Past NICQ Collaboratives

NICQ Next2Transforming Newborn Care 2016/17.  A 2 year, intensive collaborative supporting 6 Homerooms and 62 teams.  Themes included embedding quality improvement methods, achieving family-centeredness, expanding engagement of the unit team, and resourcing teams with tools to achieve improvement.  The collaborative opened with a meeting attended by all teams that provided Homeroom time, plenaries addressing key components of the collaborative, and workshops that reinforced and in some cases reintroduced quality improvement methods.  In the spring and summer of 2017, Homerooms gathered at host sites for a unique immersion and collaborative experience – Open NICU Supporting Improvement Toward Excellence (ONSITE).  Teams learned from and with each other.  Host teams received valuable feedback and suggestions from their colleagues in exchange for their incredible generosity and sharing.  In the fall of each year, Homerooms gathered in the days leading up to VON’s Annual Quality Congress in Chicago.  Dedicated Homeroom time, along with presentations from each Homeroom at the NICQ & iNICQ Symposium, and poster presentations by each team provided an opportunity to celebrate achievement and share improvement stories.

NICQ Next: Innovations in Newborn Care 2014/15. This 2 year collaborative supported six Homerooms and 59 teams. Themes included standardization, the context for improvement, family-centered care / understanding the patient journey, and the value equation wherein value is a measure impacted by both quality and cost. Teams participated enthusiastically in immersion learning through attendance at annual ONSITEs (Open NICU Supporting Improvement Toward Excellence). Inspiring examples of excellence were witnessed and immersion in another NICU environment presented unique opportunities to reflect on the practice and culture norms of teams’ own NICUs. Teams shared many examples of their improvement journey through participation in NICQ Next webinars and the NICQ Symposium, hosted in conjunction with the Annual Quality Congress in Chicago each fall.

NICQ 8: NICQ 8 was a one-year collaborative in 2013 built on the existing foundation of expertise and relationships among NICQ 7 participants and faculty. In addition to the continuing work of NICQ 7, the teams focused on standardization and contextual inquiry while exploring a new collaborative learning model, “Open NICU Supporting Improvement Toward Excellence” (ONSITE). This successful innovative approach to collaboration was based on a deep, shared understanding of context and the power of standardization of NICU processes examined during ONSITE visits to participating NICUs.

NICQ 7: Solving the Value Equation for Neonatal Intensive Care. Interdisciplinary teams and families from 49 NICUs worked under the guidance of expert faculty to create unique improvement portfolios for their organizations and to make measurable improvements in the quality, safety, and value of the care they provide. Teams developed and applied new strategies for improving value (measured as a quality/cost ratio). By eliminating waste, overuse, underuse, and misuse, and working more efficiently, our patients and families would be exposed to fewer unnecessary and inappropriate procedures, interventions, and days in hospital, translating into an improved care experience for patients, families, and staff.

NICQ 2009: NICQ 2009 included 52 interdisciplinary NICU teams and seven statewide collaborative leadership teams. The vision of NICQ 2009 was “To be an inclusive community of practice that supports the pursuit of shared goals for improvement and the provision of exemplary care for all newborn infants and their families.” To that end, NICQpedia, the online repository of tools, materials, and work products of the NICQ collaboratives, was established. For this collaborative, participating teams chose nine topic areas for improvement: medication safety, discharge management, respiratory care, resuscitation, nutrition, nosocomial infection, neonatal encephalopathy, electronic health records, and NICU design. Topic experts created “starter kits,” including an initial set of potentially better practices and change ideas, for each topic group. The goal was for interdisciplinary NICU teams to modify the kits based on their improvement work and to develop a comprehensive new improvement resource for neonatal care. These quality improvement kits reside on NICQpedia.

NIC/Q 2007: Forty-seven teams focused on improving and standardizing specific NICU processes, utilizing a framework of the six improvement themes (safe, family centered, effective, efficient, timely, and equitable) adapted from the Institute of Medicine’s aims, first published in Crossing the Quality Chasm: A New Health System for the 21st Century (IOM 2001). A seventh theme, socially and environmentally responsible, was adopted by VON. Family-centered care became a strong focus of the collaborative, with teams encouraged to include family members as partners in their improvement work. Senior leaders and CEOs were invited to join their teams at the final meeting to address measurement of quality using the “Measure What Matters” framework. The e-book NICQ 2007: Improvement in Action is the culmination of NIC/Q 2007. The chapters addressing the seven improvement themes were written by invited experts and illustrated with improvement stories from teams that participated in the collaborative.

NIC/Q 2005: The fourth NIC/Q collaborative had two arms. The “Your Ideal NICU” (YIN) arm included 12 veteran teams that sought to transform their units through intensive work with expert coaches, utilizing a microsystems approach developed at Dartmouth College. The YANG arm included 42 new and experienced interdisciplinary teams working under the guidance of expert faculty to identify, test, and implement a broad range of potentially better practices in the areas of neonatal surgery, the physical NICU environment, management of blood pressure and hemodynamics, obstetric neonatal collaboration, nutrition, medication safety, and respiratory care. Each focus group developed a resource kit documenting the potentially better practices that they identified, tested, and implemented.

NIC/Q 2002: Forty-eight interdisciplinary NICU teams formed groups on chronic lung disease, pain and sedation, family-centered care, discharge planning, staffing, obstetric/neonatal/perinatal communication, and nosocomial infection. These teams worked together from March 2002 through December 2004 with the guidance of expert faculty and staff to identify, test, and implement potentially-better-practice change ideas that were designed to improve the quality and safety of care. Patient safety continued to be an underlying theme throughout the collaborative, with emphasis on implementing the JCAHO patient-safety goals in the neonatal population. The results of NIC/Q 2002 are reported in the “Evidence Based Quality Improvement in Neonatal and Perinatal Medicine: The NIC/Q 2002 Experience” November 2006 supplement to Pediatrics.

NIC/Q 2000: Based on the successes of the initial NIC/Q Collaborative, VON recruited 34 institutions to participate in the second collaborative. Multi-center focus groups were formed to develop potentially better practice ideas in a broad range of areas, including nosocomial infection, chronic lung disease, interdisciplinary teamwork, family-centered care, brain injury, and nutrition. Teams worked together with guidance from expert faculty to develop and apply four key habits for clinical improvement: change, evidence-based practice, systems thinking, and collaborative learning. The groups reported on their work in the “Evidence Based Quality Improvement in Neonatal and Perinatal Medicine: The NIC/Q 2000 Experience” April 2003 supplement to Pediatrics.

NIC/Q: The Newborn Intensive Collaborative for Quality had its inception in 1995 when VON brought together interdisciplinary teams from 10 institutions to work on common improvement goals under the direction of an expert faculty. The major components of the collaborative were interdisciplinary collaboration within and among hospitals; feedback of information from the Network database regarding clinical practices and patient outcomes; training in quality improvement methods; and identification and implementation of potentially better practices. Teams from these centers pursued improvements in chronic lung disease, nosocomial infection, length of stay, and cost. Groups reported their work in Pediatrics.