Massachusetts Multisite Quality Improvement to Address Family Engagement in Level 2–3 Neonatal Intensive Care Units

Introduction: Family engagement is a cornerstone of neonatal care. Few multisite quality improvement efforts using robust quality metrics focused on family engagement have occurred in the neonatal intensive care unit (NICU) setting. We aimed to increase the following measures of NICU family engagement by 20% or more of baseline within 2 years without disparities by maternal race/ethnicity or preferred language in Massachusetts NICUs: (1) multidisciplinary family meetings within 7 days; (2) social work consultations within 7 days; (3) assessment of families’ unmet basic needs; (4) any mother’s milk at discharge; (5) more than 50% participation in skin-to-skin care; and (6) training in discharge skills 48 hours or more before discharge. Methods: We used an Institute for Healthcare Improvement Breakthrough Series framework of multisite quality improvement, which included collaborative, large-scale meetings and training interspersed with local quality work. From January 2021 to December 2022, we collected data on 459 infants admitted for 14 days or more. We examined family engagement measure rates quarterly using run charts and compared overall rates by maternal race/ethnicity and preferred language using χ 2 tests. We performed pilot data collection on parent-reported measures. Results: Forty-seven plan-do-study-act cycles were conducted. We found increases in training on discharge skills (from 57% to 90%) and in the assessment of unmet basic needs (from 39% to 96%). Many drivers occurred more often among infants with non-White and non-English-speaking mothers. Conclusions: Massachusetts NICUs implemented multiple interventions to increase family engagement. Our development and testing of chart-abstracted and family-reported measures of family engagement across a wide variety of topics may be generalizable to other NICUs working in this area.