From leadership research to district action: Building breastfeeding knowledgeable health systems: Focus groups with physician leaders

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Despite the growth of breastfeeding and lactation medicine as a specialty, the care of breastfeeding families is compromised because few standards and recommendations exist for its practice and integration into health systems. We conducted a qualitative study involving three focus groups (N = 13) with breastfeeding and lactation medicine physician leaders who currently work within large health systems across the United States. Our study aimed to gather the perspectives of physician leaders regarding breastfeeding care in health systems, to summarize current practices and recommendations for optimal care, and to explore barriers and facilitators to the implementation of these recommendations. A deductive content analysis approach guided by the Exploration, Preparation, Implementation, and Sustainment Framework was used to analyze the transcripts. Resulting themes revealed the important role that health systems play in modeling breastfeeding supportive practices and the strong influences of leadership and staff personal breastfeeding experiences on health system policies. Recommendations included the creation of breastfeeding and lactation medicine divisions, adequate staff education, staffing and coordination of lactation care across the system and community, support for lactating employees, and public awareness of resources and programs. Barriers to implementation included siloing of lactation services by department, lack of breastfeeding-supportive workplaces, deficient clinical billing for lactation services, and low prioritization by training programs. Facilitators included multidisciplinary collaborations, employee supportive lactation policies, appropriate dyadic lactation billing, and electronic health record workflows. Our focus groups revealed many barriers to the delivery of optimal breastfeeding care within health systems, but strategies were identified for systemic changes. Next steps include identification of breastfeeding and lactation medicine divisions and health systems already implementing the best practices described here. Further research should engage additional stakeholders to better understand administrative and financial points of view regarding barriers and facilitators of breastfeeding support.

Study methods

Qualitative focus groups were conducted with BFLM physicians working within large health systems in the US to explore their perspectives on 1) the role and rationale of health systems engaging in breastfeeding support and care, 2) current health systems’ practices, 3) recommendations for developing breastfeeding knowledgeable health systems (BKHS), and 4) barriers and facilitators to implementing such changes. For this study, large health systems were defined as multispecialty practices within a hospital system or academic medical center. The Consolidated Criteria for Reporting Qualitative Studies guided study design and reporting [35].

Limitations

Strengths of this study lie in our ability to explore the knowledge and experiences of highly accomplished physician leaders in this field and the use of the EPIS framework to understand and guide the implementation of a BKHS. Limitations of this study relate to the small sample size and homogeneity of participants, where collected perspectives may not represent all possible viewpoints within BFLM, including representativeness of the sample potential biases, and limits of saturation. This study included a sample of just 13 participants, all of whom held leadership positions in breastfeeding and lactation medicine. At the time of manuscript writing, only 159 individuals were publicly listed as board-certified by the North American Board of Breastfeeding and Lactation Medicine, which began board certification in 2023 [75]. A recent US-wide survey identified 138 physicians and other providers practicing breastfeeding and lactation medicine [76]. Given the small and specialized nature of this professional community, the high proportion of representation enhances the relevance and depth of the study findings.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one recurring leadership practice described in the source. Map its participants, incentives and constraints to a district setting, then design a small reversible staff pilot with an accountable owner. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Record implementation fidelity, staff review time, task quality and unintended burdens against a baseline. Use a comparison team where feasible and document alternative explanations before expanding. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Miena Meek Hall; Julie A Patterson; Alexandra L MacMillan Uribe; Liliana Simon; Anne R Eglash; Katherine R Standish. Building breastfeeding knowledgeable health systems: Focus groups with physician leaders. PLOS One (2026-05-28). https://doi.org/10.1371/journal.pone.0350146

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.