As any public health expert knows, change sometimes comes slowly, especially when it means changing our habitual way of doing things. From getting people to buckle their seatbelts every time they get into a car – to convincing us to exercise and cut back on high-cholesterol foods, we humans can be stubborn and do not easily change our ways, even when we know it is good for us and those we love.
On a recent trip to a partner Hospital in Gujarat India, I was able to see first hand the impact of a shift in the habitual working patterns of hospital staff to include use of the Embrace warmer. The hospital’s Neonatal Intensive Care Unit (NICU) is often overcrowded with low birth weight babies needing special attention, and has a lack of adequate equipment to provide warmth to these smallest patients. Nurses and staff had become used to placing 2-3 babies on one radiant warmer at a time, risking cross-contamination of illnesses. Other babies would be simply wrapped in blankets and placed in non-functioning incubators, risking hypothermia.
When our Embrace Fellow introduced the Embrace warmer, therefore, nurses and doctors were delighted. As an easy-to-use, safe and simple warming device that took up very little space, they saw it as a breakthrough in their ability to serve the low birth weight babies in their NICU and maternity wards. Knowing that some mothers could now have their babies at their bedside in the maternity ward, as a means of better connecting and bonding with them was also seen as a great advantage over traditional warming devices. The opportunity to train mothers in the maternity ward in Kangaroo Mother Care (KMC), or skin-to-skin contact for warmth through the Embrace training program was also welcomed and encouraged.
But in the weeks that followed the introduction of the Embrace program at the NICU, amidst the highly charged, pressured activity of a ward where staff is often stretched thin, we found that the Embrace Warmers were not always being used, despite an obvious need. Again, staff overwhelmed with responsibilities and activities were quickly and habitually placing low birth weight babies in overcrowded radiant warmers, or simply wrapping them in blankets. They were not yet used to reaching for a safer, more effective Embrace option that would have significant impact on the lives of the babies they were caring for.
The solution? Build the staffs’ reflex to ‘reach for Embrace’ when the baby was not being supported by KMC in the maternity wards with their mothers. For a few weeks, our Embrace Fellow, Poornima, followed up regularly with the NICU staff, encouraging them and guiding them to use the Embrace Warmer in the NICU. Slowly, the nurses and midwives’ habit of placing babies in blankets or doubling them in other devices began to change. With the help of hospital administrators and a close staff ally, Poornima set up an ‘Embrace Station’ in the NICU, acting as a visual reminder of the important role of Embrace at the hospital- and as a central place for a staff member to quickly and easily access an Embrace warmer when needed. Each week throughout the ward, more babies could be seen wrapped carefully in the little blue sleeping bags of Embrace, sometimes two or three in a row, sleeping peacefully and in perfect warmth, again reminding staff of the new medical device option now available to transform the lives of the infants in their care.
Embrace now had a regular presence in the hospital, and the staff’s reflex to reach for Embrace as a means of supporting low birth weight babies in the Intensive Care Unit had been established. By August, staff were not only using Embrace as a habit—but were asking Poornima if it would be possible to access additional Embrace warmers to keep more babies warm during the approaching winter months. Embrace will soon deliver a new shipment of warmers to this hospital, increasing its ability to keep low birth weight babies warm during the critical first few weeks of life. Change might come slowly, but at our partner hospitals, small changes in the reflex to reach for Embrace have significant impact on offering babies a better chance at new life.