NICQ: Newborn Improvement Collaborative for Quality

Key Drivers and Potentially Better Practices for Critical Transitions

Key Drivers

Elements of a High Quality Transition

A critical transition is any change of site of care, care plan, or care team.

Our aim is to achieve transitions that are safe, timely, effective, efficient, equitable, patient- and family-centered, and socially and environmentally responsible (STEEEPS).

The key drivers of STEEEPS transitions are:

  • Teamwork
  • Communication
  • Families as Partners
  • Health Equity
  • QI Methods

Achieving STEEEPS Transitions

The Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century is the source of the STEEEP (safe, timely, effective, efficient, equitable, patient- and family-centered) components. VON added the “social and environmentally responsible” criteria to this collaborative’s global aim.

Potentially Better Practices for Critical Transitions

Teams identify their improvement project for critical transitions by analyzing their VON data and discussing department and institutional needs and goals with stakeholders and team members. Some potentially better practices related to key drivers of high quality critical transitions are listed here.


  • Establish a shared mental model (map current/pre-improvement process)
  • Incorporate briefs, huddles, and debriefs
  • Conduct team training
  • Utilize simulation
  • Ensure team member roles are clear, flexible, and cross-trained

Families as Partners

  • Apply Families as Partners vision or philosophy of care statement to policies, practices, and programs
  • Design care processes with attention to infant and family experience of care
  • Support families to participate in care to the level they desire
  • Evaluate care practices and site of care to identify unnecessary separation of mothers, infants, and families
  • Develop strategies to support QI participation by parents including economically challenged, non-traditional and racially and ethnically diverse families

Health Equity

  • Screen all families for social risks and social support using a standardized tool
  • Provide parenting & family support tailored to individual family strengths
  • Provide mental health services for families during the hospital stay
  • Assess eligibility for public benefits and early intervention programs
  • Begin discharge planning and teaching at admission
  • Facilitate parent support groups & peer counselling that extend beyond the stay
  • Name racism and ask, “How is racism operating here?”

QI Methods

  • Utilize the Sequence to Achieve Change
  • Analyze failures (cases not following desired process) in real time
  • Conduct root cause analyses
  • Build decision aids and reminders into the system
  • Develop order sets, checklists, and clinical pathways as a result of tests of change