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The secret sauce: secrets of high performing neonatal intensive care units

Neonatal intensive care units (NICUs) aim to provide safe, high-quality medical and surgical care for all newborns. The creation of, and widespread participation in, NICU quality collaboratives such as the Vermont Oxford Network (VON), Children’s Hospitals Neonatal Consortium (CHNC) and state perinatal collaboratives (such as California, New York, Ohio, Illinois, Massachusetts, Tennessee, Florida and North Carolina) has no doubt accelerated progress in the field of neonatal quality improvement and safety. However, there still remains limited evidence of overall efficacy of these collaboratives.1 NICUs strive to apply the best possible evidence in their local setting, known as ‘potentially better practices’, to achieve improved patient outcomes. However, similar interventions applied in a similar fashion in similar NICUs often do not produce the same results. This unexplained variability in outcomes between NICUs begs the question: What is the secret sauce ? Why do some NICUs consistently outshine others in spite of the application of the same ‘potentially best practices’?

To answer these questions, it becomes necessary to determine those factors that contribute to success or failure of improvement programmes, including less tangible aspects such as NICU culture/environment, leadership, team work and organisational structure. Barron et al 2 identified eight critical success factors evident in places with strong performance improvement (PI) programmes:

1. Strong administrative executive and PI leadership. In creating this vision of excellence, a symbiotic relationship exists between executive leadership and the NICU. Leadership is supportive of PI efforts and is actively engaged with the …