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  • Quality Improvement Article
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Never judge a book by its cover: how NICU evaluators reach conclusions about quality of care

Journal of Perinatology volume 38, pages 751–758 (2018)Cite this article

Subjects

Abstract

Objective

To identify key features in the NICU care delivery context that influence quality of care delivery.

Study design

Qualitative study using in-depth, semi-structured interviews with 10 NICU quality experts with extensive experience conducting NICU site visits and evaluating quality of care. Analyses were performed using the method of constant comparison based on grounded theory.

Results

Qualitative analysis yielded three major themes: (1) the foundation for high quality care is a cohesive unit culture, characterized by open communication, teamwork, and engagement of families; (2) effective linkages between measurement and improvement action is necessary for continuous improvement; and (3) NICU capacity for improvement is sustained by active support, exchange of skills, and resources from the hospital.

Conclusions

Team cohesion, engagement of families, culture of improvement supported by measurement and institutional support from the hospital are some of the key contextual and managerial features critical to high-quality NICU care.

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Acknowledgements

We are grateful to the following individuals for contributing their time and expertise to this study: Lisa Bollman; David Braun; Doug Cunningham; Allen Fischer; David Perrott; Cecele Quaintance; Aida Simonian.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Stanford University School of Medicine, Stanford, CA, USA

    Ravi Dhurjati, Jeffrey B. Gould & Jochen Profit

  2. California Perinatal Quality Care Collaborative, Stanford, CA, USA

    Ravi Dhurjati, Jeffrey B. Gould & Jochen Profit

  3. School of Medicine, University of California, Irvine, CA, USA

    Nabeel Wahid

  4. Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Krista Sigurdson & Christine H. Morton

  5. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Heather C. Kaplan

  6. Perinatal Institute and James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Heather C. Kaplan

  7. Lucile Packard Children’s Hospital, Palo Alto, CA, USA

    Jochen Profit

Authors
  1. Ravi Dhurjati
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  2. Nabeel Wahid
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  3. Krista Sigurdson
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  4. Christine H. Morton
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  5. Heather C. Kaplan
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  6. Jeffrey B. Gould
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  7. Jochen Profit
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Corresponding author

Correspondence to Jochen Profit.

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The authors declare that they have no conflict of interest.

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Dhurjati, R., Wahid, N., Sigurdson, K. et al. Never judge a book by its cover: how NICU evaluators reach conclusions about quality of care. J Perinatol 38, 751–758 (2018). https://doi.org/10.1038/s41372-018-0092-0

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  • DOI: https://doi.org/10.1038/s41372-018-0092-0

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