Communication and patient safety in gynecology and obstetrics - study protocol of an intervention study

Abstract

Background: Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction. Methods: The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes). Discussion: This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments.

Risk Factors for Positive Appraisal of Mistreatment during Childbirth among Ethiopian Midwifery Students

“…However, our study did not confirm that place of origin and self-esteem were associated with appraisal of mistreatment. These results are partly in line with previous research that has highlighted the importance of interpersonal interactions among healthcare staff and patients herein, and various individual level risk factors among care providers, such as young age, observation of mistreatment during education, low self-esteem, and high stress levels [6,9,[15][16][17][18]. The significant inverse relationship between positive appraisal of mistreatment and age, is in line with previous studies that have pointed toward more patient-centeredness and better communication skills among older students [32][33][34].…”

“…As maternal healthcare utilization is a major predictor of mother and child well-being, mistreatment during childbirth eventually contributes toward maternal and neonatal morbidity and mortality [8]. It hence endangers patient safety, while increasing the risk of preventable adverse events [9].…”

“…Research has indicated mistreatment during childbirth to stem from societal level risk factors (e.g., cultural beliefs), organizational level risk factors (e.g., conditions at work), and individual level risk factors among healthcare staff (e.g., beliefs and personal attributes), which may then give rise to poor health service characteristics and inadequate interpersonal interactions between healthcare staff and patients [15]. While factual knowledge is an important pillar of good communication in the healthcare branch, proper acknowledgment of interpersonal and relational information is a critical skill among midwives and obstetricians, as childbirth is often associated with feelings of anxiety and uncertainty [9].…”

Effectiveness of Communication Interventions in Obstetrics—A Systematic Review

“…Specifically, communication errors have been identified as the main cause in 72% of all perinatal deaths [ 2 ]. A key component to reducing errors and thus ensuring patient safety is promoting good patient–provider communication and effective communication between healthcare professionals [ 3 , 4 ]. However, communication in obstetric care needs to be improved, and this need has been reflected in public debates about obstetric violence, and in the face of emergencies [ 5 ].…”

“…Patient safety is commonly defined as the absence of preventable adverse events (PAE) or incidents [ 4 ]. Patient safety incidents are PAEs that are a consequence of healthcare processes and healthcare interventions, rather than of the patients’ condition itself.…”