1. 1 Roger A. Edwards, ScD Assistant Professor Bouvé College of Health Sciences Northeastern University 360 Huntington Ave, 206 Mugar Building Boston, MA 02115 Phone (0ffice): 617 373 8344 Phone (mobile): 508 472 0406 E-mail: ro.edwards@neu.edu MBC BF Collaborative – May 14, 2009

2. CQI principles provide the framework for implementing changes Approach... Source: http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/ Forming the Team Setting Aims Establish Measures Selecting Changes Testing Changes Plan, Do, Study, Act Implementing Changes Spreading Changes 2

3. The PDSA cycle is helpful for talking through examples of your specific priority areas Approach... Source: http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/ Testing Changes Plan, Do, Study, Act 3 Step 1: Plan State the objective of the test Make predictions about what will happen and why Develop a plan to test the change (who? What? When? Where? What data need to be collected?) Step 2: Do Carry out the test Document problems and unexpected observations Begin analysis of the data Step 3: Study Complete the analysis of the data Compare the data to your predictions Summarize and reflect on what was learned Step 4: Act Determine what modifications should be made Prepare a plan for the next test

4. Mother and infant care in medical settings is a primary determinant of breastfeeding success. Disruptive maternity care practices were noted as obstacles to initiation and continuation of breastfeeding in the AAP guidelines (Chung et al., 2008). DeClerq et al’s (2009) analysis of a nationally representative survey found –4 practices were statistically significantly associated with the likelihood of achieving breastfeeding intention: Helping mothers get started AOR= 6.3 (95%CI: 1.8-21.6) Hospital staff not supplementing with formula or water AOR= 4.4 (95%CI: 2.1-9.3) Telling mothers about community resources for breastfeeding support AOR= 2.3 (95%CI: 1.1-4.9) Staff not giving the baby a pacifier AOR= 2.3 (95%CI: 1.2-4.4) –49% of first-time mothers who intended to exclusively breastfeed reported that their baby was given water or formula for supplementation –Primaparas who delivered in hospitals that practiced six of seven practices associated with facilitating breastfeeding were 6x more likely to achieve their intention to exclusively breastfeed 4 Where we are today...