be marshalled to achieve stated goals. Finally, a starting point can be identified and Plan-Do-Study-Act (PDSA) cycles, as outlined by the Institute for Healthcare Improvement, can be initiated. (1) During periodic Task Force meetings, progress can be charted, refinements made to plans, and future directions mapped out.
While the change process is under way, the Task Force can follow along with Patient Satisfaction Scores which are in use in most hospitals and NICUs today, recognizing the lag time between when patients (or in this case, their parents) are actually surveyed and when results are reported, often a period of six months or more. These can be used as a corollary measure that should indirectly reflect the success of change efforts as families give general feedback about the nature of their NICU experiences. Another dimension to track would be staff satisfaction, as an improvement in this area will further lift the tide of positive change in the NICU. When staff have more tools and skills at their disposal for supporting and encouraging families—and when they themselves receive adequate support for the work they do–they are more likely to be satisfied with their day-to-day interactions and to do a better job at meeting families’ needs. The NICU Self-Assessment can be revisited on an annual basis, again to track progress and celebrate improvements.
As a NICU caregiver—whether you’re a NICU professional or a volunteer peer mentor to parents—we encourage you to ask each family individually at any time during the NICU stay and especially as the end of their NICU approaches, “How are you finding things (how did you find things)? Is there anything we could be doing (could have done) better to help you?” Inviting personal feedback is a powerful way to let parents know that you are there to serve them and that their opinions matter. Receiving feedback is a great way to engage in course correction during a family’s NICU stay, should it be necessary, and responding to feedback in a positive way further cements the team relationship between NICU parents and staff.
We wish you every success in transforming your NICU, and invite you to utilize the resources on this website, and our new Quality Improvement page, as needed in your efforts. We would welcome the opportunity to hear about the Quality Improvement projects you choose, and what successes and failures you have as you move towards the goal of providing comprehensive psychosocial support to NICU families. Please email us at info@support4NICUparents.org with your stories, which we would be happy to share with our readers and visitors.
- The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on IHI.org) [Accessed 11/25/15]