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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e482-e488

ELECTRONIC ARTICLE

Implementing Potentially Better Practices for Multidisciplinary Team Building: Creating a Neonatal Intensive Care Unit Culture of Collaboration

Mark S. Brown, MD, MSPH*, Judy Ohlinger, RN, MSN{ddagger}, Connie Rusk, RN, NNP*, Paula Delmore, RN, MSN§ and Patricia Ittmann, DO|| on Behalf of the CARE Group

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

--> Objective. Part of the process of deriving and refining the CARE (communication, accountability, respect, empowerment) focus group’s potentially better practices (PBPs) for multidisciplinary teamwork was to evaluate and experience the PBPs through implementation.

Methods. The 4 neonatal intensive care units (NICUs) in the CARE focus group each worked with implementation of the PBPs. The choice of initial PBP and method of implementation was left up to each NICU’s core team.

Results. The experience of each of the PBPs that is reported was selected from only 1 of the NICUs. These are summarized and described in a plan-do-study-act type of format.

Conclusions. There was no ideal PBP with which to start. The intertwined nature of all of the PBPs provided additional opportunities to implement other PBPs. A change seemed to be a matter first of vocabulary, then of tentative acceptance, followed by gradual integration into the culture. Change was facilitated when there was acknowledgment of a need to do things differently by the NICU leadership. Although the validity of the PBPs and their importance in cultural change have yet to be confirmed, once there was a persisting intent to change, the makeup of the NICU culture moved to embrace change as part of its culture.

Key Words: neonatal intensive care units • organizational culture • interprofessional relations • collaborative quality improvement • NIC/Q 2000

Abbreviations: PBPs, potential better practices • NICU, neonatal intensive care unit • CARE, communication, accountability, respect, empowerment • PDSA, plan-do-study-act

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