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Newborn Initiative!!!
 W 2

Martin J McCaffrey, MD, CAPT USN (Ret)

Professor of Pediatrics
UNC School of Medicine
Director of the PQCNC
For the PQCNC
Evidence Based Best Clinical Practices
Exposing Sources of Unexplained Variation:
PQCNC QI Focus
• People
– Expertise
– Communication
– Leadership
• Practices and processes
– Standardization & compliance with guidelines/policies
• Technology
– Unit & Hospital
• Organizational structure
– Finances, Volume, Staffing
• Culture
– Chain of command
– Unit/hospital societal structure
– Beliefs, empowerment, behaviors, traditions
 Executing Successful Quality Improvement

1. Empirical studies control context but we live in a world of context

2. Unit level processes, people, traditions, technology, organization
3. Special types of measurement & techniques that include time in the
analysis, as all improvement involves change over time
4. “+”: Employ modalities, including standardization & forcing functions
to apply and adapting generalizable evidence to context
5. The “→” symbol represents the knowledge and coordination required
for execution locally—what you need to know to “make things
happen”, the organizational drivers of change in a particular place.

Batalden PB and Davidoff F. What is "quality improvement" and how can it transform
healthcare? Qual Saf Health Care. 2007;16(1):2-3.
 Da 2
ta

Forcing Functions
1
Data

Standardization
Evidenc
e
Culture Eval
The QI Team
Successful QI Work

Leadership

Mission
Organization
Knowledge
 Accomplishing the PQCNC Mission:
The PQCNC Value Equation

• Partnership with patients and families

• Spread best practice and eliminate unjustified
variation
• Resource optimization
Accomplishing the PQCNC Mission
• Build an environment of trust and transparency
• Develop commitment to collaborative performance
– Facility desire to improve
– PQCNC facilitates a view to the state
– As one we learn from successes and challenge
• Use data to support improvement
– Your facility over time
ta
Da
– See what is possible via others
– Learn from challenges of others
– Change outcomes through small tests of change
The Heart of PQCNC: The Perinatal Quality
Improvement Teams (PQIT)

• Members
– Physician and Nursing leadership
– Junior staff
– Patient and family partners
– Direct links: Engaged executive leadership
• Customize action plan to your hospital
• Regularly review data, identify opportunities and
communicate to staff
• Facilitate PDSAs
 Types of Organizational Cultures

Baker G R et al. Using Organizational Assessment Surveys for Improvement in

Neonatal Intensive Care. Pediatrics 2003;111:e419-e425
 Types of Organizational Cultures

Baker G R et al. Using Organizational Assessment Surveys for Improvement in

Neonatal Intensive Care Pediatrics 2003;111:e419-e425
 NCABSI: Can We Can Do This?
• Nine states CLABSI prevention project, 91 NICUs
• 17 NCABSI NICUs with no infections
• 8 NCABSI NICUS with average of 150 line days per
month with no infections
• 4 NCABSI NICUS with average of at least 300 line
days per month with no infections

Hardy et al. PAS 2014.

 NCABSI: Can We Do This?
Minimal or No reductions CLABSI rates
• RNs and MDs: “Tiny babies with
central lines get infections”
• “We need a bigger budget & better
equipment.”
• “Our patients are sicker.”
• Nurses: “We can’t monitor each
other.”
• Doctors: “They don’t buy-in to the
theory that we can knock our
infection rate down.”
• Nurses: “I think that trying to get
them to buy-in to that is very hard
because they don’t see the
importance of it.”
• “They refuse to do unit time
outs…they say its ridiculous.”
Large reductions CLABSI rates
• RNs and MDs: “It might be
possible for us to eliminate
infections in tiny babies.”
• RN’s: “We can help each other
take better care of central
lines.”
• RN’s: “Our docs and NNPs at
first hated unit time outs but
we all adapted to it.”
• RNs and Docs: “It’s a good idea
to be reminded about how we
should care for central lines.”
• Docs: “This encourages us to
think about when we get lines
out.”
We’re making changes, are
we changing culture?
Tales from the
Jersey Turnpike
Getting To We…
 The Perinatal Quality Collaborative of
North Carolina: PQCNC
• Mission: Make North Tell me about your hospital or unit?

Carolina the best place What?

to give birth and be How?
born
• Return maximal value Why?
on perinatal care in
North Carolina
– Spread best practice
– Partner with families and
patients Simon Sinek: How Great Leaders Inspire
Action http://on.ted.com/q0Nly
– Optimize resources
 Supporting Patient & Family
MD MOC Partners
How? How?
Payment
Clinical Incentives
Leaders How?
How?

Why?
Making North
Quality Carolina the Best Data &
Improvement
Place to Give Birth Measures
What? How?
and Be Born

Public Effective
Policy & Teams
Reporting How?
How? Pay for
Collaborative Evidence
Performance How?
How?
 We x Why= W 2

“If we tell people where to go, but not

how to get there, we will be amazed at
the results.” (Gen George S Patton)
PQCNC 2018 Quality Award