title: Promoting Breastfeeding-Friendly Hospital Practices: A Washington State Learning Collaborative Case Study.
abstract: BACKGROUND
  Hospital breastfeeding support practices can affect breastfeeding outcomes. Learning collaboratives are an increasingly common strategy to improve practices in health care and have been applied to breastfeeding in many cases.
  
  
  OBJECTIVE
  The aims of this study of the Evidence-Based Hospital Breastfeeding Support Learning Collaborative (EBBS LC) were to describe the perceptions of participants regarding the process and effectiveness of the EBBS LC, describe perceived barriers and facilitators to implementing the Ten Steps to Successful Breastfeeding, and identify additional actions and resources needed in future learning collaboratives.
  
  
  METHODS
  Qualitative, semistructured telephone interviews were conducted with 13 key staff who represented 16 of the 18 participating hospitals.
  
  
  RESULTS
  The learning collaborative was perceived positively by participants, meeting the expectations of 9 and exceeding the expectations of 4 persons interviewed. The most beneficial aspect of the program was its collaborative nature, and the most difficult aspect was the time required to participate as well as technological difficulties. The key barriers were staff time, staff changes, cost, and the difficulty of changing the existing practices of hospitals and communities. The key facilitating factors were supportive management, participation in multiple breastfeeding quality improvement projects, collecting data on breastfeeding outcomes, tangible resources regarding the Ten Steps, and positive community response. Participants in the EBBS LC stated that they would like to see the Washington State Department of Health create a resource-rich, centralized source of information for participants.
  
  
  CONCLUSIONS
  This learning collaborative approach was valued by participants. Future efforts can be guided by these evaluation findings.
authors.affiliation: University of Washington, Seattle, WA, USA efreney@uw.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Freney
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Johnson
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Isabella
authors.initials: I
authors.lastname: Knox
mesh_terms: D001291:Attitude of Health Personnel; D001942:Breast Feeding; D003299:Cooperative Behavior; D005260:Female; D006293:Health Promotion / Q000379:methods; D006761:Hospitals; D006801:Humans; D009741:Nursing Staff, Hospital; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000458:organization & administration; D011181:Postnatal Care / Q000379:methods* / Q000458:organization & administration; D036301:Qualitative Research; D014861:Washington
keywords: Baby-Friendly Hospital Initiative; attitudes; breastfeeding; breastfeeding promotion; breastfeeding support; hospital practices