Evaluating an evidence-based approach to support practice change


Large-scale Sustainable Change
Evidence into Practice: Breastfeeding & Kangaroo skin-to-skin care for babies and families in neonatal units in Scotland.  A realist evaluation: what works for                            whom & in what settings?



What we know

The Evidence into Practice (EiP) approach was successfully used in neonatal units in Yorkshire and Humberside to implement practice change and improve care. 

Maternal and child health is a priority highlighted in the Route Map to the 2020 Vision for Health and Social Care in Scotland.   Our project aims to implement and evaluate the EiP approach to create sustained improvements to the quality of care given to mothers and babies; to support the delivery of the Route Map and Best Start, Scottish Government’s policies.


Project aim

The aim of this project is to perform a large-scale evaluation, to understand whether the Evidence into Practice (EiP) approach can be translated into a different context, i.e. neonatal units in Scotland.  Enhance our understanding of large-scale sustainable change – and translate learning from this evaluation that can support large-scale implementation within different contexts. 


What this research explores

The focus of this project is to implement evidence-based recommendations on how to improve neonatal breastfeeding and parent-baby attachment; working with neonatal units across Scotland.

The EiP approach has four phases:

  • Phase 1 review systematic review level evidence of best practices in skin to skin care (kangaroo care) and breastfeeding for neonatal infants to develop evidence statements.
  • Phase 2 consultation of evidence statements via an online survey to key stakeholders.  Evidence statements appraised in terms of impact and feasibility and around the barriers and facilitators to implementation and reflections on current practice.
  • Phase 3 consultation workshops were repeated to capture views on the impact and feasibility of the evidence statements, share practice and the barriers and facilitators.  AS well as capturing individual views, the workshops enabled group consensus views in terms of impact and feasibility and to identify barriers, strategies in relation to the evidence based statements.
  • Phase 4 analysis and synthesis of the data from both the online and workshop consultations and dissemination of the findings.

As part of the consultation and dissemination process, analysis of the quantitative and qualitative data from the consultation workshops was conducted.  A summary report and infographic highlighting the key barriers and enablers was produced and disseminated to all key stakeholders – practitioners, managers and third sector groups to sense-check the initial findings. 

A further report with the key interventions with high impact and feasibility, along with the synthesis of barriers, strategies and practice examples relating to the evidence-statements was published and used to as the basis for teams to develop local action plans at a national workshop.  

All presentations and documentation used during the consultation workshops are available:  consultation workshops documentation and presentations


Realist evaluation

In addition to the improvement and implementation work that was undertaken, the SISCC team conducted a detailed evaluation of the EiP approach to gain a better understanding of the elements that support large-scale sustainable change and strengthen the evidence-base for improvement and implementation science.

What this study will add

The realist evaluation of the EiP approach which will address the question of whether this participatory approach can support services to implement large scale change, is completed and is expected to published in the summer of 2020. 


Collaborators

The implementation elements of this project were led by Gill Milner and the evaluation by Dr Alison Munro, both based at the School of Health Sciences at the University of Dundee.  The project was supported by a cross-sectoral national advisory group, chaired by Professor Helen Cheyne, University of Stirling and involved neonatal staff from Units across Scotland. 


For more information please contact SISCC (siscc@dundee.ac.uk)



Links:

The best start: five-year plan for maternity and neonatal care 

Maternal and Child Health – Scottish Government 

UNICEF The Baby Friendly Initiative

Scottish Patient Safety Programme – Maternity and Children Quality Improvement Collaborative 

British Association of Perinatal Medicine

RCM - Royal College of Midwives

BLISS UK

Public Health Scotland

Feed Good - Scottish Government

Providing the best medicine : summary of the evidence  in support of breast(milk) feeding in neonatal units

A Route Map to the 2020 vision for Health & Social Care