Improving and Sustaining Breastfeeding Practices through a Statewide Learning Collaborative

Objective: The aim of the Texas Breastfeeding Learning Collaborative (TBLC) is to increase in‐hospital exclusive breastfeeding rates by 35% across three, sequential, regional, quality improvement, learning collaborative cohorts of as many as 81 birthing facilities. Design: Use of the Institute for Healthcare Improvement's Breakthrough Series (BTS) and Model for Improvement (MFI) to facilitate uptake of the Ten Steps to Successful Breastfeeding (Ten Steps). Sample: Cohorts A and B included 41 hospital improvement teams in two geographic regions cumulatively accounting for 99,000 births (26% of Texas births and 2.5% U.S. births) annually. Participating facilities included a diverse mix of urban/rural, large/midsized/small, and public, private, and academic center settings at varying stages of Ten Steps implementation. Methods: The TBLC utilizes the BTS, MFI, and complementary support to facilitate implementation of the Ten Steps within participating facilities. Implementation Strategies: Twenty hospital teams (Cohort A) were guided through a BTS Learning Collaborative with components including data collection, self‐assessment surveys, discussion forums, support calls, leadership events, face‐to‐face learning sessions (LS), and virtual action periods (AP) calls. Components work to accelerate plan‐do‐study‐act cycles for improvement and to facilitate sharing of best practices among teams. Learning sessions included didactic lectures to communicate the evidence base of the Ten Steps and interactive workshops focused on sharing strategies to overcome common and special cause barriers. Teams were linked to breastfeeding support resources of the Department of Health and Human Services. Cohort B built upon Cohort A successes, and collective learning was spread to hospital teams through cross‐cohort collaborative mentorship and continuous quality improvement within the project structure. Results: Cohort A's quality data indicated aggregate improvements from February 2013 to April 2014 for multiple outcome and process measures. Conclusion/Implications for Nursing Practice: Multidisciplinary teams engaged in a quality improvement learning collaborative to accelerate adaptation of recommended maternity practices across diverse hospital settings to achieve improved process‐ and outcome measures. Improvement strategies and lessons learned are transferable to other projects and settings. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses