Story of Merge: Episode 1

As neonatal care professionals, we come to work each day and hope for the best. Work in the NICU is challenging for many reasons. We try to deliver high-quality care to critically ill babies in a health system that hasn’t changed much in half a century. Work is completed just in time and most of the time, it is just good enough. We know it could be better.

Sometimes a quality improvement project comes along that addresses an important issue in one area for a limited time, and then any positive results erode until the next project comes along. We remain mostly isolated in our disciplines – physicians with physicians, nurses with nurses and so on. Staff come and go, and neonatal care professionals are back in survival mode, still believing the health system could be better for babies, families, and themselves.

Healthcare in the NICU requires transformational culture change. Continuing to fix one lane in a complex health system will not result in sustained change, and we will still come to work each day hoping for the best.

The story of Merge started at a ‘brown bag’ lunch when a colleague and I were brainstorming ideas about projects that would fit with a new call for research grant funding. Merge was one of the projects we scratched on a napkin at the end of the lunch; I cannot even remember the second. There was a flurry of activity to write the grant and obtain health system operational support. One of our research assistants took a 3-hour bus ride to the neighboring city to obtain original signatures on letters of support from two of the ten sites. Co-investigators and operational leads from across the province gathered the rest. The health system was interested in projects that saved money, so we include a health economics sub-project. I am not a health economist, but time was short and we needed an estimate of how much money we could save with this project. So I asked, “What is the average length of stay in a level II neonatal intensive care unit?” The answer was 16 days. Bravely, I took a big risk and wrote in the application that we could save 10% or 1.6 days in the average length of stay at the same time as improving the quality of neonatal care. When we received the grant, I had no idea where this journey would eventually lead.