47 - The Culture of Dyad-Centered Care in Birth Hospitals: Differences between Neonatal and Obstetric Staff

Publication Number: 4046.47

Sara Handley, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Cecelia Corson, Childrens Hospital of Philadelphia, Cardiff by the Sea, CA, United States; Joshua Radack, Childrens Hospital of Philadelphia, Boston, MA, United States; Elizabeth E. Rogers, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Meera N. Sankar, Stanford University School of Medicine, Palo Alto, CA, United States; Melissa Rosenstein, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Scott A. Lorch, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States; Ingrid Nembhard, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States

Background: Patient-centered care is a core element of organizational culture (shared beliefs, perceptions, and values across an organization, unit, or team) that is associated with improved team performance in other health care settings. In the childbirth context, "dyad-centered care", reflecting simultaneous maternal and infant care, may be a core element as well. Given that culture is associated with better teamwork and patient outcomes, identifying opportunities to optimize dyad-centered culture may improve perinatal care.

Objective: To compare dyad-centered culture between neonatal and obstetric staff and examine associations with staff-reported outcomes.

Design/Methods: We administered a cross-sectional, validated survey to neonatal and obstetric staff in birth hospitals that measured 7 components of dyad-centered culture and 3 staff-reported outcomes on a 7-point Likert scale (Table 1) and respondent characteristics. Higher scores indicate more positive culture and more favorable outcomes. Analyses described respondent characteristics and compared culture and outcome scores between neonatal and obstetric staff. Linear models with random effects assessed associations of culture scores with outcomes at the individual staff level. The ß reflects the change in each outcome score with a 1-point culture score increase. We included hospitals with ≥10 neonatal or obstetric responses.

Results: Of 141 hospitals contacted, 56 (40%) participated with 1,878 respondents, of which 54% were neonatal and 46% were obstetric staff. Most respondents identified as female (90%) and nurses (70%) (Table 2). Obstetric staff reported higher scores in respect, care coordination/integration, and physical/emotional comfort (all p< 0.001), while neonatal staff reported higher scores in involvement of family/friends (p < 0.001) (Figure 1, panel A). Obstetric staff reported higher scores in team effectiveness and communication (all p< 0.001) (Figure 1, panel B). A 1-point culture score increase was positively associated with satisfaction (neonatal ß 0.61 [95% CI 0.56-0.66], obstetric ß 0.59 95% CI [0.54-0.65]), team effectiveness (neonatal ß 0.60 [95% CI 0.54-0.65], obstetric ß 0.54 95% CI [0.49-0.60]), and overall communication (neonatal ß 0.67 [95% CI 0.62-0.73], obstetric ß 0.67 95% CI [0.61-0.72]).

Conclusion(s): Dyad-centered culture predicts staff-reported outcomes, yet neonatal and obstetric staff report the components of dyad-centered culture differently. Future work should assess whether these differences have implications for care, and whether alignment improves teamwork and care delivery for the dyad.

Table 1. Description of dyad-centered culture concepts and staff-reported outcomes
1There staff-reported communication outcomes included 7 items.

Table 2. Survey respondent characteristics from 56 hospitals
Abbreviations: PT - Physical Therapist, OT - Occupational Therapist
1There were a total of 21 respondents who identified as social workers/case managers. The number who identified as neonatal and obstetric staff are suppressed ( <10 in either group) to preserve respondent anonymity.
2There were a total of 21 respondents who identified as unit support. The number who identified as neonatal and obstetric staff are suppressed ( <10 in either group) to preserve respondent anonymity.

Figure 1. Differences in dyad-centered culture scores (panel A) and staff-reported outcomes (panel B) between neonatal and obstetric staff
Higher scores reflect more positive culture or more favorable outcomes.
In the box and whisker plot the horizonal bar indicates the median, the box the interquartile range, and the whiskers the range.
Reported p-values reflect the Wilcoxson rank sum test comparing scores between neonatal and obstetric staff.