OP36 The role of communication between health professionals and patients as a factor in patient complaints in obstetrics and gynaecology: a mixed methods review from an irish maternity hospital

Abstract

Background Improving quality of care in Irish health services is an on-going challenge particularly around the area of maternity care services. It has been estimated that 17% of all settled legal health claims in Ireland for 2012 were related to maternity care. The aim of the study was to conduct a review of patient complaints letters submitted to Cork University Maternity Hospital (CUMH) in order to explore the relevance of communication in how patients interpreted their experience and interaction with staff. Methods This study comprised of a retrospective mixed methods review of complaint letters (n = 138) received by CUMH over a two year period (2012–2013). Quantitative data was collected from all the letters including; type and location of event, staff members involved. A qualitative review was then undertaken of obstetric clinical complaint letters (n = 76) in order to explore patient’s perceptions of staff communication, in the context of their complaint, and the impact the experience had on them. Results Communication played a central role in 93% of obstetric clinical complaints with 67% of these complaints having more than one communication issue. The majority of complaints related to the labour ward (47%; n = 35) and the Emergency Room (21%; n = 15). Key qualitative themes included; patient’s perception of a loss of personal autonomy and a loss of trust in staff particularly around the communication of complex clinical events. Patients placed great confidence in staff and how staff communicated with them during their experience of care. Of most concern to patients in their letters was a lack of understanding as to what was happening to them and their baby during delivery. Women experiencing delivery for the first time also had expectations of a particular outcome and when things did not proceed as expected they struggled to understand this and often felt that staff did not explain what was happening during the event. Discussion These findings demonstrate that there is a need to continue to support multidisciplinary staff training around communication with patients particularly in relation to challenging clinical events. Further exploration of the complex issues around women’s expectations and perceived experience of pregnancy and delivery is necessary. This study also highlights the diverse experiences of obstetric care and the subsequent impact they had on their lives and plans for future pregnancies.