Factors I s Influencing t the Experiences o s of Obst stetrics - - PowerPoint PPT Presentation

Factors I s Influencing t the Experiences o s of Obst stetrics Care P Patients w s within t the Milit ilitary H Health S Sys ystem 2020 APHA Annual Meeting Presenter: Kimberley Marshall-Aiyelawo, PhD

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Disclaimer ∎ The opinions expressed herein are those of the authors, and are not necessarily representative of the opinions or policies of the Department of Defense (DoD); or the United States Army, Navy, Air Force, or Coast Guard. Presenter Disclosures ∎ Presenters have nothing to disclose

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Background

∎ Obstetric inpatient comments from the TRICARE Inpatient Satisfaction Survey (TRISS) were reviewed from 18 military healthcare facilities in an effort to understand and improve MHS patient experience. ∎ A literature review of factors influencing inpatient childbirth experience was also conducted to provide a framework for this research.

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Overview of Findings

∎ Most positive comments focused on satisfaction with staff (nurses, doctors, and other staff) and overall hospital experience. ∎ Most negative comments were related to dissatisfaction with patient rooms and amenities, provider communication, and hospital administration.

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Literature Review

∎ Factors Influencing OB Patient Experience:

Provider Patient Communication

• Engaging patient in decision-making
• Providing information about procedures, happenings, and

follow-up care

• Listening to and heeding patient requests
• Demonstrating empathy

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Literature Review

∎ Factors Influencing OB Patient Experience:

Wait Times

• Delays in admission & appointment scheduling
• Delays at pharmacy & discharge
• Delays for pain relief (e.g. epidurals, medications)

Physical environment

• Cleaning rooms regularly
• Providing modern, functioning amenities

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Results

∎ Patient Experience Drivers:

 Provider engagement feedback was positive when patients were given clear communication, included in decision-making process, and perceived empathy from providers.  Negative comments referenced administrative issues including discharge processes, wait times, lack of supplies, and mistakes with paperwork.  Hospital environment (e.g., quality of rooms, cleanliness, room temperature, accommodations) is often remarked upon when patients’ standards are not met. “Medically Ready Force…Ready Medical Force”

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Inpatient Experience Comments by Category—All Services

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“Provider-Patient Communication” and “Inter-Provider Communication” are comprised of component categories that are also part of “Doctor Care” “Nurse Care” and “Hospital Staff & Trainees”.

Patient Experience Findings

∎ Patients felt engaged in decision-making and that birth plan was respected ∎ Patients felt well-informed when engagement was prioritized ∎ Staff are described as caring, helpful, supportive, attentive, knowledgeable, and professional

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Patient Experience Findings: Areas for Improvement

∎ Amenities: Cleanliness of patient rooms, unavailable accommodations for spouses, and food service/quality ∎ Provider/Patient Communication issues, specifically related to pain management and admitting patients in (possibly early) labor. ∎ Discharge issues (e.g. being rushed, no wheelchairs, paperwork mishaps) ∎ Limited availability of lactation consultants

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Recommendations

∎ Facilities

 Institute regular cleaning regimens.  Ensure amenities are up to date and functioning.  Provide comfortable accommodations for patients and guests (spouses).

∎ Provider Engagement

 Provide clear and consistent explanations and instructions for post- partum care.  Include patients in decision making.  Focus on politeness, professionalism, and attentiveness with patients. “Medically Ready Force…Ready Medical Force”

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Recommendations

∎ Administration/Policy Expand lactation services Streamline discharge processes Provide nurseries and/or explanation of baby friendly hospital focus (enhance patient understanding when nurseries are not standard)

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Areas for Future Research

∎ Provider Communication and Trust

Deeper exploration into the factors that drive patient-provider communication within DHA/MHS could enable more targeted efforts to improve communication and patient trust.

∎ Birth Preparedness and Experience

Patient experience that includes provider engagement and gives the mother a sense of being informed (e.g. pre-labor knowledge, preparedness of the MHS, pain management) could influence birth satisfaction.

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Future Research

∎ Parity and Birth Experience

Variation in expectations, needs, and overall experience may exist between first-time mothers (primipara) and mothers who have given birth before (multipara) that may impact a patient’s experience within MHS.

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Acknowledgments & Contact Information

∎ The Defense Health Agency within the Department of Defense funded the study. ∎ For more information, contact kimberley.a.aiyelawo.civ@mail.mil.

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