Collecting reliable feedback on midwifery care experiences from new parents is challenging and analysis of the data is costly. This article described the challenges and opportunities faced by midwifery units in obtaining quality, timely and actionable feedback on maternity care from new parents, with a focus on a potential solution using automated data collection and AI-enabled analysis. Experiences from the Royal Surrey NHS Foundation Trust are drawn on to illustrate the uses of this method.
There are many reasons why a parent might withhold the reality of their midwifery care experience from maternity services. During pregnancy, expectant parents will be concentrating on preparing for a positive birth experience and there is anecdotal evidence to show they may ‘vote with their feet’ by choosing a different midwifery unit, rather than share their preferences or recent care experiences after being discharged.
At the Royal Surrey NHS Foundation Trust's midwifery unit, obtaining high-quality information from new parents on their care experience can be a challenge. New parents are always encouraged to complete surveys during their pregnancy and when they are discharged home after the birth of their baby, so the service can understand their experience and pinpoint areas to improve. While important feedback is received using these surveys, the response rate is fairly low according to internal records, so it is likely that they do not provide the fullest picture.
In response to the pandemic, the maternity service undertook its own risk assessment in relation to homebirths, which was reviewed and supported by the Trust board. Based on this risk assessment, the homebirth service was temporarily suspended for approximately 3 months to protect staff and patients. As one would expect, this resulted in many women expressing disappointment that this birth option was unavailable to them. Through the unit's ‘you said, we did’ forms, it was possible to listen to women's stories and concerns and take action to address them.
Feedback such as this is vital to understand patient concerns and support a responsive approach to care. Following this feedback, the homebirth team midwives decided to work nightshifts in the maternity unit during the suspension to maintain continuity of care in labour for women in their caseload.
Elise Cordell had originally been booked to have a homebirth for her second child; however, because of the pandemic, she had to give birth at the maternity unit in April 2020. Although she was unable to have a homebirth, Elise was supported by the homebirth team to maintain continuity of care. She shared her experience via the Royal Surrey maternity unit Facebook group:
‘Hospitals had put in restrictions to visitors, including birthing partners. These restrictions meant that overnight, unless a woman was labouring, birth partners had to go home and only one visit per day was allowed. I went into hospital at the last minute and was met at the delivery suite door by a familiar face from the homebirth team. Everyone on the ward was so apologetic for the [personal protective equipment] – I imagine it's very odd for maternity [wards] to have such barriers – but honestly so lovely. I felt so supported and looked after.’
(Elise Cordell, Facebook)
Parents are often keen to complete their discharge and get home with their new baby and may not complete the hospital survey in much depth. The COVID-19 pandemic has only heightened this issue. There is always a lot to cover during the discharge period, with final tests for the baby and consultations with obstetricians and midwives. Therefore, completing a survey on discharge is understandably not always a family's priority.
One solution to meeting the feedback gap is to follow parents on social media and online forums where they will often access information and discuss their experiences. In the experience of those working at the maternity unit, parents freely share information about their personal experiences of the unit's midwifery care with other parents or expectant parents online. In addition to traditional feedback channels, these social media sites can be excellent sources of feedback on parents' experiences.
While social media and parent forums are clearly a valuable source of parent experience information, trawling through platforms manually would be heavy work. The Royal Surrey maternity unit have recently started working with a patient experience platform to automate the collection and analysis of online feedback, meaning insight can be gathered more effectively than traditional methods, while also saving time and money.
The platform automatically identifies and gathers publicly available feedback from a variety of online platforms, including social media sites such as Facebook and online patient groups. The unit staff have found it invaluable to collate both positive and negative feedback monthly for each ward area to share at relevant meetings and drive service improvements.
During 2020, almost 800 comments were collected using this system, specifically from maternity services users that would almost be impossible to analyse manually. Across the Trust, it has been possible to access automated analysis and satisfaction scores, helping to make sense of over 5000 comments each month.
Prior to using this platform, the unit relied on face-to-face feedback and patient surveys, which were inconsistent in terms of response rates across touch points. Having the ability to draw on feedback from more sources and go to places where patients were already sharing their experiences has given better opportunities to learn from a more diverse group of service users.
The unit is fortunate to have a dedicated patient experience midwife who collates monthly feedback from the platform, which is shared at multidisciplinary team quality and safety meetings. Sometimes it leads to direct changes on how care is delivered. For example, online feedback showed that people needed more information on antenatal classes during lockdown. Classes were adapted to suit the restrictions, so more information needed to be provided, particularly on social media channels.
A further example of reviewing patient feedback and using it to drive improvement concerned wait times for women and babies being discharged from the postnatal ward. Families were not aware of the steps required to facilitate a safe discharge for mother and baby. The matron for postnatal services addressed this by developing a bedside folder that explained the process. This information was also shared with the local Maternity Voices Partnership to ensure they have the correct information to share widely with women so that expectations are appropriate.
It was also found that some women had a misunderstanding about the duration of inductions, with many women expecting the process to be much quicker than it often was. Some women had a poor understanding of body mass index, which is discussed at their booking appointment. Being aware of these issues led to the launch of #AskUs and ‘Sign Post Saturday’ posts on the Maternity Hub each week to explain terminology or elements of care that women may come across in their pregnancy and may not fully understand.
Online channels have become a safe and inclusive space for new and expectant mothers to communicate and share experiences, providing additional support outside of the traditional care setting.
‘I imagine lots of women were feeling the same as I did when the homebirth team was disbanded. So, I wanted to share my experience and try to reassure them that while they may feel disappointed that they couldn't have the birth experience they wanted, it can still be amazing regardless. I also wanted to share how brilliant the hospital team were and how supportive they were throughout.’
(Elise Cordell, Facebook)
The platform not only helps pinpoint negative feedback or address key areas for improvement, it is also beneficial in highlighting positive feedback that motivates teams too. It is important for midwives to see how they are valued, so when they are mentioned on social media or online forums, it is used in their personal validations that supports their development and helps with team morale.
The analysis that the platform provides is ongoing, so the data are ingested daily and automatically tagged and scored. This means data can be filtered by date and it is possible to see how performance is tracking from one period to the next. Interestingly, the trust received higher satisfaction scores during the COVID-19 pandemic than before, which given all the extra pressures during that period, is pleasing to see. Keeping that satisfaction high during the post-COVID-19 period will be the next step for the unit.
Maternal safety is paramount given the accelerated focus in the NHS (2019) Long Term Plan on achieving 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025. The unit is always looking to understand how performance varies at different times and how it benchmarks against other trusts, and the platform shows how scores compare to others in any given period.
The information about parent experience that has been drawn from the platform has been invaluable in understanding how the unit is tracking against performance metrics, both for parent satisfaction and safety. The author belives it can be harnessed to bridge the gap in obtaining reliable, quantifiable parent experience information and enable midwifery units to get better insight into the parent experience. With advances like this, we are moving towards achieving the objectives set out in the NHS Long Term Plan.