Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives.
BACKGROUND
Postpartum haemorrhage (PPH) remains a major contributor to maternal morbidity even in high resource settings, despite the development and dissemination of evidence-based guidelines and Advance-Trauma-Life-Support (ATLS) based courses for optimal management of PPH. We aimed to assess current influencing factors (obstacles and facilitators) for the delivery of high quality PPH-care from both patient and professional perspective.


METHODS
We qualitatively explored influencing factors for delivering high quality PPH-care, by having individual interviews with PPH-patients and focus group interviews with the different types of professionals working in the delivery room. For both perspectives, the theoretical frameworks of Grol and Cabana were used to classify the influencing factors for optimal PPH-care (factors of the guidelines, of professionals, of patients, of the social setting and of the organisation). In order to assess the importance of the influencing factors found among the professionals, we quantified these factors in a web-based questionnaire.


RESULTS
A total of 12 patients and 41 professionals participated in the interviews, and 315 complete surveys were analyzed. The main obstacle for high quality PPH-care identified by patients was the lack of information given by the professionals to the patient and partner before, during and after the PPH event. An informative patient website, a patient leaflet and a follow-up consultation were mentioned as facilitators. The main obstacles according to the professionals were: lack of clarity of the guidelines, lack of knowledge and failing team-communication. Team training and checklists/ flowcharts were considered facilitators.


CONCLUSIONS
Different obstacles to the delivery of high quality PPH-care were identified by both patients and professionals. These data can be used to develop a focused strategy to improve PPH-care.


BACKGROUND
NCT 00928863.
Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, P. O. Box 9101, 6500 HB, Nijmegen, The Netherlands. mallory.woiski@radboudumc.nl.
Mallory D
MD
Woiski
Scientific Institute for Quality of Hospital and Integrated Care (IQ healthcare), Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Evelien.Belfroid@radboudumc.nl.
Evelien
E
Belfroid
Scientific Institute for Quality of Hospital and Integrated Care (IQ healthcare), Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Janine.Liefers@radboudumc.nl.
Janine
J
Liefers
Scientific Institute for Quality of Hospital and Integrated Care (IQ healthcare), Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Richard.Grol@radboudumc.nl.
Richard P
RP
Grol
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. hcj.scheepers@mumc.nl.
Hubertina C
HC
Scheepers
Scientific Institute for Quality of Hospital and Integrated Care (IQ healthcare), Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Rosella.Hermens@radboudumc.nl.
Rosella P
RP
Hermens
D000328:Adult; D001291:Attitude of Health Personnel; D057189:Checklist; D002983:Clinical Competence; D003142:Communication; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016389:Maternal-Child Nursing / Q000193:education; D008880:Midwifery / Q000193:education; D009426:Netherlands; D009774:Obstetrics / Q000193:education; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D006473:Postpartum Hemorrhage / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011369:Professional-Patient Relations; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires