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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e471-e481

ELECTRONIC ARTICLE

Development of Potentially Better Practices for the Neonatal Intensive Care Unit as a Culture of Collaboration: Communication, Accountability, Respect, and Empowerment

Judy Ohlinger, RN, MSN^*, Mark S. Brown, MD, MSPH, Sue Laudert, MD, Sue Swanson, RN, NNP^|| and Ona Fofah, MD^|| on Behalf of the CARE Group

^* Children’s Hospital Medical Center of Akron, Akron, Ohio
Presbyterian St Luke’s Medical Center, Denver, Colorado
Wesley Medical Center, Wichita, Kansas
^|| Rockford Memorial Hospital Rockford, Rockford, Illinois

--> Objective. The Vermont Oxford Network (VON) CARE Group was formed in response to the need to create organizational cultures supportive of change and quality improvement.

Methods. The CARE Group consisted of team members from 4 participating neonatal intensive care units (NICUs). All CARE Group members chose to work on multidisciplinary teamwork for the duration of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000. A questionnaire was developed by the CARE Group and administered to the 4 focus group NICUs. The survey focused on 6 domains of the organization: unit coordination, working in the NICU, leadership, management of disagreements, authority, and unit culture. Benchmarking visits were completed to supplement the information found in the survey and the literature.

Results. Seven potentially better practices (PBPs) were developed on the basis of the surveys, benchmark visits, and literature reviews. The PBPs include 1) a clear, shared NICU purpose, goals, and values; 2) effective communication among and between teams and team members; 3) leaders lead by example; 4) nurture a collaborative NICU environment with trust and respect; 5) live principled standards of conduct and standards of excellence; 6) nurture competent and committed teams and team members; and 7) commit to effective and positive conflict management.

Conclusions. The CARE Group successfully used quality improvement methods and collaboration to delineate principles and practices of multidisciplinary teamwork.

Key Words: collaboration • multidisciplinary teamwork • leadership • culture • collaborative quality improvement • NIC/Q 2000

Abbreviations: NICU, neonatal intensive care unit • NIC/Q 2000, Neonatal Intensive Care Quality Improvement Collaborative Year 2000 • PBPs, potentially better practices

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Received for publication Aug 13, 2002; Accepted Oct 24, 2002.

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