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Breastfeeding clinics
The general aims of breastfeeding clinics are to advise, support and encourage mothers who have left hospital and who wish to breastfeed [1, 2, 3]. Breastfeeding clinics in Australia are mostly based in maternity hospitals, predominantly staffed by International Board Certified Lactation Consultants (IBCLCs) [4]. Clinics generally provide consultations with Lactation Consultants who observe breastfeeding problems through several feeds and write plans to guide the mothers when they return home [4].
The Breastfeeding Education and Support Services (BESS) is a unit of The Royal Women's Hospital in Melbourne, Australia, for women experiencing problems with breastfeeding. The unit has developed Clinical Practice Guidelines for the management of breastfeeding problems [5] and Fact Sheets for consumers [6].
In Victoria, it is routine for all new mothers to attend Maternal and Child Health Centres where they are seen by triple-certificate nurses (qualified in nursing, midwifery and maternal and child health) in the local community without charge on a regular basis. Most of the women attending BESS are referred by their Maternal and Child Health Nurse because they require additional help with breastfeeding. As well as referral by a health provider, women can self-refer. Women may have given birth at the Royal Women's Hospital or elsewhere. At the time of this study (2005/6) there were five permanent Midwife/IBCLCs and one General Practitioner/IBCLC working at BESS.
BESS offers services in a day/short-stay clinic (across the road from the hospital) and also in an outpatient clinic (Tuesday afternoons). BESS day/short-stay offers services for mothers and babies up to three months of age. 'Day-stay' clients stay from around 9 a.m. until 3 p.m.; 'short-stay' clients usually arrive around 11 a.m. for one feed only. Each day (Monday to Friday) usually six infant-pairs spend the day with an IBCLC (three mother-infant pairs for each IBCLC) and one mother-infant pair attends a short-stay appointment with the 'duty IBCLC', whose job also includes telephone counselling. Day-stay clients are provided with lunch. The IBCLC takes a history, observes several feeds, helps with positioning and attachment if needed, and provides a written plan for the mother. Women are given handouts or shown videos as appropriate for their needs. One of the hospital obstetric doctors in training attends BESS each day to see women who need to see a medical practitioner and/or need a prescription. Outpatient appointments are 30 minutes (with the General Practitioner/IBCLC or the Midwife/IBCLC) and may be for new clients, follow-up appointments, infants over 3 months or antenatal appointments. The hospital provides these services without charging clients.
According to the BESS database, throughout the whole of year 2005, BESS received 1,137 patients and the total number of visits to BESS was 2,029. The proportion of visits to day-stay, short-stay and the outpatient clinic was 67.6% (1371/2029), 7.5% (153/2029) and 16.1% (326/2029) respectively. The main breastfeeding problems reported were difficulties attaching the baby to the breast, difficulty breastfeeding a neonate and low milk supply (October 2004 to March 2005). Other problems include maternal candidiasis, nipple pain, nipple trauma/cracked nipple and slow feeding of newborn.
Patient satisfaction
Patient satisfaction assessment is important as a mechanism for quality assurance to ensure standards of health care are achieved and maintained [7]. Readers interested in a systematic review of patient satisfaction are recommended to read the 200-plus page review published in Health Technology Assessment in 2002 [7].
One study has suggested that there are six key aspects of general health care that affects satisfaction – these include medical care and information, food and physical facilities, non-tangible environment, quality of food, nursing care, and visiting arrangements [8]. A well known model that measures consumer satisfaction – the SERVQUAL model – has been used to measure consumer satisfaction in many areas of health as well as the service industry [9
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10, 11]. The definitions of the SERVQUAL items – tangibles, reliability, responsiveness, assurance and empathy – are listed in Table
1[9].Variable | Definition |
|---|---|
Tangibles | Appearance of physical facilities |
Reliability | Ability to perform the promised service dependably and accurately |
Responsiveness | Willingness to help customers and provide prompt service |
Assurance | Knowledge and courtesy of employees and their ability to convey trust and confidence |
Empathy | The firm provides care and individualized attention to its customers |
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We found only two published studies of satisfaction surveys conducted for a breastfeeding clinic [12, 13]. The Richmond Breastfeeding Drop-in Centre, in British Columbia, Canada, operated for three hours per week when it was evaluated in 1995 [12]. The 57 respondents rated their satisfaction as 8.7 on a scale of 1 (lowest) to 10 (highest). The most common reasons for attending were 'wanting reassurance, crying/fussy baby and poor latch' [12]. Sixty-eight women responded to the satisfaction survey in Saskatoon, Canada, in 1996 [13]. One hundred percent of the respondents (n = 68) replied they were satisfied with the interpersonal aspects of the services, including how well the Lactation Consultants handled the baby, autonomy in decision-making, and the comfort established with the Lactation Consultant [13]. The 'quality of information given, support and encouragement and reassurance, and knowledgeable staff'(p.34) were reasons that respondents claimed to have an effect on whether or not they would recommend the service to others or return to the clinic if needed again [13]. Recently in the UK, women attending a drop-in clinic for infant feeding difficulties reported that they found the expert hands-on, one-to-one support was invaluable [14].
The previous client satisfaction survey at BESS was conducted between July to September 2002 [15]. The survey was distributed to an unknown number of women during their visit to BESS (day-stay only in 2002). A total of 78 surveys were completed and an informal report was compiled for the staff [15]. The majority of respondents agreed that the waiting time to attend the service was satisfactory (92%), the location was convenient (92%), the surroundings were comfortable (92%), the advice offered was achievable (90%), meals were satisfactory (86%), and their breastfeeding problem improved (78%). There was no overall measurement of satisfaction; parity and baby's age were the only sociodemographic variables collected.
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The aim of this project was to conduct an anonymous postal survey to measure patient satisfaction with the Breastfeeding Education and Support Services at The Royal Women's Hospital.