Patients as stakeholders: a mixed-methods evaluation to understand patient experiences of care at a public-private partnership hospital network in Lesotho
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Abstract
BACKGROUND: Patient-centered care that is dignified and respectful, shares information, and encourages patient participation is a fundamental building block of high quality healthcare. As part of a larger performance evaluation of the Public Private Partnership (PPP) Queen ‘Mamohato Memorial Hospital Integrated Network (QMMH-IN) in Lesotho, we explored patients’ experiences of care.
METHODS: Guided by the Quality of Care and Donabedian Model frameworks, we administered surveys and in-depth interviews (IDIs) in three sites across QMMH-IN. For the survey, we calculated a patient-centered composite score then identified its significantly associated variables using logistic regression. For IDIs, we used an inductive-deductive coding approach and content analysis to identify key themes.
RESULTS: 692 surveys and 46 IDIs were administered to patients across the Outpatient Department (surveys=434, IDIs=15), Maternity Department (surveys=210, IDIs=16), and Likotsi Filter Clinic (surveys=48, IDIs=15). Survey respondents across all locations reported receiving patient-centered care from doctors (86%), nurses (82%), and other staff (77%). However, Maternity Department respondents were 71% less likely (aOR: 0.29, 95% CI: 0.13 – 0.67) and 70% less likely (aOR: 0.30, 95% CI: 0.12 – 0.79) to report receiving patient-centered care from doctors and nurses, respectively. Qualitative findings suggest respondents’ interactions with doctors, nurses, and other staff were mostly positive. However, mothers in the Maternity Department reported experiences of discrimination, threats, and being shouted at by nurses. Mothers mentioned missing mealtimes or not being told to bring their own tableware. Qualitative findings also suggest respondents experienced long wait times, with 32% of survey respondents reporting having waited two or more hours to see a doctor.
RECOMMENDATIONS: To improve patient-centered care, we recommend implementing quality improvement programs like Problem Solving for Better Health Nursing, utilizing Lean Management principles to address wait times, and developing a Maternity Department food provision policy.
CONCLUSION: This study offers a unique insight into patients’ experiences of patient-centered care in three sites of a Lesotho PPP hospital network. Recommendations can be used by hospital management to inform more respectful and responsive department-specific approaches such as those targeting respectful maternity care. Considering patients as key stakeholders should be foundational to future QMMH-IN quality of care strengthening initiatives.