D3: Dissemination Phase

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The D3: Dissemination Phase is the "implementing phase" of the 4-D Pathway. 

Your facility will enter the Dissemination Phase after successfully completing all six tasks of the Development Phase and submitting the Dissemination Phase fee to Baby-Friendly USA (BFUSA).  At that time, BFUSA will provide your facility a Development Phase Certificate of Completion and access to the online Dissemination Phase Tool Kit.

The Dissemination Phase fee covers your facility for up to one year in the phase. During this time your facility will roll out the infant feeding policy and all Development Phase plans.  You will need to disseminate information about the Baby-Friendly Hospital Initiative (BFHI) to staff and patients as you roll out your Development Phase plans. 

Click here to view Everyone Plays a Role, a presentation that will help you to prepare your team.

Staff Training

One of the major goals of the Dissemination Phase is to impart information about the Baby-Friendly Hospital Initiative (BFHI) to facility staff.

Components of staff training include:
(1) Orient all staff and providers to the facility's position on breastfeeding and the infant feeding resources available in the facility.
(2) Orient all departments impacted by the BFHI.
(3) Train all maternity care staff and providers on the policies developed/revised during the Development Phase.
(4) Train maternity care staff and providers according to the requirements found in the Guidelines and Evaluation Criteria.
(5) Verify competencies for all maternity care staff.
(6) Document initial training, verification of staff competencies, and annual breastfeeding continuing education for all maternity care staff.

Evidence-based training is essential to ensure that all staff members providing direct care to mothers and infants have the knowledge and skills necessary to safely and effectively implement the care practices included in the infant feeding policy.

Collect Data - This should begin immediately and be on-going throughout the Dissemination Phase.

Data collection and evaluation are the foundation of a robust quality improvement program.  The goal is to establish the baseline for designing a quality improvement program that informs your facility as to your progress towards meeting all of the benchmarks outlined in the Guidelines and Evaluation Criteria.  It is not only critical to the successful implementation of the practices outlined in the Guidelines and Evaluation Criteria but also to the continued sustainability of those practices.
As detailed in the online Dissemination Phase Tool Kit, you should collect data from patient charts and audits of maternity care practices that impact breastfeeding. 

Patient Education

During this phase, your facility must also implement a breastfeeding education program for pregnant women and new mothers based on the education plans prepared during the Development Phase. 


BFUSA is available to answer questions from your facility about moving through this phase of the Baby-Friendly process.  The online Dissemination Phase Tool Kit contains a series of tools to use in implementing your training and quality improvement processes.  

Request to Move to the Designation Phase – within 10 months of entry into the Dissemination Phase

When the results of your facility's quality improvement program show you are meeting, or are close to meeting the benchmarks outlined in the Guidelines and Evaluation Criteria, your facility is ready to request to move to the next phase of the 4-D pathway, the D4: Designation Phase. 

Movement to the Designation Phase

A “Request to Move Letter” should be sent to BFUSA at approximately 10 months into the Dissemination Phase.  Your facility will then be sent an invoice for the Designation Phase fee.

When BFUSA has both the “Request to Move Letter” and payment of the Designation Phase fee, your facility will be mailed a Dissemination Phase Certificate of Completion and provided with the online Designation Phase Tool Kit. (Facilities completing their work early and wishing to move through the 4-D Pathway faster may contact BFUSA and request a Designation Phase invoice sooner than 10 months.  

Receipt of the Dissemination Phase Certificate of Completion acknowledges your facility's enrollment into the D4: Designation Phase of the 4-D pathway.

NOTE: facilities who have not submitted the request to move into the Designation Phase within 10 months of their entry into the Dissemination Phase will be invoiced for a second year in the Dissemination 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.

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