D2: Development Phase
The D2: Development Phase is the “planning phase” of the 4-D Pathway. Your facility will enter the Development Phase after successfully completing the three tasks of the Discovery Phase and submitting the appropriate Development Phase fee to Baby-Friendly USA (BFUSA). At that time, BFUSA will provide your facility a Discovery Phase Registry of Intent Certificate and access to the online Development Phase Tool Kit.
The online Development Phase Tool Kit contains a number of tools and planning templates intended to help your facility with completing the tasks of this phase.
The Development Phase fee covers your facility for up to one year in the phase. During this time your facility will develop a comprehensive plan for implementing, and sustaining, the Ten Steps to Successful Breastfeeding in a manner consistent with the Guidelines and Evaluation Criteria. There are six primary tasks that must be accomplished during the Development Phase. The Development Phase tasks are:
(1) Convene a Baby-Friendly Committee or Task Force (also referred to as the Multidisciplinary Committee)
(2) Develop a Baby-Friendly Hospital Initiative work plan
(3) Develop an Infant Feeding Policy that supports breastfeeding as the normal method of infant feeding and addresses all Ten Steps to
(4) Develop a Staff Training Plan and, if applicable, training curriculum
(5) Develop Prenatal and Postpartum Teaching Plans (also referred to as the Patient Education Plan)
(6) Develop a Data Collection Plan
All plans developed during this phase are submitted to BFUSA before the facility moves on to the D3: Dissemination Phase. BFUSA does NOT approve these plans; it assesses and provides facilities with feedback regarding their consistency with the Guidelines and Evaluation Criteria.
For your convenience, a timeframe for completing the Development Phase within one year is offered below. Please be aware your facility may submit task materials to Baby-Friendly USA ahead of the timeframes listed below. Also, the materials for all tasks are not required to be submitted all at one time. However, all of the materials for each individual task must be submitted at the same time.
TASK 1 – CONVENE TASK FORCE/COMMITTEE - This should be convened immediately upon entry into the Development Phase.
The Baby-Friendly Task Force should be multidisciplinary and consist of individuals responsible for successfully guiding your facility through the 4-D Pathway. The online Development Phase Tool Kit suggests key staff/disciplines to participate on your Task Force. Be sure to include some Baby-Friendly Champions.
TASK 2 – DEVELOP WORK PLAN - This should be developed within 3 months of entry into the Development Phase.
The online Development Phase Tool Kit provides a work plan template to assist facilities in developing a work plan that will lead to practice change that is both comprehensive and sustainable. The work plan should address issues identified in the Self-Appraisal Tool completed during the Discovery Phase as well as a review of the maternity care practices that impact infant feeding outcomes.
TASK 3 – DEVELOP POLICY - This should be developed within 9 months of entry into the Development Phase.
A fundamental premise of the BFHI is that the hospital policy drives practice. Step 1 of the Ten Steps to Successful Breastfeeding requires the development of a comprehensive infant feeding policy that establishes breastfeeding as the norm and describes how the remaining steps will be practiced at the facility. As indicated in the policy development materials contained in the Development Phase Tool Kit, the infant feeding policy should include all facility practices that could potentially impact breastfeeding success.
TASK 4 – DEVELOP STAFF TRAINING PLAN -This should be developed within 9 months of entry into the Development Phase.
The purpose of your staff training plan is to ensure that your facility has a comprehensive plan for helping staff gain the knowledge and practical skills necessary to implement your facility's infant feeding policy in a safe and effective manner. The online Development Phase Tool Kit provides details on who should be trained and what content should be included in the training.
TASK 5 – DEVELOP PRENATAL/POSTPARTUM TEACHING PLANS (Patient Education Plan) - This should be developed within 9 months of entry into the Development Phase.
This task requires your facility to develop a comprehensive patient education plan for use with prenatal and postpartum women at your facility. As detailed in the Development Phase Tool Kit, these patient education plans should support and enhance your facility's infant feeding policy.
TASK 6 – DEVELOP DATA COLLECTION PLAN - This should be developed within 9 months of entry into the Development Phase.
Data collection and evaluation are vital to measuring your facility’s progress towards implementing the Guidelines and Evaluation Criteria. The first step in this process is for your facility to design data collection tools and plans. The Development Phase Tool Kit contains guidance on designing your facility's data collection plan.
Baby-Friendly USA Review of Development Phase Materials – within 6 weeks of receiving the materials.
BFUSA will review and provide feedback on your hospitals’ preliminary infant feeding policies, work plan, staff training plan, patient education plan, and data collection plan during the Development Phase to assess if all necessary components are addressed and are consistent with the Guidelines and Evaluation Criteria. This is not, and should not be considered, approval of any plan or policy. In addition, BFUSA will not address practice guidelines that do not directly pertain to the Guidelines and Evaluation Criteria assessed by BFUSA. It is expected that all guidelines within the policies be founded in current evidence and implemented in a manner consistent with your facility’s safety protocols.
Please note: BFUSA will perform only one review of your materials during the Development Phase.
Facility Review of BFUSA Feedback and Preparation of Roll Out Plan – This should begin immediately upon receiving BFUSA feedback – approximately at months 10-12 of the Development Phase.
Once you receive feedback from BFUSA on the Development Phase materials, you should convene your Baby-Friendly Multidisciplinary Committee to review the comments and discuss how to address issues requiring some additional work. Updated plans should not be resubmitted to BFUSA. A final BFUSA review of the infant feeding policy will take place in the D4: Designation Phase.
You should also take these last remaining months in the Development Phase to make decisions about which practice changes you will roll out first. It is always wise to choose a change for which you can have an early success. This will help inspire the staff and prepare them for the tougher challenges.
Movement to the Dissemination Phase
Once your facility has successfully completed the six tasks detailed above, you will be invoiced for the Dissemination Phase fee at approximately 10 months after entry into the Development Phase. (Facilities completing their work early and wishing to move through the 4-D Pathway faster may contact BFUSA and request a Dissemination Phase invoice sooner than 10 months.) Once payment is received, your facility will be moved into Dissemination Phase. BFUSA will mail your facility a Development Phase Certificate of Completion and will provide your facility with the online Dissemination Phase Tool Kit.
Receipt of the Development Phase Certificate of Completion acknowledges your facility's enrollment into the D3: Dissemination Phase of the 4-D Pathway.
NOTE: Facilities that have not submitted any Development Phase materials to BFUSA within 10 months of entry into the Development Phase will be invoiced for a second year in that phase.
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.