Being Small Has Advantages for Hospitals Implementing the Ten Steps

Posted November 13, 2015 by Cindy Hutter

Staff Photo
Meet the Adirondack Medical Center improvement team. (From left) Marilyn Leitsch, RN, director of Maternity Services; Sharlon Shatraw RN, data manager; Geraldine Peckham (Gigi), RN, IBCLC, team leader; Sharon Martin, RNC, staff support; and Darci Beiras, MD, Pediatracs. Missing from the photo are Jessica Duhaime, RN, IBCLC, team support and DeAnna Peckham, LPN, community mother partner.
Turns out, size may not matter. Small rural hospitals in New York State are experiencing as much, if not more, success in implementing evidenced-based practices to improve maternity care practices as their bigger suburban and urban counterparts.

United Memorial Medical Center in Batavia, NY, is one of 13 hospitals participating with NICHQ in the New York State Breastfeeding Quality Improvement in Hospitals (NYS BQIH) Learning Collaborative. The goal of the collaborative is to increase exclusive breastfeeding rates and the duration of any breastfeeding among new mothers by improving hospital-based maternity care practices. With about 650 births a year, United Memorial doesn’t get as many opportunities to implement changes in maternity care practices as larger hospitals in the collaborative. But it’s not all about size, according to improvement team leader Linda Stoiber, RN, BSN, ICBLC.

“Our small size fosters a positive and highly engaged team with fewer communication and process barriers,” says Stoiber. “It’s much easier to have questions answered timely and leadership is very accessible. There are fewer people to train and to get onboard with the changes we’re implementing.”

United Memorial’s maternity staff is about 20 people, including one lactation consultant and one lactation counselor. As with all NYS BQIH hospitals, the improvement team had to make the case for change and find a few innovators who were willing to try some new ideas and then champion their experience. Some of those changes included equipping obstetricians with information to talk with pregnant women about breastfeeding prior to labor, having babies room-in with the mothers instead of going to a nursery, and ensuring babies go skin-to-skin with the mother immediately after birth.

“Before the collaborative, skin-to-skin contact hardly ever happened,” said Stoiber. “Now everyone knows they have to keep the baby with the mother for the first three to four hours. They don’t go from the obstetrician’s hands to the scale anymore. They go straight to mom. That was a 360 degree turnaround. It took us a couple months of iterating on PDSA cycles to get there.” [PDSA cycles are an improvement tool that encourages small, incremental tests of change.]

Another advantage for small or rural hospitals is their close connection to the community.

Small Hospitals 10 Step Advantage Helps New Moms
An Adirondack Medical Center mom bonds with her baby, Ezra.
“Because we live in the community, we work, we shop, we have family members that deliver here, friends, staff—we see these new moms shopping and can ask them how they are doing,” says Stoiber. “We routinely have 12 to 18 breastfeeding mothers join us every week at our Breastfeeding and Beyond Baby Café.”

Adirondack Medical Center in Saranac Lake, NY, is even smaller, averaging 175 births per year—one of the lowest of all hospitals participating in NYS BQIH. Their size has benefitted them too. Quality improvement team leader Geraldine Peckham, IBCLC, says a 10 person staff has simplified the change process.

“All staff members are involved,” says Peckham. “When they see policies are changing and they are a part of making those policies, they are more likely to be on the same page.”

One challenge of having so few births at Adirondack is that it has been hard to get a new mothers support group going, especially to support mothers who go back to work soon after delivery and need encouragement to continue breastfeeding or supplementing instead of quitting. To overcome that challenge, hospital staff make sure to follow-up with all of their new mothers once they are home.

“It’s rewarding knowing we’re helping to improve health outcomes for mothers and babies,” says Peckham. “Big or small, that’s the best reason for a hospital to join [a collaborative].”
The next round of recruitment for NYS hospitals to join the NYS BQIH collaborative opens in January. If interested in participating, please contact

Learn more about NICHQ’s breastfeeding work and how you can partner with NICHQ to help your hospital to improve maternity care practices.


Add your comment





qi collaboration engagement partnerships larc im coiin nichq nashp breastfeeding new york wic quality improvement onboarding new york state hospitals mom mother partners epilepsy data AAP early childhood eccs coiin pdsas texas community support learning session infant mortality children's health new technology engineering transgender collaborative learning planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke toolkit e-module infant health dental care oral health underserved populations health inequity public health Maternal and Child Health Journal tips leadership engagement Sickle cell disease indiana SCD medicaid perinatal regionalization safe sleep sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support family engagement families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting preterm birth prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision vision screening eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series health equity health disparities access BQIH exclusive breastfeeding long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in Baby-Friendly parent partner patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching PDSA Cycle leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media advocacy leadership Berns Best Fed Beginnings Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening ASTHO reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis Huffington Post fundraising campaign first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Cross-Sector Collaboration Knowledge Sharing Child Health