Linda Young MScN, EdD BFI National Symposium September 2017

Transcription

1 Becoming A Baby-Friendly Province: The Ontario Adventure Linda Young MScN, EdD BFI National Symposium September 2017

2 Objectives The BFI change journey for Ontario The change roadmap Tools for tracking change Lessons learned and insights with implementing complex change

3 Local Health Integration Networks (LHINs) 14 LHINs created by the Ontario government as Crown Agencies in 2006 Plan, integrate and fund local health services, including: Hospitals Community Care Access Centres Community Support Services Long-term Care Mental Health and Addictions Services Community Health Centres Oversee nearly two-thirds of the $40+ billion health care budget in Ontario

4 BFI Implementation in Ontario Organization Canada ON Hospitals 14 6 Birthing Centres* 7 0 Community Health Services / CLSC Native Health Center 1 0 Total

5 BFI Strategy for Ontario MOHLTC Commitment 2013 Providing hospitals and community health organizations with training, tools, guidance and resources to help achieve World Health Organization s BFI designation and adopt best practices that meet BFI requirements Goals number of organizations pursuing BFI number of organizations implementing BFI best practices number of organizations achieving BFI designation or re-designation CQI strategy for sustainability of designation BFI Strategy for Ontario Target/Scope Organizations 36 Public Health Units 92 Hospitals 55 Community Health Centres 10 Aboriginal Health Access Centres 25 NP-led clinics 160+ Family Health Teams 3 Birthing Centres Midwifery Practices

6 Getting Started ENABLERS and BARRIERS Drivers Barriers THINK TANK INSIGHTS Culture Existing resources Engage leaders at all levels Peer support networks Use key messages Tailor to audience variation Help organizations track outcomes IMPLEMENTATION COMMITTEE Supporting & guiding implementation Identifying critical success factors Identifying gaps & areas for more support Webinar based & face to face meetings

7 Expected Impact of BFI Strategy Increased rate for initiation of breastfeeding Increased rate of exclusive breastfeeding at discharge from hospital Decreased non medical supplementation in hospital Increased duration of breastfeeding Increased number of organizations reaching BFI implementation milestones Increased number of organizations achieving BFI designation Ultimately, a positive impact on the health of infants and mothers in Ontario

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9 Strategy Timeline Component Timeline Nov 13/14 14/15 15/16 16/17 17/18 Information and Awareness Engagement Implementation Designation and Sustainability Tracking Progress System Building

10 1. Information and Awareness Strategies Introductory webinars Conference circuit BFI TEGH Introductory survey CEO / ED letter with BFI survey BFI Strategy Newsletter Media Launch October 2014 Lessons Learned Ever changing list of participants Match message to audience Ask lots of questions MEDIA LAUNCH Leadership and building partnerships to enhance breastfeeding support for women and their families

11 2. Engagement Strategies BFI Implementation Toolkit Workshops to regional groups Webinar series for hot topics Coaching strategies KEY MESSAGES Share newsletter Check out website Send in status reports Tell us about your challenges Lessons Learned Face to face contact is helpful Need multiple opportunities for messaging Regional groupings work well

12 3. Implementation Strategies Patient education resources Capacity building in organizations Physician strategies Coaching Strategies Lessons Learned Understand unique needs of the attendee organizations Design tools for enhanced accessibility Multiple coaching strategies Leave the door open Leverage existing strengths Appreciating different pathways Resource development takes longer than you expect

13 Supporting Patient Education Currently Available Updated Breastfeeding Matters Updated My Breastfeeding Guide Breastfeeding Your Early Preterm Infant Breastfeeding your Late Preterm Infant Updated BSRC Fridge magnet Infant Formula - What you Need to Know BFI Introductory videos - Indigenous Community, & mainstream Coming Soon Informed Decision Making Guide for Health Professionals Patient education resources except videos translated into 16 languages

14 Capacity Building in Organizations Toolkits and Workshops Implementation Toolkit and Workshops BFI 20-Hour Course Toolkit and Workshops Webinars and Coaching Monthly Hot Topics Webinars Monthly Check In Webinars Site Visit Strategy for Hospitals Virtual site visit for community agencies 10 Steps Video Clip Story Series Other Initiatives Baby-Friendly 101 e-learning Module Breastfeeding Module for IPE at U of T Clearing House for resources BORN ON BFI Reports

15 BFI Strategy for Ontario Tools for Physicians Website:

16 Breastfeeding Resources Ontario Clearing House for BFI Resources Free downloadable, multiple languages Usage from Feb 1, 2016 Jan 31, 2017: 5,803 users in 8,670 sessions 21,013 page views, average duration 2:27 minutes 66.7% new visitors; 33.3% returning Cities with most users in Ontario were: Toronto, Ottawa, Sudbury, Hamilton, Barrie, London (ON), Kingston (ON) 82% from Canada, 5.5% from U.S., 3.2% from U.K.

17 Coaching Strategy Update Total Coaching Requests June 2015 August 2017 = 266 Types of Requests: Where to find key BFI documents and templates How to apply for certificates Developing presentations Designing communications Work plan development and refinement Overcoming barriers and implementing specific steps Co-facilitating the 20 Hour Course Preparing for designation process milestones Organizations Seeking Coaching Support Hospital CHC PHU FHT Aboriginal services Midwifery/ Birthing centres Other

18 4. Designation and Sustainability Strategies Sustainability Toolkit Readiness coaching for document review Review materials for designation Mock designations Team motivation sessions Webinar series for ongoing CQI Planning with Ministry for continuing BFI Strategy

19 5. Tracking Progress BFI Implementation Status Report Tool Self-monitoring electronic survey tool Initial survey sent to hospital CEOs and Maternal/Newborn program directors through PCMCH Subsequent surveys sent to contacts in hospitals and community health services quarterly Aggregate results sent 2x year to hospital and LHIN CEOs through PCMCH

20 BFI Status Report Tool

21 Hospital BFI Implementation Aug-14 Jan-15 Jan-16 Jan Not initiated Preliminary Work Intermediate Work Advanced Work Designated

22 BFI Status Update Report % Hospitals Working on 10 Steps 0 Step Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 9 10 % in progress % completed Breastfeeding policy 2. Health provider education 3. Prenatal education on infant feeding 4. Uninterrupted skin-to-skin 5. Maintain lactation if mother and baby separated 6. Exclusive breastfeeding for first six months hour rooming in 8. Baby led or cue based feeding 9. Breastfeeding without bottles or pacifiers 10. Continuity of care post discharge

23 Reporting Hospital Progress 84/88 hospitals engaged (95%) 64 hospitals have moved at least one step closer to designation since April 2014 TC LHIN REPORT LHIN Hospital Never Responded Not Formally Initiated Preliminary Work Intermediate Work Advanced Work Designated Mount Sinai Hospital LHIN 7 - Toronto Central Summary St. Joseph's Health Centre St. Michael's Hospital Sunnybrook Health Sciences Centre The Hospital for Sick Children Toronto East General Hospital!00% hospitals are engaged!00% hospitals have moved at least 1 step closer to designation

24 BORN Reports Provincial BFI Rates Q1-3 Initiation Exclusive BF Rate Adjusted BF Rate Hospital level reports available Initiation Exclusive BF Rate Adjusted BF Rate Provincially Small incremental changes n=137,000 births per year

25 6. System Building Strategies Relationship building and exploring opportunities with organizations Webinars and conference presentations Working through networks and communities as well as individual organizations Partnering with BFI Ontario for assessor development, aligning coaching, identifying opportunities and posters for BFI Expo Lessons Learned Ongoing work occurs in an ever enlarging circle of influence with stakeholders

26 BFI Implementation Challenges Self Assessment & Data Review Identify Roadblocks Identify, Engage & Understand Key Stakeholders BFI Integrated 10 Steps Outcome Indicators Establishing and maintaining leadership support Time and resources to implement changes Funding to support BFI designation Changing patterns supplementation rates, sustaining breastfeeding

27 Many Paths Becoming Baby-Friendly Becoming BFI Designated Supporting Breastfeeding in the community

28 How Organizations are Overcoming Challenges We had two nursing students initiate some work on BFI which gave us a foundation on which to build. We have formed a small task team, and as a first step have reviewed the outcome indicator document. We have identified some small improvements that are already underway and have registered two staff to attend the train-the trainer workshop. We are preparing a summary report for our leadership team so that all are aware of what is involved in this initiative. We have organized a team of several members to promote the BFI and take baby steps to implement some changes to ensure all of our clinics/offices are as BFI friendly as we can be.

29 BFI - Four Years in Review Nov 13- March 14 April 14- March 15 April 15- March 16 April 16- March 17 Proposal and budget MOU TEGH with PCMCH and BSRC Think Tank Implementation Committee structure Baseline data Awareness strategy Toolkits and workshop design BFI Implementation and 20 Hour Course Implementation workshop Assessor Workshop Translation of Toolkits Clearing House TTT 20 Hour Course Breastfeeding course for small hospitals Coaching strategy with monthly webinars New patient resources BORN & Community data Implementation workshops TTT 20 Hour course Breastfeeding course for small hospitals Coaching strategy & monthly webinars New BORN Reports Assessor Workshop Workshops Coaching strategy & monthly webinars Resources Premies, Formula & Informed decision making Born reports Assessor Workshop

30 Navigating Complex Change Focus On Relationships between parts Using minimum specifications to enhance creativity and innovation Leaders must look across the system as a whole Enable the development of stakeholder relationships Encourage dialogue and system action Identify and build on intrinsic motivators attractors Paradox, tension and anxiety are natural by-products of complex systems

31 BFI Indicators BFI vs Non BFI Initiation Exclusive BF Rate Adjusted BF Rate BFI Hospitals NON BFI hospitals Supplementation - BFI vs Non BFI BFI Hospitals NON BFI hospitals Supp- Medical Reason Supp - NO Medical reason Does BFI Make a Difference? Ontario data comparing care at designated vs non designated hospitals demonstrates the value of BFI designation to ensure optimal breastfeeding support for mothers. n=375,859 births About 7.5% of births are in BFI designated hospitals

32 The BFI Strategy Team Sonya Boersma Louise Guthro Linda Young Doris Balcarras Hiltrud Dawson Yolande Lawson Catharine Lowes Kristina Niedra - MLOA Elizabeth Brazeau Wendy McAllister BSRC

33 Questions? Suggestions?

34 CONTACTS Hiltrud Dawson Project Manager, BFI Strategy Toronto East General Hospital Linda Young Director Maternal Newborn Child, Mental Health, Interprofessional Practice and Organizational Learning, Lead BFI Implementation Growing a Baby-Friendly Ontario!