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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:
• 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

Forcing Functions

Culture Eval
The QI Team
Successful QI Work


Accomplishing the PQCNC Mission:
The PQCNC Value Equation

• Partnership with patients and families
• Spread best practice and eliminate unjustified
• 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
– 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 Large reductions CLABSI rates

• RNs and MDs: “Tiny babies with • RNs and MDs: “It might be
central lines get infections” possible for us to eliminate
infections in tiny babies.”
• “We need a bigger budget & better
• RN’s: “We can help each other
take better care of central
• “Our patients are sicker.” lines.”
• Nurses: “We can’t monitor each • RN’s: “Our docs and NNPs at
other.” first hated unit time outs but
• Doctors: “They don’t buy-in to the we all adapted to it.”
theory that we can knock our • RNs and Docs: “It’s a good idea
infection rate down.” to be reminded about how we
should care for central lines.”
• Nurses: “I think that trying to get
• Docs: “This encourages us to
them to buy-in to that is very hard think about when we get lines
because they don’t see the out.”
importance of it.”
• “They refuse to do unit time
outs…they say its ridiculous.”
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?
• Return maximal value Why?
on perinatal care in
North Carolina
– Spread best practice
– Partner with families and
patients Simon Sinek: How Great Leaders Inspire
– Optimize resources
Supporting Patient & Family
MD MOC Partners
How? How?
Clinical Incentives
Leaders How?

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

Public Effective
Policy & Teams
Reporting How?
How? Pay for
Collaborative Evidence
Performance 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