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Facilitators and Barriers to the Implementation of Family Integrated Care in Ontario Level II Neonatal Intensive Care
Ayah Al Bizri1, Mariana Bueno2, Vibhuti Shah1
1Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada.
Insights
Family Integrated Care (FICare) shows promise for Neonatal Intensive Care Units (NICUs) in Ontario. Readiness for FICare implementation varies, with leadership interest as a key facilitator and resource limitations as a barrier.
Area of Science:
- Neonatal care
- Implementation science
- Healthcare management
Background:
- Approximately 8% of infants in Ontario are born preterm annually, requiring care in Level II Neonatal Intensive Care Units (NICUs).
- Family Integrated Care (FICare) is an innovative model designed to increase parental involvement in NICU care.
- Understanding the needs of Level II NICUs is crucial before implementing FICare.
Purpose of the Study:
- To assess the general and specific needs of Level II NICUs in Ontario for FICare implementation.
- To identify facilitators and barriers to FICare adoption in this setting.
Main Methods:
- A cross-sectional study design was employed.
- Two surveys (leadership and site resources) were developed based on the Consolidated Framework for Implementation Science Research.
- Surveys were distributed to medical and nursing leaders in Level II NICUs across Ontario.
Main Results:
- 24 out of 44 (55%) Level II NICUs in Ontario responded to the surveys.
- Key facilitators included leadership interest, staff/volunteer availability, and supportive policies.
- Barriers comprised financial constraints, skepticism about cost savings, need for tailored approaches, and inadequate environmental support for parental presence.
Conclusions:
- Many Ontario Level II NICUs express interest in implementing FICare.
- Readiness for FICare implementation is variable, influenced by identified facilitators and barriers.
Abstract:
Background/Objectives: In Ontario, approximately 8% (11,000) of infants are born preterm (22-<37 weeks gestation) each year. Many of these infants are cared for in a Level II Neonatal Intensive Care Unit (NICU). Family Integrated Care (FICare), an innovative model of care, aims to facilitate the involvement of parents in the care of their infants in NICUs. The aim of this study was to gain a better understanding of the general and specific needs of Level II NICUs in Ontario prior to implementation of FICare. Methods: Using a cross-sectional study design, two surveys (leadership and site resources) were developed using the Consolidated Framework for Implementation Science Research's innovation, inner setting, and outer setting constructs and distributed to Level II NICUs medical and nursing leaders. Results: The surveys were sent to 44 Level II NICUs in Ontario, of which 24 hospitals (55%) responded. Key facilitators to implementation of FICare in Level II hospitals in Ontario were leadership interest, availability of staff and parent volunteers, and existing policies to support implementation. The identified barriers were lack of financial resources for new initiatives, skepticism in FICare's ability to save costs, need for tailored implementation due to variability in NICU characteristics, and the lack of environmental support for prolonged parental presence. Conclusions: This study has confirmed the interest of many Ontario level II NICUs in implementing FICare and variability in their readiness for implementation based on the identified facilitators and barriers.
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