Purpose for the program: The birth of a baby is a major life event for mother and family. Current literature suggests that outcomes are best when mothers and babies stay together. The existing care model in the Family Birth Center was contrary to the current recommendations and promoted the separation of mothers and babies.  Care was often more nurse centered rather than patient or family centered and this culture can be difficult to change. 

Proposed change: The goal was to transition from traditional postpartum and newborn care to mother/baby couplet care. This change process had been attempted in the past but had failed. This failure was thought to be due to the lack of front line involvement and the presence of an authoritative leadership style that attempted to dictate rather than collaborate with staff. To be successful,  front line team members had to be involved, champion, and ignite the change process.  Leadership served as facilitators and allowed the process to be driven by front line team members.  Throughout the transition feedback on process changes was encouraged, welcomed, and accepted from front line team members.

Implementation, outcomes and evaluation: Transition occurred in less than three months when front line team members were driving the change. The staff embraced the change, promoted it to co-workers and encouraged involvement and input. Patient satisfaction scores have shown improvement consistently above the target mean. Team member satisfaction has been noted as well. Breast milk feeding rates have improved.  An outcome that was not anticipated was improved thermoregulation of the newborn. Continued challenges exist related to getting full buy-in from pediatricians who still insist on making rounds in the newborn nursery rather than the mother’s room. As a result of the success of the change, the process is now being implemented system-wide and the team members are being used as resources for other hospitals to aid in their transition.

Implications for nursing practice: This was an excellent example of how change occurs smoothly when stakeholders and front line team members participate, are given the rationale and evidence for making change, and are allowed to own the project. Leaders must instill the need to support change and promote evidence based care in front line team members. The change demonstrates the effectiveness of involving front line staff  to take on the challenge for making change and improving quality of care in order to benefit the healthcare of patients. 

 Keywords: Change process, couplet care, front line team members, mother-baby care, patient satisfaction