Marg Seppelt, Director Patient Care Services

Julie de Salaberry, Programs Leader

HONOURING WOMEN’S

VOICES

BC WOMEN’S NICU

MOTHER BABY CARE

5th Annual Quality Forum BC Patient Safety & Quality Council

Understand how the mother’s voice drove the innovation

of Mother Baby Care.

Understand the Mother Baby Care model.

Outline the anticipated impacts on health outcomes,

family experience, and health care system cost.

Share strategies to support the culture shift.

Share one thing we are most proud of.

Share one significant lesson learned.

OBJECTIVES

BC WOMEN’S 1ST STRATEGIC AIM

Be recognized as a world class service

provider who strives for perfection in

delivering best care in response to the

needs of women, newborns, and their

families across the life continuum.

HOW DO WE ACHIEVE THIS?

By listening to the voices of women,

we will honour their life values.

http://jenniferswriting.blogspot.ca/2009/07/history-of-human-

incubators.html

http://www.neonatology.org/classics/silverman/silverman1.f3.gif

It all began….

Current NICU 60 bed “open bay” design

An Opportunity …

Teck Acute Care Centre: “TACC”

GUIDING PRINCIPLES

• Women/Patient & family-centered

• Integrating families as part of the care team

• Support a healing environment

• Give time back for patient care

• Line of Sight

• Form follows function

• Build “Tents not Castles”

… with paper…string…

Mother participant moved the LEGO and placed herself inside the room

The first mock up!...involving mothers

and clinicians at every step of our journey

“I knew what was best for me

was to be with my baby” “If I could stand up after my C-Section, I would drag my IV pole to go to be with my baby!” “Teach me how to take care of a premature baby before I am ready to go home!”

Mother’s Voices from multiple improvement and design events

From The Cardboard Hospital

70 single room NICU

“Mothers ON ALERT

provided instant response to new ideas as we were

designing”

• Mothers and babies will be cared for in the 12 room short stay MBC unit (currently Intermediate Nursery).

• Mothers and babies will be cared for in the same room by the same nurse to eliminate or minimize separation from time of birth in a combined care model.

LEADING PRACTICE

MOTHER BABY CARE

(MBC)

• Separation is minimized - mothers and families actively partner in their baby’s care…providing as much care as possible.

Grounded in a philosophy of Patient and Family Centered care characterized by mutual respect and shared decision-making between the parent and health care team.

LEADING PRACTICE

PARTNERS IN CARE

“Core Care Team” Parent

Nurse Physician

Mother Baby Care supports

Evidence Informed Best Outcomes

• Enhanced long term physiologic organization and cognitive control1

• Reduced risk of mortality and nosocomial infections and reduced severe sepsis2,4

• Supporting secure maternal infant attachment impacts brain maturity3,7

• Earlier and more sustained breastfeeding, weight gain, and enhanced growth4

• Reduced newborn length of stay 5,6

• Parents taking an active role in their baby’s care5,6,7

1Feldman, R., Rosenthal, Z., & Eidelman, A. I. (2014) 2 Conde-Agudelo, A., Diaz-Rossello, J., & Belizan, J. M. (2014) 3 Kaffashi et al. (2013); Smith et al. (2011); Milgrom et al., (2009); Scher et al. (2009); Schore,(2001) 4Lester et al. (2013) 5 Örtenstrand et al. (2010) 6 Heinemann et al. (2013) 7 Altimier et al. (2013)

Early Implementation Opportunity

24 Couplets cared for to date

Renovated 2 parent rooms in existing NICU space

(NOTE: Place holder for breastfeeding data in progress)

Improved Health Outcomes Anticipated Increased Breastfeeding

Reduced Neonatal Length of Stay

0

20

40

60

80

100

120

140

160

180

C/S Vag C/S Vag

Mothers with babies in NICU or IN Other Mothers

ALOS in hours of Mothers Discharged from BCW Postpartum Units FY 2014/2015 , 2015/2016 YTD

2014/2015 2015/2016 YTD

Improved Efficiency Anticipated Reduction Maternal LOS

Improved Experience Patient/Family Experience

Staff awareness

Improved Experience Patient Experience Survey Results

“If you could change on or two things, what would you change?”

Feedback from

Intermediate Nursery Feedback from

Mother Baby Care

Awareness Desire Knowledge Ability Reinforcement

54.5% 30.6% 16.9% 30.5% 67.8%

26.4% 30.2% 18.0% 22.7% 30.1%

50.6% 8.0% 9.9% 14.4% 9.5%

-- 64.8% -- -- --

-- 72.7% -- -- --

43.8% 41.26 14.9% 22.5% 35.8%

Build Awareness through: • Clear Vision • Face to Face dialogue with direct supervisor • Share early patient feedback from first MBC patients • Share what might happen if these changes are not made • Variety of ways to exchange information

SUPPORTING OUR STAFF ADKAR CHANGE MANAGEMENT

• Living our BC Women’s values – honouring women’s voices.

• Our amazing nursing staff…who asked tough questions and helped transform the care for women and their newborns!

• Re-thinking our relationships…… all mothers are post partum.

• “Build tents not castles”

MOST PROUD OF ….

• Never under estimate the impact of change….

• Timing of sharing the vision aligning the best available evidence with the organization’s strategic aims to engage staff

• Cannot Communicate enough!

KEY LESSON …

Questions?