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Arrowe Park Hospital

Problem definition:

Management at the Wirral NHS Foundation Trust are concerned that Wirral residents are choosing to travel to Liverpool or Chester, for obstetric and gynaecology support. The Trust’s management is keen to ascertain what barriers exist with their current support provision preventing the repatriation of local residents to their hospitals and/or specialist centres.

Design:

Based on the four strategic principles of the obstetrics and gynaecology health care provision, namely time spent travelling, choice, facilities and reputation, the objectives of the study are:

  • Evaluating the relative importance of these four principles among local residents
  • Establishing within each strategic principle, local residents’ preference for a particular level of service
  • Gauging which service levels or combinations of service levels they would be prepared to trade-off to achieve what they consider to be important.
  • Deriving the ‘optimum’ mix of service levels among the 64 permutations to recommend to Wirral University Teaching Hospital NHS Foundation Trust to help them shape the future of obstetrics and gynaecology health care provision on the Wirral

For each of four drivers there were varying levels

  • Proximity/Accessibility: About 30 minutes travelling time or 30 minutes to 1 hour travelling time
  • Choice: Choice of hospital or no choice of hospital
  • Facilities available: Own room, free car parking, state-of-the-art technology and all-embracing/one-stop service.
  • Reputation: Respectful staff, knowledgeable staff, cleanliness of surroundings and quality care

Analysing the data:

In order of importance, and in overall terms, the four strategic principles or drivers are ranked as follows:

  1. Choice
  2. Proximity to their home
  3. Facilities
  4. Reputation

This is reflected when asked what influenced their decision to make their most preferred selections.

  • Choice, the most important driver in the decision-making process, yielded the highest utility scores of all levels scored. In particular, gynaecology patients appeared more likely to select this level as a key determinant in their decision-making process.
  • The nearer the proximity to home the higher the utility.
  • Within the facilities section, positive utilities were derived from state-of-the-art technology and all services and facilities available in the same centre.
  • However, free carparking as an out-patient, and own room as an inpatient recorded negative utility scores.
  • The only level within the reputation section to have recorded a positive utility, based on all respondents, was cleanliness of surroundings and wards.
  • The highest utility score was derived from the additive values of: travelling time from your home up to 30 minutes, you are offered a choice of hospitals to attend, the equipment used by the clinicians is up-to-date state-of-the-art technology, and the wards and surroundings of the hospital are regularly and thoroughly cleaned.
  • The implication of this to make more obstetrics and gynaecology centres available throughout the Wirral may be financially impractical.

Reflection on learning:

To be able to exercise their informed choice, have facilities which represent state-of-the-art technology and be treated in regularly and thoroughly cleaned wards and surroundings, patients are prepared to travel further to achieve this. In other words, patients are prepared to trade-off travel time to achieve care using up-to-date technology administered in clean wards after having evaluated the options available.

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