Promoting breastfeeding: strategies for changing hospital policy.

Evidence suggests that specific, affordable changes in maternity hospital policy can make the difference between nursing success and failure for some women. This paper presents a guide for health workers who wish to transform the maternity hospital system into an active support for the nursing mother. A model of organizational change which posits 3 stages including unfreezing (creating motivation to change), changing (developing new responses based on new information), and refreezing (stabilizing and integrating change) is elaborated and applied to the hospital setting. The model is diagrammed and its various steps described, including defining the problem, defining the change goal, determining the change agent, identifying relevant systems, determining change forces, developing objectives, unfreezing via an action plan, changing by implementing the change goal and evaluating positive and negative outcomes, and refreezing. A case study in which a rooming-in policy was successfully instituted in a large voluntary hospital in order to promote breastfeeding illustrates the application of the change strategy.