Abstract :
[en] To improve patient experience, hospitals seek to become more hospitable and enhance the patient journey. Such efforts are especially pertinent in relation to childbirth experience, because maternity wards are sites of particularly complex journeys that feature multiple, critical touchpoints. If those touchpoints can be designed to provide a smooth service experience for the crucial customer segment of (soon-to-be) mothers, the outcomes benefit both the patients and their families (well-being, self-esteem, empowerment) and the hospital (patient loyalty, word of mouth, engagement). But maternity wards also face various challenges, from both architectural design and service perspectives, in achieving smooth childbirth experience, which might lead to negative birth experience and negative outcomes, including postpartum depression among patients.
From an architectural design perspective, the healthscape—that is the physical healthcare service environment—represents a key aspect of the patient experience, though extant literature into maternity ward healthscapes is rather imprecise. Maternity healthscapes (MHS) require specific attention, due to their unique characteristics and distinctions from other healthcare departments. In particular, MHS need to be designed to account for the specificities of childbearing and the needs of multiple patients and their family members.
From a service perspective, the experience of (soon-to-be) mothers (and their families) is life-changing and memorable, and the quality of the experience affects the well-being and health of women and their babies, relationships with partners, and future childbearing experiences. The related journey is multifaceted and invariably explores the intimacy of maternal patients, because medical staff requires them to disclose intimate information and body parts. Understanding and managing patient intimacy is thus a critical imperative.
With these considerations as a foundation, this dissertation examines how to make healthscapes more hospitable by clarifying the role of the MHS on childbirth experience and patient intimacy, and thus provide healthcare managers and architects with relevant insights to improve MHS and services, with three studies. First, Chapter 2 presents a novel conceptualization and index of the multidimensional concept of MHS, based on a multidisciplinary literature review and 39 in-depth interviews with various stakeholders, including mothers, midwives, heads of midwives, and senior managers. This novel conceptualization provides a comprehensive view of the dimensionality of MHS. Then, in line with that comprehensive conceptualization, a proposed index provides a census of aspects in the MHS that various actors (e.g., healthcare providers, service designers, architects) should account for when conceiving MHS. Together, the conceptualization and index offer a strong foundation for continued empirical research into healthscapes, across other healthcare departments as well, and highlight key aspects of MHS that thus far have received relatively less attention. In particular, the conceptualization and index
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can support efforts to monitor and measure MHS—to, ultimately, enhance patient experience in maternity wards.
Second, to uncover critical touchpoints during mothers’ journeys in MHS, which must be managed carefully to ensure a smooth childbirth experience, Chapter 3 presents the results of 15 interviews with mothers who gave birth in public hospitals in Belgium, using the Critical Incident Technique. The findings (1) depict the journey of mothers giving birth in a public hospital in Belgium, (2) identify critical touchpoints and their (in)tangible antecedents throughout the journey, and (3) establish areas of innovation to improve mothers’ journey. This study highlights which moments of truth have the strongest effects on mother experience, such that they demand careful monitoring and should inform new hospital designs and renovations.
Third, on the basis of a multidisciplinary literature review and 39 in-depth interviews with various stakeholders from maternity wards, Chapter 4 provides a conceptualization and a theoretical framework of patient intimacy in healthcare services, together with an overview of its (in)tangible antecedents and short- and long-term outcomes. Understanding and managing patient intimacy is an important area of inquiry, because intimacy influences patients’ attitudes and behaviours. This framework can guide healthcare providers and (service) designers, as well as provide a foundation for further research into patient intimacy, which represents an under-investigated but crucial concept in healthcare services.
Finally, Chapter 5 provides an overview of the overall contributions of the dissertation. We first summarise the structure of the dissertation and key conclusions from each chapter in the synopsis. Then we integrate the findings of the separate studies, to compile a list of academic contributions and implications for practice. These implications for practice are supported by additional interviews conducted with two healthcare architects. Finally, we suggest avenues for further research, which might address the limitations of this dissertation.
