Systems Based Practice

System Based Practice​​

Goal A

Residents will support and advocate for policies which promote and support breastfeeding as the cultural norm within the medical community and the community at large.

​Learner​​​ Objectives

  1. Describe the general benefits of and risks of not breastfeeding for the infant, mother, and the community at large, and be able to list common barriers to successful breastfeeding.
  2. Understand why it is important to work actively toward eliminating hospital policies and practices that discourage breastfeeding for patients, employees, and residents.
  3. Identify the Baby Friendly Hospital Initiative,The Ten Steps to Successful Breastfeeding​​ as described by the World Health Organization and UNICEF, and supported by the AAP, ACOG, and AAFP policy statements.

​​Activities and Evaluation Strategies

  1. Assess the hospital policy with respect to the Baby Friendly Hospital Initiative​, The Ten Steps to Successful Breastfeeding, and identify at least 1 barrier and 1 solution that could be suggested to improve the hospital's policy. The Ten Steps are clearly described in the AAP/ACOG Breastfeeding Handbook for Physicians
    Use the Baby Friendly Hospital Initiative Self-Appraisal Tool​ ​and have the resident present this information to the mentor.
    Additional Activities

    1. Participate in or present at multidisciplinary conferences on breastfeeding-related topics. Attendees to these conferences should include pediatric, obstetric, gynecologic, family medicine, and preventive medicine physicians. Conferences should be case-based, and residents from different disciplines should work together to present. 
      Use the evaluations of the multidisciplinary conferences (overall and individual sessions) by residents and other attendees to determine the success of this activity.
    2. Investigate and/or develop systems for follow-up of breastfeeding infants and mothers (phone/visit log book) and for referral to breastfeeding resources (informational card development) at your hospital. Compare to the practices of a Baby Friendly Hospital and suggest that these systems be implemented in the hospital or clinic setting. 
      Evaluate this activity by developing a score sheet to compare/contrast your hospital/clinic's policies and promotional practices versus those of a Baby Friendly Hospital or breastfeeding friendly clinic.
    3. Observe breastfeeding promotional practices and policies at a breastfeeding friendly medical office or Baby Friendly Hospital and compare to breastfeeding policies of your hospital unit or clinic; evaluate teaching materials provided to families – including cultural appropriateness (handouts, videos, posters depicting breastfeeding infants and mothers, availability of materials in different languages, advertising). Review your hospital's existing policies and promotional practices and originate, co-author, or review and revise, your hospital's policies to encourage breastfeeding (suggest revisions to policies that discourage breastfeeding). 
      Evaluate this activity by developing a score sheet to compare/contrast your hospital/clinic's policies and promotional practices versus those of a Baby Friendly Hospital or breastfeeding friendly clinic.
    4. Describe your hospital's breastfeeding program for employees, and investigate 2 other workplaces that have policies or programs related to working breastfeeding mothers. Survey hospital employees that have been affected by these policies. Make recommendations to revise the policy, and prepare a report of your findings including the existence of:
      • Established policy or program
      • Flexible work hours
      • Part-time options
      • On-site child care
      • Time, adequate space, and flexibility for pumping
      • Support groups or the availability of a lactation consultant
      Evaluate this activity by developing a score sheet to compare/contrast your hospital/clinic's policies and promotional practices versus those of a Baby Friendly Hospital or breastfeeding friendly clinic.
    5. Make contact with your state Chapter of your professional organization (such as the State AAP Chapter Breastfeeding Coordinator ) and investigate if there are opportunities for education and collaboration within the Chapter. Have the resident report on the number of breastfeeding educational opportunities at the state level for physicians and compile a report of what types of education are available. 
      Evaluate the quality of the resident's report.
    6. Identify and attend educational/prenatal classes available at your hospital or clinic for new parents. Survey parents on the quality of the class and its impact on their decisions about infant feeding. Have residents report their findings to the mentor and make recommendations to improve the classes. 
      Evaluate the residents by the number of parents that they surveyed and the quality of their recommendations to improve the classes.
    7. If a breastfeeding committee is active in the hospital, have the residents participate in their meetings and possibly join. 
      Determine the number of residents that have joined the hospital breastfeeding committee pre- and post-participation in the program.
    8. Advocate for reimbursement for breastfeeding support and lactation services in the workplace by conducting a letter writing campaign or in person meetings with businesses and insurance companies. 
      Evaluate the quality of the letters and business meeting and if the residents were able to bring about change.

​Goal B

Residents will understand how to coordinate services with, and provide appropriate referral to, other professionals, laypersons, and community groups, consistent with a multidisciplinary approach to care.

 Learn​​er Objectives

  1. Identify and establish a relationship with community and professionals groups, such as State AAP Chapter Breastfeeding Coordinators  and WIC Breastfeeding CoordinatorsLa Leche League, etc., that have activities that promote and support breastfeeding.
  2. Identify various professionals who contribute to the support and management of the breastfeeding infant and mother.

​ Activities an​​d Evaluation Strategies

  1. Attend community educational sessions at 1 of the following groups or bring together these groups at a fair for the residents (2 sessions per rotation):
    • Postpartum Support Groups for New Mothers and Families such as La Leche League Support Groups, Grandmother's Tea, Father's Supporting Breastfeeding, Mother's Milk Club, etc.
      For the Grandmother's Tea or the Father's Supporting Breastfeeding Groups contact your local WIC office to see if they support these programs. Contact local hospitals to see if they have Mother's Milk Clubs.
    • WIC clinic lactation consultant sessions
    • Maternal and child health outreach groups or individual sessions
    • Other peer support groups, or charitable or religious organizations that offer support and education 
    Following the visit, residents can survey parents about the community services and report on this feedback as well as their own experiences. 
    Evaluate residents by the number of parents they surveyed and the quality of their suggestions to the various community education services.​
    Additional Activities

    1. Create a Breastfeeding Resource Guide, which includes contact information for community, state, and national resources, such as:
      • Breastfeeding medical and nursing specialists
      • Lactation educators and consultants
      • Breast pump rental stations
      • State AAP Chapter Breastfeeding Coordinator
      • WIC Breastfeeding Coordinator
      • La Leche League
      • Community coalitions
      Grade the prototypes for a breastfeeding resource card or referral list and determine if implementation is possible.
    2. Access and evaluate child care licensing regulations pertaining to breastfeeding. Identify the differences in the national child care standards (Caring for Our Children: National Health and Safety Performance Standards - Guidelines for Early Care and Education Programs, Third Edition Chapter 4.3, Requirements for Special Groups or Ages of Children​ and Standard 4.011 - Nutrition for Infants and the General Plan for Feeding Infants and those of your state licensing agencies.) 
      Score each resident's ability to identify the differences in the childcare national standards and the state licensing breastfeeding policies.
    3. Review and advocate for new state and local laws (maternity/family leave policies, own institution-hospital policies, clinic/residency program policies, breastfeeding in public laws, lactation services laws, breast pump rental coverage laws). Draft a letter to local legislators to support pending legislation that advocates for breastfeeding women. 
      Grade the quality of actions taken on behalf of breastfeeding mothers, such as letters to legislators.
    4. Perform a cost/benefit analysis of breastfeeding support within a defined population, including pump rental and lactation support in the workplace, and present in a teaching forum. 
      Evaluate the resident's ability to perform a cost analysis and present findings at a teaching conference on breastfeeding advocacy.
    5. Accompany a public health nurse/home care nurse on a visit to a breastfeeding infant and mother and record and present observations to mentor as a case study. 
      Evaluate the content of the case study presentation.
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