Always Events(R) are defined as those aspects of the care experience that should always occur when patients, their family members or other care partners, and service users interact with health care professionals and the health care delivery system. A one page overview is also available.

The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization based in Boston, Massachusetts, is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide. At its core, IHI believes everyone should get the best care and health possible. IHI has a commitment to Person- and Family-Centered Care. This page lists resources for getting started.

This worksheet is a component of IHI’s QI Essential Toolkit. The Plan-Do-Study-Act (PDSA) cycle is a useful tool for documenting a test of change. Use this worksheet for each change you test.

The QI Project Charter provides a rationale and roadmap for team to clarify thinking about what needs to be done and why.

Walk-throughs enable providers to understand the experience of care from the patient’s and family’s points of view by going through the experience themselves.

A resource from IHI.

Higher acculturation is inversely related to breastfeeding rates, independently of income

Funding is increasingly competitive for community health organizations and federally qualified health centers. Institutions and agencies that receive funding or adequately allocate funding to include lactation services cannot address breastfeeding barriers within socioeconomically marginalized communities. Inconsistencies persist between breastfeeding information provided by lactation providers and delivery team care received in the hospital.

The prevalence of breastfeeding initiation was 84.1% overall and varied by maternal race/ethnicity, ranging from 90.3% among infants of Asian mothers to 73.6% among infants of Black mothers. Across states, the magnitude of disparity between the highest and lowest breastfeeding rates by racial/ethnic groups varied, ranging from 6.6 percentage points in Vermont to 37.6 percentage points in North Dakota, as did the specific racial/ethnic groups with the highest and lowest rates.

To meet the needs of sexual and/or gender groups, it is important that nurses use strategies focused on promoting respectful, affirming care, reducing negative experiences, and eliminating marginalizing language and practices.

Among patients delivering at an urban academic hospital, women on Medicaid were significantly less likely to breastfeed than those with private insurance.

Racism, bias, and discrimination are modifiable barriers that adversely affect breastfeeding among African American women. (The authors are from Marquette University, Milwaukee, WI.)

Breastfeeding continuation among U.S. Hispanic mothers varied by birth country, highlighting the heterogeneity of breastfeeding populations of Hispanic mothers in the United States. Tailored interventions should strengthen policies supportive of positive attitudes toward and subjective norms around breastfeeding.

Among Black mothers in the United States, breastfeeding continuation varied substantially by birth country. Promotion of interventions targeting positive attitudes, perceived control, and subjective norms may reduce disparities among Black and between Black and White mothers.

This study indicates a persistent disparity in breastfeeding outcomes in women with OUD (81.6% initiate and 23% at 6 months) relative to controls (97% initiate and 53% at 6 months), consistent with prior reports.

Interpersonal and systemic barriers in health care related to access, quality, support, and resources hindered Black mother’s breastfeeding across generations. Mothers across each age and breastfeeding cohorts emphasized a need for culturally tailored pro-breastfeeding health care systems to meet their breastfeeding needs.

AWHONN’s nursing care quality measures were feasible in hospitals in which medical records were configured to document the start and stop times of skin-to-skin contact.

This paper reviews the newborn’s progression through Widström’s 9 observable stages.

Process mapping of optimal skin-to-skin contact in the first hour after birth produced an accurate and useful measurement, showing how work is conducted and providing patterns for analysis and opportunities for improvement. The algorithm used, is Figure 1 on page 488.

The paper highlights specific social interactions and institutional structures that affect rooming-in and can be used by leadership and educators to develop targeted interventions to ensure consistent rooming-in.

After three months, first-hour breastfeeding rates increased from 12% to 80% applying QI strategies. The article describes the process and PDSA cycles used.

Lyndon A, Simpson KR, Spetz J, Zhong J, Gay CL, Fletcher J, et al. Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding. Nurs Res. 2022 Dec 1;71(6):432–40.