St. Joseph Medical Center in Tacoma, WA, recently was certified as a Baby-Friendly hospital, which is a World Health Organization and United Nations Children’s Fund initiative designed to encourage breastfeeding. Leaders there say the achievements that led to the certification could be duplicated at other hospitals seeking to improve maternal quality of care.

However, they point out that the certification does not come easily.

The Baby-Friendly designation process was challenging because it required St. Joseph to revamp the way it works with expectant mothers and staff to educate them about breastfeeding, says Michelle H. Kinne, IBCLC, ICCE, CD(DONA), international board-certified lactation consultant and lead for the Baby-Friendly Hospital Initiative Project at St. Joseph.

Now, all of the other hospitals under the CHI Franciscan umbrella are following suit. The Baby-Friendly Hospital Initiative (BFHI) is a global initiative of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). The goal is to improve health outcomes for pregnant women, mothers, and newborns through breast-feeding. (More information is available online at: https://bit.ly/1KcIemg.)

Hospitals seeking the certification must meet the criteria established by the BFHI, which includes 10 steps and additional requirements to encourage breast-feeding and best practices when mothers cannot breast-feed. (See the related story in this issue for an example of the requirements.)

No Easy Task

To comply with the rigorous BFHI review process, St. Joseph nurses and medical staff took part in 20 hours of required education. The hospital also made changes to its breast-feeding policy.

St. Joseph used grant funding from the United Way to set up an interdisciplinary committee with nurses, physicians, lactation consultants, leadership, and ancillary staff, Kinne says. The committee worked to develop an action plan to collect data, develop new breast-feeding policies, train staff and physicians, and publish breast-feeding educational materials for patients.

Adhering to the BFHI guidelines required significant changes to existing policy and procedures, says Jakki Stodola, MBA, BSN, RNC, director of the family birth center at St. Joseph. The certification requires far more than simply telling parents that breast-feeding is the best option, she notes.

“It was quite a laborious quality project. It was far-reaching, beyond our own department,” Stodola says. “We were trying to convince people to do things that they really didn’t think they needed to do. That was one of the biggest challenges.”

The effort was worthwhile, Stodola says, and staff are proud to have achieved the certification. St. Joseph changed the culture surrounding breast-feeding, she says.

The primary practice changes took place in the hospitals’ birth centers and neonatal ICUs, but the project requires the involvement of many other parts of the hospital infrastructure, Kinne explains. It intersects with procurement and contracting, outpatient ambulatory care services, and the supply chain.

“The challenge is balancing the desire for quality improvement while being held to various standards for productivity and budget,” Kinne says. “How do you balance funding the work that is necessary to accomplish the goals associated with your project while you’re being held responsible for other expectations as well? The project required a change in mindset for some of our team, and that takes education, time, and modeling.”

Significant Commitment of Time, Money

Every nurse in the department was assigned 15 hours of didactic education, plus five hours of hands-on learning with certified lactation consultants, notes Debbie Raniero, RNC, regional director of women’s and children’s services with CHI Franciscan, the parent company of St. Joseph in Tacoma, WA.

“With almost 200 nurses, it was a significant financial and time commitment for the organization,” Raniero says. “We feel lucky that our senior leadership recognized the importance of this and supported the project.”

Kinne found that networking with her counterparts at other hospitals was helpful in moving the project forward, particularly with mining details that were not readily apparent in the criteria provided by BFHI.

She notes that while BFHI is a global program, each country has its own certification body, and the standards can be different from one to another.

“We have to be mindful not to take criteria from another country because it may not necessarily translate into what you’re expected to do in the United States,” she says. “I would recommend reaching out to other hospitals pursuing this certification, or those that have achieved it already, to learn about the realities of putting these guidelines into practice. Meet with them and learn about their successes and their challenges, too, so you can apply that knowledge in your own effort.”

SOURCES

• Michelle H. Kinne, IBCLC, ICCE, CD(DONA), International Board Certified Lactation Consultant and Baby-Friendly Hospital Initiative Project Lead, Tacoma, WA. Phone: (253) 382-8576. Email: michellekinne@chifranciscan.org.
• Debbie Raniero, RNC, Regional Director of Women’s & Children’s Services, CHI Franciscan, Tacoma, WA. Phone: (253) 382-8586. Email: debbieraniero@chifranciscan.org.
• Jakki Stodola, BSN, RNC, Director, Family Birth Center, St. Joseph Medical Center, Tacoma, WA. Phone: (253) 426-6752. Email:
  jakkistodola@chifranciscan.org.