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1 – 10 of over 1000Sook Fern Yeo, Cheng Ling Tan and Yen-Nee Goh
This study aims to investigate the link of functional service quality (hospital’s reputation, administrative procedures, trustworthiness, patient-care provider relationship and…
Abstract
Purpose
This study aims to investigate the link of functional service quality (hospital’s reputation, administrative procedures, trustworthiness, patient-care provider relationship and waiting time), satisfaction and patient loyalty on the obstetrics services in private health-care in Malaysia.
Design/methodology/approach
A total of 419 mothers who had obtained obstetrics services had participated in this study in a continuous and coordinated manner. The study was conducted in 10 private hospitals in Malaysia throughout April 2018.
Findings
Results show that providing excellent service had increased the level of patient satisfaction and achieved patient loyalty. Patients tend to switch to other obstetricians if they are unhappy with the current services that are being offered. The findings showed that patient satisfaction was found to be mediating the relationship between hospital reputation and patient loyalty; trustworthiness and patient loyalty; patient care relationship and patient loyalty; and waiting time and patient loyalty. However, this study also found that administrative procedures do not influence patient satisfaction significantly.
Practical implications
The outcome of this study able to assist the management of the private hospitals to have more operational and practical strategies that would enhance their service quality for the betterment in their services for their patients in this competitive industry.
Originality/value
This paper provides patients’ perception of their loyalty towards obstetrics services offered by private hospitals in Malaysia.
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Similar to many business processes, waiting times are also essential for health care processes, especially in obstetrics and gynecology outpatient department (GOD), because…
Abstract
Purpose
Similar to many business processes, waiting times are also essential for health care processes, especially in obstetrics and gynecology outpatient department (GOD), because pregnant women may be affected by long waiting times. Since creating process models manually presents subjective and nonrealistic flows, this study aims to meet the need of an objective and realistic method.
Design/methodology/approach
In this study, the authors investigate time-related bottlenecks in both departments for different doctors by process mining. Process mining is a pragmatic analysis to obtain meaningful insights through event logs. It applies data mining techniques to business process management with more comprehensive perspectives. Process mining in this study enables to automatically create patient flows to compare considering each department and doctor.
Findings
The study concludes that average waiting times in the GOD are higher than obstetrics outpatient department. However, waiting times in departments can change inversely for different doctors.
Research limitations/implications
The event log was created by expert opinions because activities in the processes had just starting timestamp. The ending time of activity was computed by considering the average duration of the corresponding activity under a normal distribution.
Originality/value
This study focuses on administrative (nonclinical) health processes in obstetrics and GOD. It uses a parallel activity log inference algorithm (PALIA) to produce process trees by handling duplicate activities. Infrequent information in health processes can have critical information about the patient. PALIA considers infrequent activities in the event log to extract meaningful information, in contrast to many discovery algorithms.
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Neda Rasooli, Fariborz Jolai, Mohammad Mehdi Sepehri and Afsaneh Tehranian
The childbirth process is a complex and vital event that requires careful analysis and improvement. This experience can shape a woman's perspective on motherhood and even affect…
Abstract
Purpose
The childbirth process is a complex and vital event that requires careful analysis and improvement. This experience can shape a woman's perspective on motherhood and even affect her mental health. Healthcare providers must prioritize improving the birth experience for women. In this interdisciplinary research, a combination of business process modeling (BPM) and medicine have been used with the aim of realizing an improved delivery experience and increased maternal satisfaction.
Design/methodology/approach
The data collection of this study was done by observing 518 childbirth processes and interviewing the chief of labor, chief residents, and midwives in the obstetrics and gynecology department of a hospital in Tehran from October 2022 to February 2023.
Findings
The research has been done in four main stages. The first phase is to model the primary process and sub-processes of normal vaginal delivery (NVD). The second phase is validation using expert confirmation and process mining (PM). The third phase is the analysis of the causes of maternal dissatisfaction in labor. The fourth phase of the heuristics redesigning and improving the process, in which for the first time three new categories have been presented including hospital-based, patient-based, and medical technique-based results show BPM intervention effect can be far-reaching in improving patient care and optimizing operational efficiency.
Originality/value
This study is one of only a few to adopt a process-oriented perspective to show how BPM can be used in clinical processes and has specifically examined an essential clinical process, i.e. childbirth.
Highlights
Developing business process management (BMP) applications in a medical special process related to childbirth as interdisciplinary research.
A combination of qualitative and quantitative techniques contains engineering software and management approaches for a Case study, Implementation of BPM lifecycle in the women's hospital in Iran, Tehran, for a clinical process, which is called, normal vaginal delivery (NVD) process for fetal expulsion normally.
Modeling NVD clinical process and sub-process for the first time by BPMN2.0 notations in visual paradigm (VP) software and Validation of the made model with process mining (PM), by Disco process mining software. This was done through event log collection from HIS at the hospital.
Improving the childbirth process by redesigning heuristics and Introducing two new categories special for clinical process improvement for the first time.
Clinical process improvement heuristics obtained in this research are not consistent with the previous seven categories presented in previous studies such as Marlon Dumas' book. Therefore, we have introduced two new heuristics to redesign clinical processes compatible with medical centers, including hospital-based, patient-based, and medical technique-based.
Providing a framework for clinical process modeling and improvement containing steps and tools.
Developing business process management (BMP) applications in a medical special process related to childbirth as interdisciplinary research.
A combination of qualitative and quantitative techniques contains engineering software and management approaches for a Case study, Implementation of BPM lifecycle in the women's hospital in Iran, Tehran, for a clinical process, which is called, normal vaginal delivery (NVD) process for fetal expulsion normally.
Modeling NVD clinical process and sub-process for the first time by BPMN2.0 notations in visual paradigm (VP) software and Validation of the made model with process mining (PM), by Disco process mining software. This was done through event log collection from HIS at the hospital.
Improving the childbirth process by redesigning heuristics and Introducing two new categories special for clinical process improvement for the first time.
Clinical process improvement heuristics obtained in this research are not consistent with the previous seven categories presented in previous studies such as Marlon Dumas' book. Therefore, we have introduced two new heuristics to redesign clinical processes compatible with medical centers, including hospital-based, patient-based, and medical technique-based.
Providing a framework for clinical process modeling and improvement containing steps and tools.
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Abhijit Basu, Deepa Gopinath, Naheed Anjum and Susan Hotchkies
The purpose of this paper is to determine the prevalence of feedback following adverse clinical incident reporting among trainee doctors in obstetrics and gynaecology within the…
Abstract
Purpose
The purpose of this paper is to determine the prevalence of feedback following adverse clinical incident reporting among trainee doctors in obstetrics and gynaecology within the Northwestern Deanery of England.
Design/methodology/approach
An anonymous questionnaire was circulated among the Specialist Registrar trainees within the specialty attending a regional teaching session. The questionnaire was analysed.
Findings
There were 50 responses, of those 45 (90 per cent) had been involved in an adverse clinical incident; 44 had submitted an incident form related to the incident. Three had submitted incident forms without being involved in an adverse incident. Most (80 per cent) had submitted an incident form as well as a related statement. Feedback was available to 23 (51 per cent) of those involved in adverse incidents. More of the senior trainees received feedback than the junior ones. A lecture on clinical incident reporting was available to only 35(70 per cent) of the respondents on the hospital induction day at their latest clinical placement.
Research limitations/implications
This study is limited to adverse clinical incident reporting among the trainees in a single specialty within one deanery in UK; hence the small numbers.
Practical implications
This study demonstrates the presence of awareness regarding adverse incident reporting among the trainees in a high‐risk specialty. It also shows the suboptimal rate of feedback following adverse incident reporting, which does not encourage a learning environment. It is suggested that a lecture should be dedicated to incident reporting at the junior doctors' induction day programme in every hospital.
Originality/value
This paper highlights the lack of adequate feedback following adverse clinical incident reporting.
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Abstract
Purpose
The aim of this paper is to examine an audit to assess compliance with the national standards for intimate examination and to identify areas where changes are required to improve the quality of patient's care.
Design/methodology/approach
A patient‐based questionnaire was designed. The total numbers of clinics analyzed were 16. All the new patients, who had vaginal examinations, were asked to complete the semi‐anonymous questionnaire after their consultation. These questionnaires were designed on the basis of RCOG and GMC standards for the intimate examination.
Findings
The overall response rate was 50 per cent. Only 27 patients (36 per cent) received the offer for a chaperone. Of the total 75 patients, 40 (53 per cent) patients have received the chaperone without an offer. The remaining eight patients (11 per cent), neither had the chaperone offered nor had one present at the time of examination. The presence of a chaperone was recorded for only 47 (62 per cent) patients.
Practical implications
It is recommended that all patients undergoing an intimate examination should be given a choice of having a chaperone after adequate explanation irrespective of the gender of the gynaecologist. The documentation regarding chaperones can be improved by increasing the awareness of its use among clinical staff through regular audits. The pre‐printed chaperone tick box as a part of history/examination sheet is recommended.
Originality/value
This audit is different from previous audits in terms of its setting in secondary care. The majority of audits with a chaperone have been performed in a primary care setting. Its application has not been studied in secondary care settings before.
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Figen Alp Yilmaz and Yeter Durgun Ozan
The impact of birth beliefs on pregnancy and delivery are universally recognized, but the factors that affect birth beliefs vary across regions depending on individual and…
Abstract
Purpose
The impact of birth beliefs on pregnancy and delivery are universally recognized, but the factors that affect birth beliefs vary across regions depending on individual and cultural characteristics. This study aimed to determine women's birth beliefs and examine their associated factors.
Design/methodology/approach
This cross-sectional study was conducted with 548 primiparas in the obstetrics clinic of a university hospital located in the Southeastern Anatolian Region of Turkey from February to June 2019. Descriptive characteristics, form and the Birth Beliefs Scale were used in data collection. To analyze the data, descriptive statistics, T-tests and ANOVA analyses were used.
Findings
It was determined that factors such as age group, income level, any problems during pregnancy and preferred delivery mode statistically affected women's birth beliefs.
Originality/value
Based on the findings from this study, healthcare personnel should provide training and consultation services to pregnant women starting from the prenatal period to help ensure a positive labor experience.
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A. Nooh and G.P. Downey
The aim of this audit was to determine if patients with a diagnosis of a suspected ectopic pregnancy had been managed in accordance with the evidence‐based guidelines policy of…
Abstract
Purpose
The aim of this audit was to determine if patients with a diagnosis of a suspected ectopic pregnancy had been managed in accordance with the evidence‐based guidelines policy of the obstetrics and gynaecology department at City Hospital, Birmingham. In particular, the authors wished to review the surgical management of tubal ectopic pregnancy.
Design/methodology/approach
The authors retrospectively analysed 50 cases of tubal ectopic pregnancy managed over 15 months between October 2001 and December 2002.
Findings
A total of 26 patients (52 per cent) were managed successfully by the laparoscopic approach with no major intraoperative or postoperative complications; 24 patients (48 per cent) had a laparotomy. Salpingectomy was the preferred procedure performed either laparoscopically or by traditional open surgery. A total of 30 patients (60 per cent) had their surgery where the registrar at various grades of training was the main surgeon. The estimated blood loss, the need for blood transfusion and the length of hospital stay in the laparoscopy group were significantly less than those in the laparotomy group.
Originality/value
This audit demonstrates that, in the hands of trained personnel, laparoscopic management of tubal ectopic pregnancy is more beneficial with maximum safety and efficacy.
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Lambert J.G.G. Panis, Frank W.S.M. Verheggen, Peter Pop and Martin H. Prins
Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is inappropriate…
Abstract
Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is inappropriate. Within obstetrics, inappropriate hospital stay consists mostly of delays in hospital discharge. The specific goals of this study were to reduce inappropriate hospital stay by fine‐tuning patient logistics, increasing efficiency and providing more comfortable surroundings. New policies using strict discharge criteria were implemented. Total inappropriate hospital stay decreased from 13.3 to 7.2 per cent. The delay in discharge procedures halved. P‐charts showed a decrease in inappropriate hospital stay, indicating the current process to be stable. Concludes that a significant reduction in inappropriate hospital stay was found following the implementation of innovative hospital discharge policies, indicating greater efficiency and accessibility of hospital services.
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Sherif Shawer, Shirley Rowbotham, Alexander Heazell, Teresa Kelly and Sarah Vause
Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK…
Abstract
Purpose
Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK National Health Service maternity units to improve patient care. St Mary’s Hospital, Manchester implemented 24-7 consultant presence in September 2014. The paper aims to discuss these issues.
Design/methodology/approach
To assess the impact of 24-7 consultant presence upon women and babies, a retrospective review of all serious clinical intrapartum incidents occurring between September 2011 and September 2017 was carried out by two independent reviewers; disagreements in classification were reviewed by a senior Obstetrician. The impact of consultant presence was classified in a structure agreed a priori.
Findings
A total of 72 incidents were reviewed. Consultants were directly involved in the care of 75.6 per cent of cases before 24-7 consultant presence compared to 96.8 per cent afterwards. Negative impact due to a lack of consultant presence fell from 22 per cent of the incidents before 24-7 consultant presence to 9.7 per cent after implementation. In contrast, positive impact of consultant presence increased from 14.6 to 32.3 per cent following the introduction of 24-7 consultant presence.
Practical implications
Introduction of 24-7 consultant presence reduced the negative impact caused by a lack of, or delay in, consultant presence as identified by serious untoward incident (SUI) reviews. Consultant presence was more likely to have a positive influence on care delivery.
Originality/value
This is the first assessment of the impact of 24-7 consultant presence on the SUIs in obstetrics.
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Rachel Cannon, Jessica M. Madrigal, Elizabeth Feldman, Kelly Stempinski-Metoyer, Lillian Holloway and Ashlesha Patel
The purpose of this paper is to examine the risk of unintended pregnancy among women during Cook County Jail intake by assessing basic contraceptive history, the need for…
Abstract
Purpose
The purpose of this paper is to examine the risk of unintended pregnancy among women during Cook County Jail intake by assessing basic contraceptive history, the need for emergency contraception (EC) at intake, and contraception at release.
Design/methodology/approach
This is a cross-sectional study of women 18–50 years old at Cook County Jail in Chicago, Illinois from June 2011 through August 2012. The authors administered the survey at the time of intake on 33 convenient evenings. Surveys consisted of multiple-choice close-ended questions administered via interview. Topics included contraceptive use, pregnancy risk and pregnancy desire. The authors computed frequencies to describe the distribution of question responses and used logistic regression modeling to identify factors significantly related to the use of contraception at intake and to the acceptance of contraception at release.
Findings
Overall, 194 women participated. Excluding women not at risk for pregnancy (4.6 percent currently pregnant, 17.5 percent surgically sterilized/postmenopausal and 4.6 percent using long-acting reversible contraceptives), 73.2 percent of women were at risk for pregnancy (n = 142) and, therefore, had a potential need for contraception. Among these women at risk for unintended pregnancy, 68 (47.9 percent) had unprotected intercourse within five days prior to survey administration. When asked about EC, most women (81.4 percent) would be interested if available. Additionally, 141 (72.7 percent) of women would be interested in contraceptive supplies if provided free at release.
Originality/value
Newly incarcerated women are at high risk for unintended pregnancy. Knowledge about EC and ability to access birth control services are both significantly limited. These conclusions support providing an intake screening in jails to identify women at risk for unintended pregnancy.
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