Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics

Abstract

Ensuring patient satisfaction is crucial in obstetrics and gynecology (OB/GYN) care. This study aimed to assess patient satisfaction and experiences with respectful and culturally competent care in an institution's OB/GYN clinics following the initiation of diversity, equity, and inclusion programming. A survey was conducted from September 2021 to February 2022 among patients who had completed outpatient OB/GYN visits, focusing on staff and provider cultural competency, treatment discussion, clinic accommodations, and comfort during sensitive exams. Results from 246 participants indicated that most had positive interactions with clinic staff and healthcare providers. However, disparities emerged, with black or African American participants reporting lower satisfaction and a higher incidence of unfair treatment due to race. These findings highlight the need for additional educational endeavors to equip clinical care teams with skills for providing respectful, inclusive, and culturally competent care. Future qualitative research can further explore patient experiences with inclusive practices in OB/GYN care.

Introduction

Ensuring patient satisfaction remains an important objective for obstetrics and gynecology (OB/GYN) care. Increased patient satisfaction has been found to be correlated with improved patient health outcomes, reduced malpractice litigation, and improved patient compliance. ¹ Although clinician training in patient-centered communication and culturally competent care can increase patient satisfaction,^1–4 we lack studies assessing patient experiences with this care in OB/GYN. Diversity, equity, and inclusion (DEI) initiatives have been increasingly undertaken in OB/GYN departments. ⁵

Our academic institution is a large hospital system that serves the Midwestern United States, with 8 outpatient clinic locations, serving 77,000 patients per year presenting for both general and specialty obstetrics and/or gynecology care. Starting in 2020, our OB/GYN department implemented a series of DEI programming to improve the patient experience. This included unconscious bias training for all staff, faculty, and house officers involved in the hiring process, an “Inequity Inbox” for anonymous reporting concerns about unit-level procedures and policies, utilization of an ethics consult service to assist with health equity and/or ethical concerns, and monthly Health Equity Grand Rounds to discuss concerns when inequity impacts health care. Therefore, we aimed to assess patient satisfaction and experiences with respectful and culturally competent care in our academic institution's OB/GYN clinics, following initiation of DEI programming.

Method

From September 2021 to February 2022, we recruited participants who had completed outpatient OB/GYN visits to participate in a satisfaction survey. We recruited a convenient sample via outpatient waiting rooms and telephone, and written informed consent was obtained from the patients for their anonymized information to be published in this article. Participants were offered the opportunity to enter a raffle for a $100 gift card. The 21-item survey (Supplementary Appendix B) asked participants to rate their experiences regarding staff and provider cultural competency, ⁶ treatment discussion,^7–9 clinic accommodations, and comfort during sensitive exams (ie, pelvic exams, breast exams) using a Likert scale. Participants self-reported demographic characteristics. Data analysis included descriptive statistics, chi-square analyses, and Fisher's exact tests (SPSS Inc., IBM Corp., Armonk, NY). This study was deemed exempt from Institutional Review Board Review [HUM0016242].

Results

Completed surveys were returned by 246 participants. Most participants were under 35 years old (51%) and had at least a college degree (66%). Among those who reported race and/or ethnicity (N = 157), the majority were white (65%), followed by black or African American (10%), Asian (4%), or other races. This demographic breakdown is consistent with the typical characteristics of patients who frequent our clinics, in terms of both race and age (Supplementary Appendix A). Participants generally had positive interactions with clinic staff and their healthcare provider: they felt listened to (91%), respected (95%), and had their cultural and/or spiritual beliefs considered in treatment plans (95%). Participants felt respected and comforted during sensitive exams (96%) and expressed satisfaction with treatment discussion (84%). However, participants with a high-school education were less likely than those with college or graduate degrees to feel that administrative staff listened to them and their family (79% vs. 93%, 93%, P < 0.05). They were also less likely to agree that the clinical staff understood that people of their racial or ethnic group are not all alike (50% vs. 82%-88%, P < 0.01). Black or African American individuals reported the highest incidence of unfair treatment due to race (20% vs. 0%-2%, P < 0.01) (Supplementary Appendix C).

Discussion

Our survey revealed overall positive patient experiences in outpatient OB/GYN care, particularly regarding treatment discussion, accommodations, and comfort during sensitive exams. However, disparities in satisfaction were noted, particularly among black or African American participants, who reported lower satisfaction and a higher incidence of unfair treatment due to race. These findings underscore the importance of ongoing efforts to improve cultural competence in healthcare settings. Other studies have also identified disparities in patient satisfaction regarding cultural competence across different races.^10,11 To address these disparities, healthcare providers and institutions should consider implementing targeted educational programs to enhance staff understanding of diverse cultural and racial experiences. ¹² Additionally, future qualitative research can explore the long-term impact of DEI initiatives on patient satisfaction and outcomes in OB/GYN care.

Limitations

This study's findings offer valuable insights into patient satisfaction in OB/GYN clinics; however, they should be interpreted considering some limitations. This survey, initiated as DEI efforts were gaining focus in academic medical centers, served as a baseline assessment of patient satisfaction. No prior evaluations had been conducted at our clinics, and we did not have pre-DEI satisfaction rates for comparison. Furthermore, the convenience sampling method used may not fully represent the diverse patient population. Additionally, the reliance on self-reported data could introduce some bias in the responses. The study also did not gather data on patients’ sexual orientations or explanations for their responses, which could offer clarity on perceptions of unfair treatment, for example. In addition, the study's focus on a single institution might limit the applicability of the results to other settings. To address these limitations, future studies could employ a more diverse and representative sampling strategy to enhance generalizability. Longitudinal designs might also provide a deeper understanding of the long-term effects of DEI initiatives on patient satisfaction (Table 1).

Table 1.

Patient Satisfaction by Race Regarding Cultural Competence (N = 157).

	The staff here understand the experiences that I, my family, and others from my cultural, racial, or ethnic group may have.			The staff here understand that people of my racial or ethnic group are not all alike.			The staff here understand that I might want to talk to a person from my own racial or ethnic group about getting the help or treatment that I need.			I have been treated unfairly at this office because of my race and/or ethnicity.			The staff here respects my religious and spiritual beliefs.
Responses, n (%)	Agree	Neutral	Disagree	Agree	Neutral	Disagree	Agree	Neutral	Disagree	Agree	Neutral	Disagree	Agree	Neutral	Disagree
Asian, Native Hawaiian, or Other Pacific Islander	8 (67)	3 (25)	1 (8)	9 (82)	2 (18)	0 (0)	8 (73)	3 (27)	0 (0)	0 (0)	0 (0)	13 (100)	8 (80)	1 (10)	1 (10)
Black or African American	11 (55)	4 (20)	5 (25)	10 (50)	5 (25)	5 (25)	9 (47)	6 (32)	4 (21)	4 (20)	3 (15)	13 (65)	13 (68)	4 (21)	2 (11)
Middle Eastern or North African	7 (88)	0 (0)	1 (13)	8 (89)	0 (0)	1 (11)	6 (100)	0 (0)	0 (0)	0 (0)	0 (0)	8 (100)	6 (86)	0 (0)	1 (14)
White (Not Middle Eastern or North African)	87 (79)	21 (19)	2 (2)	92 (84)	15 (14)	2 (2)	63 (72)	21 (24)	3 (3)	3 (2)	2 (2)	126 (96)	87 (81)	19 (18)	1 (1)
Multiracial	3 (75)	1 (25)	0 (0)	2 (50)	2 (50)	0 (0)	1 (33)	2 (67)	0 (0)	0 (0)	0 (0)	5 (100)	4 (80)	1 (20)	0 (0)
P value	<0.05			<0.01			0.063			<0.01			0.11

Note: Bolded P-values indicate statistical significance at P < 0.05.

Conclusion

This study highlights the importance of culturally competent care in patient satisfaction within OB/GYN clinics and contributes to the ongoing evaluation of DEI training programs and their effectiveness across a diverse patient population. While overall satisfaction was high, the disparities observed among black or African American patients indicate a need for targeted interventions to address racial biases and improve inclusivity in healthcare. For example, utilizing collected patient satisfaction data could inform educational initiatives aimed at improving staff awareness of cultural and racial experiences. Continued efforts to implement and evaluate DEI initiatives are essential to ensure equitable and respectful care for all patients in OB/GYN settings.

Supplemental Material

sj-docx-1-jpx-10.1177_23743735241297620 - Supplemental material for Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics

Supplemental material, sj-docx-1-jpx-10.1177_23743735241297620 for Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics by Julia Bhuiyan and Charisse Loder in Journal of Patient Experience

Supplemental Material

sj-docx-2-jpx-10.1177_23743735241297620 - Supplemental material for Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics

Supplemental material, sj-docx-2-jpx-10.1177_23743735241297620 for Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics by Julia Bhuiyan and Charisse Loder in Journal of Patient Experience

Supplemental Material

sj-docx-3-jpx-10.1177_23743735241297620 - Supplemental material for Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics

Supplemental material, sj-docx-3-jpx-10.1177_23743735241297620 for Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics by Julia Bhuiyan and Charisse Loder in Journal of Patient Experience