Implementing potentially better practices to reduce lung injury in neonates.
OBJECTIVE
Adherence to basic quality improvement principles enhances the implementation of potentially better practices (PBPs) and requires extensive planning and education. Even after PBPs have been identified and acknowledged as desirable, effective implementation of these practices does not occur easily. The objective of this study was to identify and assess implementation strategies that facilitate quality improvements in the respiratory care of extremely low birth weight infants.


METHODS
The 9 members of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000 Reducing Lung Injury focus group identified 9 PBPs in a evidence-based manner to decrease chronic lung disease in extremely low birth weight newborns. Each site implemented several or all PBPs based on a site-specific selection process. Each site was asked to submit 1 or more examples of experiences that highlighted effective implementation strategies. This article reports these examples and emphasizes the principles on which they are based.


RESULTS
The 9 participating institutions implemented a total of 57 PBPs (range: 1-9; median: 5). Including previous implementation, the 9 participating institutions implemented a total of 70 of a possible 81 PBPs before or during the study period (range: 5-9; median: 8). We report 7 approaches that facilitated PBP implementation: information availability, feedback, perseverance, collaboration, imitation, recognition of implementation complexity, and tracking of process indicators.


CONCLUSIONS
Quality improvement efforts are enhanced by identifying and then implementing PBPs. In our experience, implementation of these PBPs can be difficult. Implementation strategies, such as those identified in this article, can improve the chances that quality improvement efforts will be effective.
Burch
Kelly
K
St John's Mercy Medical Center, St Louis, Missouri 63141, USA. burckj@mercy.stlo.net
Rhine
William
W
Baker
Robin
R
Litman
Fern
F
Kaempf
Joseph W
JW
Schwarz
Edward
E
Sun
Shyan
S
Payne
Nathaniel R
NR
Sharek
Paul J
PJ
D019985:Benchmarking; D002908:Chronic Disease; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D017144:Focus Groups; D006284:Health Plan Implementation; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000592:standards*; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000592:standards; D008171:Lung Diseases / Q000517:prevention & control*; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D012121:Respiration, Artificial / Q000379:methods*; D017749:Total Quality Management / Q000379:methods*; D014481:United States