Use of WHO standards to improve quality of maternal and newborn hospital care: a study collecting both mothers’ and staff perspective in a tertiary care hospital in Italy

Abstract

BackgroundWHO developed a list of standards for improving maternal and newborn hospital care. However, there is little experience on their use, and no precise guidance on their implementation. This study aimed at documenting the use of the WHO standards for improving the quality of maternal and neonatal care (QMNC) in a tertiary hospital, Northeast Italy.MethodsThe study was conducted between May 2016 and May 2018, in three phases: phase I—sensitisation and training of health professionals; phase II—data collection on the WHO standards through a survey among service users and providers; phase III—based on the findings of phase II, development of recommendations for improving the QMNC.ResultsOverall, 101 health professionals were successfully trained. 1050 mothers and 105 hospital staff participated in the survey. Key indicators of QMNC (and related prevalence) from the mothers survey included: caesarean section (23.1%); episiotomy (18.3%); restrictions to free movements during labour (46.5%), lithotomy position for staff choice (69.3%); skin to skin (80.8%); early breast feeding (67.2%); information on newborn danger signs (47.2%); high satisfaction with QMNC (68.8%). Only 1.2% and 0.7% of women respectively reported discrimination or abuse. Key indicators (and prevalence) reported from staff included: availability of clinical protocols (37%); regular training (14%); health information system used for quality improvement (16.3%); training on effective communication (9.7%) and on emotional support (19.6%); protocols to prevent mistreatment and abuse (6.9%). On several indicators, the opinions of mothers on QMNC was better than those of staff. Overall, 55 quality improvement recommendations were agreed.ConclusionsInformation on the WHO standards can be collected from both services users and providers and can be proactively used for planning improvements on QMNC.

Women’s suggestions on how to improve the quality of maternal and newborn hospital care: a qualitative study in Italy using the WHO standards as framework for the analysis

“…Data were collected using a field-tested, anonymous, selfadministrated, questionnaire in the local language (Italian). The questionnaire and the procedure for its validation, together with preliminary results of a survey conducted have been reported in a previous publication [25]. Briefly, the questionnaire was developed after a large review and thematic analysis of other existing tools and reference standards [25].…”

“…The questionnaire and the procedure for its validation, together with preliminary results of a survey conducted have been reported in a previous publication [25]. Briefly, the questionnaire was developed after a large review and thematic analysis of other existing tools and reference standards [25]. The questionnaire was tested in a sample of voluntary mothers, with different characteristics (age, education, parity, etc) who reviewed the questionnaire individually and provided a written feedback [25].…”

“…Briefly, the questionnaire was developed after a large review and thematic analysis of other existing tools and reference standards [25]. The questionnaire was tested in a sample of voluntary mothers, with different characteristics (age, education, parity, etc) who reviewed the questionnaire individually and provided a written feedback [25]. The draft version of the questionnaire was also submitted to a panel of experts with experience on research in QMNC issues (obstetricians, neonatologists, midwives, epidemiologists), for content validity and construct coherence [25].…”

“…The questionnaire was tested in a sample of voluntary mothers, with different characteristics (age, education, parity, etc) who reviewed the questionnaire individually and provided a written feedback [25]. The draft version of the questionnaire was also submitted to a panel of experts with experience on research in QMNC issues (obstetricians, neonatologists, midwives, epidemiologists), for content validity and construct coherence [25]. Experts reviewed the questionnaire independently in a firth phase and in an extensive group discussion meeting, in a second phase [25].…”

“…The draft version of the questionnaire was also submitted to a panel of experts with experience on research in QMNC issues (obstetricians, neonatologists, midwives, epidemiologists), for content validity and construct coherence [25]. Experts reviewed the questionnaire independently in a firth phase and in an extensive group discussion meeting, in a second phase [25]. The questionnaire was optimized according to the feedback received, and the final version was re-tested in a second group of voluntary mothers [25].…”