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 “Medically Ready Force…Ready Medical Force”
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 2
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. “Medically Ready Force…Ready Medical Force” 3
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. “Medically Ready Force…Ready Medical Force” 4
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 “Medically Ready Force…Ready Medical Force” 5
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 “Medically Ready Force…Ready Medical Force” 6
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” 7
Inpatient Experience Comments by Category—All Services “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”. “Medically Ready Force…Ready Medical Force” 8
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 “Medically Ready Force…Ready Medical Force” 9
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 “Medically Ready Force…Ready Medical Force” 10
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” 11
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) “Medically Ready Force…Ready Medical Force” 12
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. “Medically Ready Force…Ready Medical Force” 13
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. “Medically Ready Force…Ready Medical Force” 14
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. “Medically Ready Force…Ready Medical Force” 15
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