Exploring the relationship between women’s experience of postnatal care and reported staffing measures: an observational study

Abstract

BackgroundWomen have reported dissatisfaction with care received on postnatal wards and this area has been highlighted for improvement. Studies have shown an association between midwifery staffing levels and postnatal care experiences, but so far, the influence of registered and support staff deployed in postnatal wards has not been studied. This work is timely as the number of support workers has increased in the workforce and there has been little research on skill mix to date.MethodsCross sectional secondary analysis including 13,264 women from 123 postnatal wards within 93 hospital Trusts. Staffing was measured at organisational level as Full Time Equivalent staff, and at ward level using Care Hours Per Patient Day. Women’s experiences were assessed using four items from the 2019 national maternity survey. Multilevel logistic regression models were used to examine relationships and adjust for maternal age, parity, type of birth, medical staff and number of births per year in the Trust.ResultsTrusts with higher levels of midwifery staffing had higher rates of women reporting positive experiences of postnatal care. However, when staffing was measured at a ward level, there was no evidence of an association between registered staffing and patient experience. Wards with higher levels of support worker staffing were associated with higher rates of women reporting they had help when they needed it and were treated with kindness and understanding.ConclusionThe relationship between reported registered staffing levels on postnatal wards and women’s experience is uncertain. Further work should be carried out to examine why relationships observed at an organisational level were not replicated closer to the patient, at ward level. It is possible that reported staffing levels do not reflect staff as deployed if midwives are floated to cover delivery units. This study highlights the potential contribution of support workers in providing quality care on postnatal wards.