Respectful Maternity Care: What to measure and how to measure it Powerpoint

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Respectful Maternity

Care: What to measure

and how to measure itEva Bazant, DrPH, MPH

Sr. MER Advisor, Jhpiego

Jennifer Huang, Jhpiego

FIGO Africa Regional Conference of

Gynecology and Obstetrics

Addis Ababa, Ethiopia

October 25, 2013


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Outline

7 Domains of RMC

FIGO Code of Ethics

Disrespectful behavior among providers

Suggested indicators for RMC

Use of monitoring and evaluation (M&E)

Data sources


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Consent

Confidential careNon-abandonment of care

No physical abuse

Dignified care

Equity in access

No abuse related to cost,including detention

Adapted from Bowser, D., Hill, K. 2010. Exploring evidence for disrespect

and abuse in facility-based childbirth: Report of a landscapeanalysis. Harvard School of Public Health University Research.

http://goo.gl/0NQ122 (Accessed Sept 22, 2013).

Respectful Maternity Care


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Professionalism in health care of

women is the means by which

physicians provide ethical care thatrespects the sexual and reproductive

rights of women.

The FIGO, Code of Ethics


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FIGO Medical Code of Ethics:

Guiding Principles

Ensure rights of persons to make

informed choices about their own

health care

Maximize the best health outcomes

Do no harm

Beneficence

Non-

maleficence

Autonomy

Distribute the burdens and benefitsof new or experimental treatments

equally among all groupsJustice

D E F I N I T I O NP R I N C I P L

E

Consent and information exchange

for informed decision-making,

confidential care

Dignified care, RMC as a larger part

of quality of care framework

Nophysicalabuse, ensures the

safety of women, Non-abandonment of care

Equity in access, No abuse related

to cost including detention

L I N K T O R M C


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Respectful Maternity Care why

does it matter?

Reputation and Professionalism

Quality of Care

Patient Safety, Service Use and Health

Outcomes

Provider Satisfaction and Retention


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Six Elements of Disrespect1. Disruptive behavior

2. Humiliating/demeaning

treatment of nurses,residents and students

3. Passive aggressive behavior

4. Passive disrespect

5. Dismissive treatment of

patients6. Systemic disrespect

Disrespect is a th reat to

patient safetybecause it

inhibits collegiality and

cooperation essential to

teamwork, cuts offcommunication,

undermines morale, and

inhibits compliance with

and implementationof newpractice.(Leape, et al. 2012)

Behavior

among Provider Teams

Leape, L. L., Shore, M. F., Dienstag, J. L., et al. 2012. A culture

of respect, part 1: The nature and causes of disrespectful

behavior by physicians.Academic Medicine, 87(7), 845-852.


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Logic Model/M&E Framework

ContextInputs/

ActivitiesOutputs Outcomes Impact

Care after

Birth

ANC

Labor and

Delivery

7 RMC

DOMAINS

AfterBefore


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Illustrative Indicators for RMC

Number of women who were asked theirpreferred birth position

Number of women who had a companionpresent in labor or delivery

Number of women able to explain the reason forreceiving a treatment for complication (cesareansection, episiotomy, etc.)

Number of women who were draped during

examinations Number of staff who rate the work environment

as respectful


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Suggested Indicators for RMC

Number of women who were asked theirpreferred birth position

Number of women who had a companionpresent in labor or delivery

Number of women able to explain the reasonfor receiving a treatment for complication(cesarean section, episiotomy, etc.)

Number of women who were draped during

examinations Number of staff who rate the work environment

as respectful


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Measuring the Indicator

Before and After

ContextInputs /

ActivitiesOutputs Outcomes Impact

Labor andDelivery

Number of

women able

to explain the

reason for

receiving a

treatment

AfterBefore

Protocol for

obtainingpatient

consent exists

Number of

providers

trained to

meet RMCcompetency

standards in

simulation Number of

women who

returned for

postnatal care(PNC)

Number of

clients

intending for

future birthsat the facility


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What sources should be used

to collect data on RMC?


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Data Sources

Data obtained from client or community

Exit interviews with clients

Companion interviews

Community interviews including community health management boardand focus groups

Formal evaluations

Document review

Facility readiness checklist

Training records and competency assessments

Supervision checklist

Labor & Delivery provider interviews Observation of labor and births (by 3rd party, trained observers or

supportive supervisor/mentor)

Service data from health information systems (HMIS) and registries


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How can these data sources be

routine?

1. Include sources in the work plan and budget

2. Data collection by local organizations, local

universities, or facility community boards

3. Have short checklists and tools

4. Feedback via mobile phone data/SMS

(anonymity ensured by 3rd party)


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Key Points

The 7 RMC domains align with the FIGO

Medical Code of Ethics

Listen to patients/clients AND providers

Select priority aspects of RMC for your

context and track indicators at the levels of

policy, outputs and outcomes

Consider data sources that can be maderoutine and collected within the budget


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Thank you!

Respectful Maternity Care: What to measure and how to measure it Powerpoint

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