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Birth & Beyond California: Hospital Breastfeeding Quality Improvement Project

MO-07-0148 BFP

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The Birth and Beyond California (BBC) Project is an approach that utilized Quality Improvement (QI) methods to improve hospital exclusive breastfeeding rates by changing hospital policies and training staff in order to better support the mothers who chose to breastfeed.

Utilizing the Regional Perinatal Programs of California (RPPC) , this project provided ongoing quality improvement (QI) technical assistance, resource development, and on-site education and training. The training curriculum was adapted from the successful Birth & Beyond Program developed by the Perinatal Services Network at Loma Linda University.

BBC was pilot-tested in hospitals with the lowest breastfeeding rates in California with a goal of developing what was needed to assist hospitals in adopting policies and training that would lead to improving exclusive breastfeeding rates.  This project allowed changes to be implemented as lessons were learned.

Project Umbrell Graph
  • Program Logic Model (PDF)Opens a new browser window.
  • Program Poster Presentation (PDF)Opens a new browser window.
  • A report on the project is available at: <Under Construction>
  • Most breastfeeding improvement programs begin with staff education and training, which, is a critical component in efforts to increase in-hospital exclusive breastfeeding rates. However, the BBC Demonstration Project showed that in order for education and training to be effective, essential preliminary steps must be taken: 

    1. Obtain administration buy-in, speaking to them individually and offering them and their leadership team a Decision-Maker Workshop
    2. Create a continuous quality improvement multidisciplinary team (Word)Opens a new browser window.and process, including continuous data gathering and monitoring.
    3. Write and begin implementing hospital policies that address issues the interdisciplinary team and the hospital administration have identified as a priority,and which will support breastfeeding mothers and the newly-trained staff, rather than challenge them.
    4. Participation in a BBC Regional CQI Network BBC Regional Hospital QI Network Meetings to support the staff working on these changes.

    During the BBC Project development, it was learned that these steps needed to be followed sequentially in order to support staff once they received new information and skills.   Without these steps preceding staff education, changes in staff behavior did not occur or were short-lived or actually created staff upset and confusion as the environment was not conducive to implement the  information and concepts they had been taught.

    The California Model Hospital Policy Recommendations (PDF)Opens a new browser window.mirror the Baby Friendly Hospital Polices as seen in the attached comparison table (PDF)Opens a new browser window.. Some hospitals have found that using the Birth and Beyond California Project process has prepared them to complete the steps required to be designated as “Baby Friendly”. CDPH encourages hospitals to pursue the Baby Friendly designation www.babyfriendlyusa.org.

    The BBC Curriculum developed by the California Department of Public Health, Maternal, Child and Adolescent Health Division, is available here.   Hospitals and organizations may duplicate the BBC Curriculum and modify it for their site as needed to develop their own hospital-based trainings without prior permission.  Hospital Administration and staff are encouraged to adapt the BBC Curriculum and materials to meet their specific needs, but should to include credit to the Birth and Beyond California Project of the California Department of Public Health, Maternal and Child Health Division. No part of this curriculum may be sold.

    Below is a summary for each component of the BBC Project.

    1. Decision-Maker Workshop to market the BBC project to hospital administration
      • Why breastfeeding is important to their agency
      • The importance of creating a Multidisciplinary Quality Improvement Team, specifically focused on   improving maternity services and implementing policy changes
      • Development of an Action Plan
    2. Creation and support of BBC Regional QI Networks
      • Include hospital staff who have the power to make system-wide changes
      • Provide them with resources, information and opportunities to brainstorm, share challenges and successes and learn from each other.
    3. Staff Education
      • Utilizes a team of trainers with experience in adult education and reflective listening and support
      • Is learner-centered and interactive
      • Allows time for staff to voice and process concerns
      • Is divided into two 8-hour training sessions with at least two weeks between the sessions to allow staff to process and practice what has been learned
    4. Train the Trainer Program - Develops internal hospital staff trainers
      • Selected by their own agency
      • Multiple hospitals are trained together
      • Learn about adult learning styles and needs
      • Allows time for staff trainees to prepare and teach a session and receive feedback from peers

    For technical assistance and support contact: Perinatal Advisory Council:  Leadership Advocacy and Consultation (PAC-LAC)
    Tel: 818-708-2850
    E-mail: info@pacdac.org

    Last modified on: 4/20/2015 2:42 PM