CWHHS Maternity Consumer Feedback Survey · Antenatal care – model of care Who did you see for your antenatal care (model of care)? Model of care by location In Longreach, there

CWHHS Maternity Consumer Feedback Survey

Community Report

Central West Hospital and Health Service Maternity Feedback Survey 2019 Page 1 of 16

Contents

Background

• Central West Hospital and Health Service Maternity Service

• Purpose of the CWHHS Maternity Feedback Survey

Results

• Responses

• Demographics o Baby number o Delivery period o Indigenous status

• Antenatal care – model of care o Model of care by location o Reason for choosing model of care o Satisfaction o Comfort raising concerns o CWHHS response – model of care

• Antenatal care – telehealth o Satisfaction o Positive feedback o Opportunities for improvement o CWHHS response – telehealth

• Delivery o Delivery location by distance from Longreach o Reason for choosing delivery location o Support for birth preferences o Satisfaction o CWHHS response – delivery

• Accommodation o Impact on decision to birth in Longreach o Satisfaction o Positive feedback o Opportunities for improvement o CWHHS response – accommodation

• Postnatal care o Six week check o Midwife visits after delivery o Postnatal support o Positive feedback o Opportunities for improvement o Satisfaction o CWHHS response – postnatal care

• New birth suite and maternity ward o Positive feedback o Opportunities for improvement o CWHHS response – new birth suite and maternity ward

Conclusion


Background

Central West Hospital and Health Service (CWHHS) Maternity Service

Longreach Hospital Maternity Service provides a vital service to the women and families of the Central West that is offered nowhere else in the district. Beyond Longreach Hospital, the closest location that women can deliver is Emerald Hospital, 416km away.

The Longreach Hospital Maternity Service operates as a Midwifery Group Practice (MGP). Under this structure, each woman is allocated one main caseload midwife in Longreach who will see her for her midwife visits during pregnancy, care during birth and visits after delivery. If this midwife is unavailable for any of these visits (e.g. working overnight, on holiday), then another midwife will see the woman while her main midwife is away. Women who live in towns outside of Longreach usually have a midwife in their town who will see them for most of their care during pregnancy and after birth, with the Longreach MGP midwife connecting with the women for a few antenatal visits and covering their care during delivery. Low risk women will see a doctor at 20 weeks after their morphology ultrasound scan, at 36 weeks and at 40 weeks. Women with medical issues in their pregnancies will need to see a doctor more often. Within this MGP structure, there are multiple models of care available to women to cater for a range of needs and preferences.

Under public care, a woman will see her allocated MGP/community midwife for antenatal visits and see a GP obstetrician at Longreach hospital for medical antenatal appointments. The on-call GP obstetrician will attend her delivery, along with her main MGP midwife and a second on-call midwife.

A woman choosing GP shared care will see a combination of her MGP/community midwife and a private practice GP of her choice, either in Longreach or a town closest to her home. She will discuss with her care providers which appointments she sees her GP for and which appointments she sees her midwife for. If her GP does not have obstetric training, she will also see a GP obstetrician in Longreach at 20, 36 and 40 weeks of pregnancy. The on-call GP obstetrician will attend her delivery, along with her main MGP midwife and a second on-call midwife.

A woman with private health insurance covering obstetrics may choose private care in Longreach. This involves seeing her MGP/community midwife and a GP obstetrician of her choice for her antenatal care. As with GP shared care, the woman will decide which visits she sees her midwife and her GP obstetrician for. The same GP obstetrician will attend her delivery along with her main MGP midwife and a second on-call midwife.

Women also have the option of receiving some or all of their antenatal and delivery care outside of the Central West HHS, either through a public hospital, private midwife or private obstetrician.

Within each of these models of care, some women have the option of telehealth consultations, either with Longreach or with a larger hospital specialist team.


Purpose of the CWHHS Maternity Feedback Survey

One of the Central West Hospital and Health Service’s priorities is to “deliver more services locally through ensuring the optimal use of the infrastructure and technology investments”.

This survey was planned and designed to give women the opportunity to give feedback to the service, both on areas that are helpful, and areas of potential improvement.

It was open as an online survey through Survey Monkey from Monday 18th March 2019 until Sunday 12th May 2019, and available as a paper survey through all GP clinics and PHCs in the district.

The survey was promoted in a range of ways including posters and hand outs distributed to all PHCs and GPs in the CWHHS, online via Facebook and the Central West internet page, articles and advertisements in multiple local newspapers and an ABC radio interview.

Results

Responses

Women who had more than one delivery during the survey period were given the option of completing the survey once for all relevant deliveries, or once for each baby. Three responses provided feedback for 2 deliveries each.

In total, 112 responses covering 115 individual deliveries were included in analysis.

Almost one fifth of all births to Central West women during this 5 year time period were included in the survey.

Demographics

Q3 What number baby was this for you?


Delivery period

Indigenous status


Antenatal care – model of care

Who did you see for your antenatal care (model of care)?

Model of care by location

In Longreach, there was a relatively even spread between public (36.3%), GP shared care (27.5%) and private GP obstetrician (32.5%) with a smaller percentage seeing a private obstetrician outside of Longreach (3.8%).

In other towns, most women (65.8%) chose public care. Of the remainder, 15.8% chose GP shared care, 5.3% private GP obstetrician, and 13.2% had a private obstetrician outside of Longreach.

Reasons for choosing model of care

Overall

The most common reasons listed for choosing a model of care were:

• Having a known doctor/ being comfortable seeing their regular GP

• No other option or not knowing the options

• Had the same model with previous baby

• Financial reasons

0% 10% 20% 30% 40% 50% 60% 70%

Longreach

Other towns

Model of care by location

Private obs away Private GP obs GP shared care Public


Public

The most common 3 reasons for women choosing public care were:

• It was the only option

• They had confidence in the midwives/ team

• Finances/no private health insurance

GP shared care

The most common reasons for women choosing GP shared care were:

• Having their choice of doctor

• Medical issues in the pregnancy

Private GP obstetrician

The most common reasons for women choosing a private GP obstetrician were:

• Having their choice of doctor

• Continuity of care

• Had this care with a previous pregnancy

Private obstetrician out of Longreach

The most common reasons for women choosing this model were:

• Medical reasons

• To be close to family

Satisfaction

Would you choose this model of care next time or recommend it to a friend?

• Public – 2 answered both yes and no, 1 was not clearo Yes: 84.4%, 17.8% very positive (“definitely”, “absolutely”, etc.)o No: 17.8%

• GP shared careo Yes – 83.3%, 12.5% very positiveo No – 16.7%

• Private GP obso Yes – 92%o No – 8%

• Private obs outside of Longreacho Yes – 87.5%o No – 12.5%


How satisfied were you with your pregnancy care?

• Public o Very satisfied/satisfied 80% o Dissatisfied/very dissatisfied 11.1%

• GP shared care o Very satisfied/satisfied 88.5% o Dissatisfied/very dissatisfied 7.7%

• Private GP obstetrician o Very satisfied/satisfied 84.6% o Dissatisfied/very dissatisfied 3.8%

• Private obstetrician out of Longreach o Very satisfied/satisfied 87.5% o Dissatisfied/very dissatisfied 12.5%

Comfort raising concerns

I felt comfortable raising questions or discussing concerns with my team of midwives and doctors

• Public o Agree/strongly agree 80.0% o Disagree/strongly disagree 8.9%

• GP shared care o Agree/strongly agree 84.6% o Disagree/strongly disagree 7.7%

• Private GP obstetrician o Agree/strongly agree 88.5% o Disagree/strongly disagree 7.7%

• GP obstetrician out of Longreach o Agree/strongly agree 87.5% o Disagree/strongly disagree 12.5%

CWHHS response – model of care during pregnancy

There were high levels of satisfaction across all models of care, and most women across all models of care felt comfortable raising concerns with their doctors and midwives.

Across all models of care, women showed that they valued choice, consistency of care, relationship with care providers they trust, and well organised, safe and competent maternity staff.

1. Work to make sure women know their options for models of care

• We are working on a brochure (paper and online) to explain options for models of care including:

o Options for women who have a medical condition or complications in pregnancy o Options for using private health insurance o When telehealth might be an option

• We will continue to discuss pregnancy care options with women during their first midwife visit and their 20 week visit to confirm who they would like to see during their pregnancy

2. Consistency of care and relationship with trusted care providers

• We aim as much as possible to have one main midwife allocated to each woman for her pregnancy care, delivery and postnatal care and to have a consistent team of doctors

o Even though staff moving away makes this challenging, we aim to recruit permanent staff over locums


• At times when this is not possible (e.g. midwife sick or fatigued from being called in to work overnight):

o We will make sure women are contacted as early as possible if their appointments or care providers change, and who will be looking after them

o Make sure every woman has the contact numbers to contact their midwife and the maternity service

• We meet every week as a whole team to make sure we are all on the same page and communicating clearly

o Make sure there is an agreed pregnancy/delivery care plan in each woman’s notes

Antenatal care – telehealth

Women who completed the survey had telehealth appointments with Longreach, Rockhampton, Brisbane and Toowoomba.

71.4% of women who had telehealth appointments during their pregnancy went on to deliver in Longreach.

Satisfaction

One hundred percent of women were either satisfied or very satisfied with their appointments by telehealth.

Positive feedback

• Not having to travel several hours to the appointment

• Getting specialist advice that was not available locally

• Becoming familiar with the team who was treating them

Opportunities for improvement

• Be on time to the appointment

• Offer telehealth appointments to more women

CWHHS response – telehealth

All women who had appointments by telehealth were satisfied with their care, and no telehealth-specific concerns were raised. Most women who had appointments by telehealth went on to deliver in Longreach.

We aim to use telehealth whenever possible for women who prefer this option.

All women will still need to travel to Longreach (or a larger hospital) for their 20 week morphology ultrasound and doctor review, and relocate at 36-37 weeks. For the visits in between, we will consider each woman individually and discuss with her whether telehealth is suitable and whether she would like this. There are 2 situations where telehealth is used:

• Telehealth to Longreach o This is used for women who had medical conditions before they were pregnant (e.g.

high blood pressure, thyroid problems), or who have new medical conditions in their pregnancy (e.g. gestational diabetes)

o They have a midwife or GP who can see them in their hometown, but need a GP obstetrician in Longreach to oversee their pregnancy and organise any extra tests and treatment that they need


• Telehealth to larger hospitals o This is for women who have more complicated pregnancies and need to see

maternofoetal medicine (when baby has medical problems), obstetric medicine (when the woman has medical problems) or perinatal mental health (for mental health problems during and after pregnancy)

o We aim to have her regular midwife or a GP obstetrician from Longreach in the appointment to help plan the care with the woman and the specialist team. This can include things like any extra tests that are needed, best choice of medication, and where to have the baby.

Delivery

Out of the women who completed the survey, 69.1% delivered in Longreach and 30.9% delivered away. Women who lived further away from Longreach were more likely to deliver away, with 100% of women who lived more than 250km from Longreach delivering outside of the district.

0% 20% 40% 60% 80% 100% 120%

<50km

50-150km

150-250km

250-350km

>500km

Delivery location by distance from Longreach

Away Longreach


Reason for choosing delivery location

The most common reasons for choosing to deliver in Longreach were:

• Closest delivery location to home (88.2%)

• Quality of the service (13.2%)

• Had other children there (10.4%)

The most common reasons to deliver away from Longreach were:

• To be close to family (42%)

• Medical reasons (42%)

Support for birth preferences

Of the women who delivered in Longreach, 85.5% felt their birth preferences were “supported” or “very supported” and 6.6% felt that their birth preferences were “unsupported” or “very unsupported”.

Satisfaction

Of the women who delivered in Longreach, 90.5% said they would choose this location next time or recommend it to a friend.

How satisfied were you with your care during and immediately after delivery?

Longreach

• Satisfied/very satisfied – 92.1%

• Dissatisfied/very dissatisfied – 5 6.6%

Away

• Satisfied/very satisfied – 85.0%

• Dissatisfied/very dissatisfied – 0%

CWHHS response – delivery

Most women chose to deliver in Longreach because it was close to home. By far the most common reasons for women to deliver away from Longreach were to be close to family or for medical reasons. As mentioned previously, Longreach Hospital is the only location in the Central West HHS that offers


delivery, with the next closest delivery centre over 400km away in Emerald. The quality of the service was a major factor for 13.2% of women who decided to deliver in Longreach.

The Central West HHS will continue to offer this important and highly valued service.

Most women (85.5%) felt that the Central West maternity team supported their birth preferences. We will continue to discuss this with pregnant women so that they are aware of their birthing options and reasons why different treatments may be needed during delivery.

Accommodation

29.5% of women who completed the survey stayed in accommodation provided by the by the health service.

Of these women, 84.8% said that having free accommodation contributed “a great deal” or “a lot” to their decision to deliver in Longreach.

Satisfaction

81.8% of women were “satisfied” or “very satisfied” with the accommodation provided, and 9.1% were dissatisfied” or “very dissatisfied”.

Positive feedback

The things women found most helpful about the accommodation were:

• Close to the hospital

• Family was able to stay together

• Functional and comfortable


The most common suggestions for improvement were:

• Outdated furniture

• Process of who to contact if there are maintenance issues

• Having a list of what to bring


CWHHS response – accommodation

Almost 85% of women who stayed in accommodation provided by the Central West maternity service identified it as a significant factor in their decision to deliver in Longreach. This is a vital service that is highly valued by the women and families who have used it.

The Central West HHS will continue to offer this support and ensure that women in outlying towns and stations are aware that it is available.

Women and families who stay in the accommodation are advised to contact their midwife if there are any issues.

The CWHHS maternity budget covers replacement of smaller items in the houses as required. We will consider discussing replacement of old furniture with some community groups.

Postnatal care

Six week check

Who did you see for your 6 week check?

Midwife visits after delivery

Number of visits Delivered in Longreach Delivered away

0 8.2% 47.8%

1 4.1% 8.7%

2 9.6% 17.4%

3 12.3% 4.3%

4 6.8% 13.0%

5 12.3% 4.3%

6+ 24.7% 4.3%

Unclear 5.5% 8.7%

Multiple unspecified 15.1% 8.7%


Postnatal support

I received enough support from the health service in the 6 weeks after my baby was born.

• Delivered in Longreach o Strongly agree/agree (78.4%) o Disagree/strongly disagree (12.2%)

• Delivered away o Strongly agree/agree (59.4%) o Disagree/strongly disagree (25.0%)

Positive feedback

The things that women found most helpful in their care after delivery were:

• Home visits

• Having a midwife available to contact when needed

• GP support

• Getting phone calls from their midwife

• Breastfeeding help


The most common opportunities for improvement were:

• Breastfeeding support

• Having more visits from their midwife

• Having the same midwife

0% 10% 20% 30% 40% 50% 60%

0

1

2

3

4

5

6+

Unclear

Multiple unspecified

Postnatal visits by delivery location

Away Longreach


Satisfaction

Overall, 77.4% of women were “satisfied” or “very satisfied” with their care after leaving hospital, and 10.8% were “dissatisfied” or “very dissatisfied”.

CWHHS response – postnatal care

1. Individualised patient-centred follow up

• Women have highly valued home visits from their midwife, knowing which midwife they cancontact and receiving phone calls from their midwife in the 6 weeks after baby’s birth. Thesevaluable services will continue to be offered. As every family has different needs, eachwoman will be able to discuss with her midwife how often she wants to be contacted andvisited after she goes home from hospital.

• This involves support for the woman’s physical and mental health, and for the baby’s growthand development

• Every woman can discuss contraception options with the doctor before discharge fromhospital and at her 6 week visit

• Each family will be provided with contact details for child health and GP to continue supportbeyond 6 weeks. Child health are available to come with the regular midwife on the week 4visit at home

2. Breastfeeding support

Support with breastfeeding was the most common area for improvement identified by women.

• Women will be supported to breastfeed by the midwives and doctors in the maternity team,including troubleshooting when there are difficulties and supporting alternatives if required.

• Access to a lactation consultant is now offered to all women from 36 weeks gestation, bothphone and face to face

3. Supporting women who deliver outside of CWHHS

Women who delivered in Longreach reported more midwife visits and higher satisfaction than women who delivered elsewhere.

While there are many possible reasons for this, we are looking at ways to maintain continuity of care with women who deliver away. This can include:

• Keeping in contact with women who consent so that we can stay updated with their progressand know when they will return home

• Make sure every woman has contact details for her midwife and GP clinic so that she cancontact them when she returns home


• We are making a brochure with details of postnatal supports including contact details forlactation consultant, women’s health and child health. This can be given to all women beforeleaving CWHHS for delivery so that they know how to access the services they need whenthey return home.

New birth suite

Of the women who had their baby on or after 12th April 2018 in the new Longreach Hospital birth suite and maternity ward, 95.5% were “satisfied” or “very satisfied” with the new unit and 4.5% were “dissatisfied” or “very dissatisfied”.

Positive feedback

The most commonly listed attractive aspects were

• Having an individual room and privacy

• The environment (comfortable, modern, spacious, clean)

• The care from the midwives and doctors


The most commonly listed opportunities for improvement were:

• Give some homely touches to make it less clinical

• Ensure doors for shared bathroom are explained if more than one woman staying in overnight

CWHHS response

The new maternity unit has been well received by the women who have used it, with very high levels of satisfaction.

• Consider involving women and consumer groups in decorating the new unit to make morehomely and welcoming

• Ensure women are aware of shared bathroom when there is more than one inpatient or userooms that don’t share the bathroom where possible


Overall, the Central West HHS Maternity Feedback Survey demonstrated the high value that the personalised local maternity service has for the Central West community. It also showed some practical ways that we can further increase support for women and their families.

We appreciate the time and effort of all the women who gave their feedback, and to everyone who contributed to developing and sharing the survey.

The CWHHS is committed to providing a safe and patient centred service by continuing the multiple aspects of the service that are being done well and by listening to the feedback from the community that we serve.

Conclusion

CWHHS Maternity Consumer Feedback Survey · Antenatal care – model of care Who did you see for your antenatal care (model of care)? Model of care by location In Longreach, there

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