A few days ago, I talked with a prospective client about her hospital’s efforts to earn the Baby-Friendly designation. Like many other hospital personnel I have spoken with, she noted that her hospital was “stuck” trying to meet the requirements of the Baby-Friendly Hospital Initiative (BFHI). I hear this often, and it’s become something of a song to me. I find no matter who is “singing,” it tends to have pretty much the same tune and the same three stanzas.
Over decades of working with organizations on system-level change, I have found three common sticking points for hospitals and other groups:
- Institutional factors—The policies, procedures, protocols, structures, norms, values, staff buy-in, etc. aren’t present.
- Implementation factors—The “structure” is present, but the process is considered cumbersome. “We can’t do X because of Y.” (Sometimes, tough analysis shows this is really “We think we can’t do X because of Y,” or even “We think we are doing X—but we aren’t.”)
- Familial factors—The hospital personnel committed to evidence-based practice would do “it” (whatever “it” is) right, but mothers/families want no part of it. “Rooming-in? Noooo, thanks. This is my last night to sleep before I go home!” That kind of thing.
The refrain is always the same: “We’re stuck, we’re stuck, we’re stuck.”
As the consultant, it’s my job to sing a new refrain, of success! I’ve never met a “stuck” hospital that couldn’t—with a bit of critical analysis and careful guidance—be unstuck.
With a little humor, I could probably put my consultancy to music from The Wizard of Oz: “Because, because, because, because, because…” That would be perfect. After all, part of my role is to help health care providers see they have what they need—brain, heart, and courage—as they establish a baby-friendly “home” (away from home) for the mothers and babies in their care.