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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e397-e410

ELECTRONIC ARTICLE

NIC/Q 2000: Establishing Habits for Improvement in Neonatal Intensive Care Units

Jeffrey D. Horbar, MD^*,, Paul E. Plsek, MS and Kathy Leahy, RN, NNP^*

^* Vermont Oxford Network, Burlington, Vermont
Department of Pediatrics, University of Vermont, Burlington, Vermont
Paul E. Plsek & Associates, Roswell, Georgia

--> Objectives. The Vermont Oxford Network is a group of health professionals who are committed to improving the quality and safety of medical care for newborn infants and their families. Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was the second in a series of multiorganization improvement collaboratives organized and administered by the Vermont Oxford Network. The objective of this collaborative was to make measurable improvements in the quality and safety of neonatal intensive care, develop new tools and resources for improvement specific to the neonatal intensive care unit setting, evaluate improvement progress, and disseminate the learning.

Methods. The 34 centers that participated in NIC/Q 2000 learned and applied 4 key habits for improvement: the habit for change, the habit for evidence-based practice, the habit for systems thinking, and the habit for collaborative learning. A plan-do-study-act method of rapid-cycle improvement was an integral part of the habit for change. Multidisciplinary teams from the participating centers worked closely together in face-to-face meetings, conference calls, and dedicated e-mail listservs under the guidance of trained facilitators and expert faculty. Focus groups formed around specific improvement topics used critical appraisal of the published literature, detailed process analysis, benchmarking, and round-robin site visits to identify potentially better practices (PBPs).

Results. The focus groups developed a total of 51 PBPs. Each focus group has developed a "resource kit" summarizing its work. Many of these PBPs have been tested and implemented at the participating centers using rapid-cycle improvement. The PBPs and descriptions of individual center PDSA cycles are available to participants on NICQ.org, the dedicated Internet site for the collaborative.

Conclusions. Collaborative quality improvement based on the 4 key habits can assist multidisciplinary neonatal intensive care unit teams in identifying, testing, and successfully implementing change.

Key Words: collaborative quality improvement • process improvement • 4 key habits for improvement • NIC/Q 2000

Abbreviations: PBPs, potentially better practices • PDSA, plan-do-study-act • NICU, neonatal intensive care unit • NIC/Q 2000, Neonatal Intensive Care Quality Improvement Collaborative Year 2000 • CAT, critically appraised topic • MDLT, multidisciplinary leadership team

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

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