A framework for improving parent satisfaction with the inpatient pediatric admission process.

Purpose: Prioritizing patient experience during the admission process is critical in improving clinical outcomes as well as patient satisfaction with health care services. Admission of a child to a hospital is a highly stressful event for the parents and timely information regarding their child’s condition is one of their most important needs during this time. Literature reporting parent experience regarding perceived quality of care from low middle-income countries is limited. We describe our experience of an initiative that implemented a communication and accountability strategy to engage all relevant hospital staff with whom the family interacts during the child’s admission process with the purpose of reducing parental anxiety and improving the patients and parents experience. Methods: The intervention for this project was developed based on the Theory of Change (TOC) framework. The messages focused on the child’s current medical condition as well as the inpatient ward environment and were to be delivered within the 1st hour of admission by support staff, nurses and trainee physicians. After pilot testing, trainings of 250 staff members were conducted. These interactive trainings were delivered weekly for 1 hour using role-plays and short videos with a strong emphasis on the communication style. Parents were asked to rate their anxiety level on a scale of 1 to 5 at admission and 24 hours post admission. A detailed monitoring and evaluation plan was designed with a live dashboard to track the indicators. Once completed and synced, an overall satisfaction score was generated. If the total score on this survey was less than 50%, the concerned bed was highlighted in red color on the dashboard for quick feedback to the service management. Weekly reports were also sent to the team leaders of each cadre for targeted intervention on the information that lagged behind. Figure 1: Implementation framework for this initiative. Results: Baseline data was collected between April -May 2018 (n=202) while post-intervention data was collected from June 2018 –February 2019 (n=1362). There was a significant improvement in message delivery across the duration of intervention (p <0.001). The overall satisfaction with the admission process also showed a significant improvement (60 to 95%) over the 9 months of intervention. Further, a reduction in patient anxiety score within 24 hours of admission (4.8 to 1.4 points) was also observed during this period. Figure 2: Trend analysis of message delivery over the intervention period Conclusion: This initiative highlighted that reengineering the current system using existing resources to improve communication between staff and parents regarding their child’s medical condition and the surroundings, with an adequate accountability and governance strategy can help reduce parental anxiety, thus improving satisfaction with the health care system and overall patient experience.