The D4: Designation Phase is the “assessing phase” of the 4-D Pathway.

Your facility will enter the Designation Phase after submitting a “Request to Move Letter” and the Designation Phase fee to Baby-Friendly USA (BFUSA). At that time, BFUSA will provide your facility with a Dissemination Phase Certificate of Completion and provide access to the online Designation Phase Tool Kit.

D4 Pathway - Baby Friendly USA

Continue auditing your practices, reviewing the data and comparing the results to the Guidelines and Evaluation Criteria. If the audits reveal you are below the benchmark for any evaluation criteria, your multidisciplinary team must design and implement a quality improvement plan to address those areas that have not yet come into compliance.

Should be requested within 2 months of entering the Designation Phase

BFUSA provides facilities with a Telephone Readiness Assessment Interview. This 90-minute phone interview conducted by BFUSA staff will ask you a series of questions intended to assess your facility’s readiness for the on-site assessment. During the interview, we will discuss your quality improvement audits, infant feeding policy, and Fair Market Price Code Compliance Verification Form. BFUSA will provide verbal and written feedback on areas in need of improvement. Facilities find that the Readiness Assessment Interview helps them identify areas that require additional attention prior to the on-site assessment being scheduled.

It is strongly recommended that this interview take place shortly after your facility enters the Designation Phase because it will provide you with ample time to correct any areas that do not meet the requirements of the Guidelines and Evaluation Criteria prior to scheduling your on-site assessment.

Should be requested within 8 months of entering the Designation Phase

Once the areas identified during the Readiness Assessment Interview are corrected, the facility will send a letter to BFUSA requesting that the on-site assessment be scheduled. In addition, BFUSA requires an updated Facility Data Sheet with 4 weeks of actual data, collected within 2 months of the on-site assessment, along with the most recent infant feeding policy and Fair Market Price Code Compliance Verification Form.

The on-site assessment is a two-stage process. The first is the on-site assessment conducted by a BFUSA assessment team. Upon completion of their visit, the findings are compiled into a report, blinded and sent to the BFUSA External Review Board (ERB). The ERB determines whether or not the facility has fully implemented the Guidelines and Evaluation Criteria. Upon determination that the Guidelines and Evaluation Criteria have been met, the facility will officially be designated and granted a license to use the Baby-Friendly certification mark. If the facility does not pass the on-site assessment, there is a corrective action process that may require a re-assessment when identified problems have been corrected.

Additional Time in the Phase

Be aware that every facility faces different challenges. Some find it necessary to take longer than the timelines outlined here to fully implement the tasks of the phase. If your facility is in this situation, you should not feel discouraged. The culture change you are making is enormous and sometimes requires additional time. If this is your circumstance, contact BFUSA to learn about your options.