Breastfeeding-Friendly Heatlhcare (BFHC) Project: Identification of strategies and process approaches that support implementation of the Ten Steps to Successful Breastfeeding

BACKGROUND An objective of Healthy People 2020 is for hospitals to become more breastfeeding-friendly, i.e., implement the Ten Steps to Successful Breastfeeding. US studies exploring such implementation are predominantly single hospital studies. The Breastfeeding Friendly Healthcare Project (BFHC) explores Ten Steps implementation in multiple hospitals and identifies strategies across similar and differing contexts. METHODS The study follows a phased quasi-experimental operations research design using multiple-case study methods. The BFHC collected breastfeeding and Ten Step compliance data by reviewing documents and medical records and administering the Baby-friendly Self Appraisal Tool, the CDC mPINC, an individual-level Electronic Survey of hospital staff, and Key Informant Interviews. Pre-post changes in breastfeeding rates and Step compliance were tested for statistical significance. Facility-specific strategies for Step implementation were documented. Strategies were triangulated with pre-post changes in breastfeeding rates and Ten Step compliance. Within-case and cross case analyses identify case-specific and project-wide successful strategies. RESULTS Preliminary results suggest: 1) trainings that meet staff where they are vis-à-vis breastfeeding attitudes and practices may be more effective than traditional approaches; 2) hospital staff identify improving group efficacy towards Step implementation as important to success; 3) successful implementation requires leadership support; and 4) rounding on breastfeeding data leads to improved breastfeeding support. CONCLUSIONS This study makes a significant contribution in its use of multiple-hospitals in exploring the implementation of the Steps. Standard approaches may not be effective across all contexts and should be tailored to specific hospital contexts. How strategies interact with hospital context may inform other hospitals' implementation efforts.