1. What Women Want: How to Fill Your OB Beds Presented by: Dr. Julie Pokela Market Street Research and Brian ODea Newton-Wellesley Hospital

2. Workshop Objectives To understand the critical role routine gynecological care plays in driving OB market share. To understand what is important to women in selecting providers and hospitals for prenatal care and birthing. To understand the factors that affect satisfaction in OB care.

3. Introduction The role of obstetrics in a hospitals overall market position Builds hospital loyalty Profit center The unique marketing opportunities afforded by obstetrics Happy event Planned event Statistics in presentation represent average findings from surveys of new mothers Quotations in presentations are from surveys and focus groups of new mothers

4. Which Comes First: Choosing the Provider or the Hospital? For most women, the selection of a provider for pre-natal care is more important than the selection of a hospital for delivery.

5. Primacy of Selecting Provider Over Hospital [Hospital has] a birthing center... that you can deliver and its pretty much natural. It looks like a real bedroom. You can deliver in a whirlpool with candles. Ive witnessed a childbirth like that. Absolutely beautiful. And I just choseI did not choose that, because I was staying with my doctor that I had.

6. Who Selects Providers/Hospitals First? In many markets, there are no demographic differences between women who select providers vs. hospitals first In some markets: Older and more affluent mothers are more likely to select providers first Younger and less affluent mother are more likely to select hospitals first

7. What Is Important to Women in Selecting Providers? Did you have an ob/gyn you used for routine care prior to becoming pregnant? Did you stay with that ob/gyn for prenatal care? Most women have an ob/gyn they use for routine gynecological care, and stay with that provider when they become pregnant.

8. Implications The patients your hospitals ob/gyns are seeing for routine gynecological care represent the majority of the patients the hospital will capture for obstetrics It is important to market your hospitals ob/gyns for routine gynecological care Your hospitals ob/gyns must have appointments available for new patients for routine care in a timely way

9. How Do Women Select Ob/Gyns? A great bedside manner is the most important criterion Any questions that I had they always took me into a room. Lets talk about it, any concerns, and just really coached me a lot, what I will be expecting, what not to worry about, hes very concerned to make sure that I was eating right for the baby, and he was always one step ahead of me. When I left, I never had to worry about questions, so it was a nice feeling. Recommendations from family and friends are also important Its great that theres these wonderful ob/gyns at [Hospital] … Its definitely tempting to tell my sister-in- law, whos looking for a new ob/gyn. Its close to home. But unless I talk to a woman that went to one of them, its hard. Its all word of mouth.

10. How Do Women Select Ob/Gyns? (cont.) About one-half of women prefer a female ob Sometimes it was nice to see the woman, when you were just having all these womens emotional things, and aches and pains, and shes had three children and…women understand what it feels like. Location is important, because most women are selecting an ob/gyn for routine gynecological care Availability of appointments is also key

11. How Do Women Select a Hospital? Provider affiliation is frequently the only criterion, because most women select their provider first Location is key to a segment of the market I just assumed I would go to [Hospital] because it was the closest hospital. Most women are willing to bypass the closest hospital Having 24 hour availability of epidurals is highly important in most markets, although many women assume that all hospitals offer this. Thats why I didnt go to [Hospital], because they cant always do [epidurals]. They only have an anesthesia team thats there during regular business [hours]. That was my number one factor.

12. How Do Women Select a Hospital? (cont.) There are some factors that are important for patient satisfaction, but dont play a major role in hospital selection High touch Physical facility Women who are concerned about high-risk births consider high tech factors. For most women, this is not a significant criterion. Having a wide range of birthing options is less important and women can be skeptical about being able to use options I have found that touring hospitals they promise you all of that stuff, and then you get there, and theyre like, Oh, no, you lay in the bed and thats it. I was asking about a water birth because I wanted to get in a tub of some sort. I mean its awful, nothing. They were like, You have an IV, you have a catheter, thats it, and when I came on my tour, I was promised all this stuff. Most women are not aware that there are different levels of nurseries, and dont want to think about problems with their babies I dont think I even thought [about the nursery]. I think, especially the first time around, I was just more concerned about myself.

13. Case Study: Newton-Wellesley Hospital Obstetrical Collaboration has Long Gestation Period

14. The Market MetroWest Caritas Norwood NWH BWH Mt. Auburn St. Es BIDMC MGH NEMC 10 mi

15. Overview Birth rate was declining Reimbursement not keeping pace Physician challenges Increasing competition BWH over capacity NWH had capacity

16. Better Together? Our market research did show that almost all categories of patients would favorably view a collaboration between BWH and NWH. Could BWH and NWH create an OB/GYN program that addresses health care for women and achieve institutional goals?

17. What impact does the collaboration with BWH have on your perception of NWHs maternity department? Source: Market Street Study, 2002 NWH loyalists NWH/PHS AMC splitters Competing comm hosp loyalists Competing comm hosp/ PHS AMC splitters PHS AMC loyalists Competing AMC loyalists % of total Much more positive Somewhat more positive A loyalist prefers a hospital for both routine and specialty care, while a splitter prefers the first hospital for routine and the second for specialty. Better Together? (cont.)

18. Our Two Medical Staffs Were Not So Sure History of competition Culture and Strategy Private practice versus academic medical center Market perception issues Brand issues Financial issues MD practice issues (e.g. site changes, splitting time) Governance issues (e.g. titles) Perception that service was devalued High resistance all around!

19. The (birth) Plan Enhance the program in ways that would benefit NWH Obs and demonstrate a commitment to expanding the scope of care to BWH docs Maternal Fetal Medicine Program Assisted Reproductive Technologies (A.R.T.) Gyn Onc Uro-Gyn Fully integrate both services Joint clinical leadership Quality oversight Geography driven cross-referral

20. The (birth) Plan (cont.) The biggest single component ended up being migrating the HVMA Wellesley site business to NWH (from the Brigham), and reopening an OB practice at Dedham Medical It was a long and complex project with many competing interests in a multi-sided negotiation. It would ultimately take a year and a half to execute.

21. The Delivery 8 new Ob/Gyns practicing at three sites 7 new Nurse Midwives A 14% increase in deliveries 1,700 A.R.T. visits/year 32 Gyn Onc. procedures/year 1,300 M.F.M. assists/year

22. The Delivery (cont.) "The response from our patients has been better than our group ever hoped for. In our first year over 80% made the transition with us from the Brigham to Newton-Wellesley and word of mouth has spread so quickly that we are now getting patients transferring from our other Brigham sites. Our patients especially appreciate access to Brigham and Women's maternal-fetal medicine specialists while enjoying the newly renovated, state of the art facility with Newton-Wellesley's personalized and family friendly care. Lori Wroble, MD Harvard Vanguard Medical Associates

23. The Delivery (cont.) "The presence of the maternal fetal medicine physicians at Newton- Wellesley enables me to continue caring for my patients during complicated pregnancies while providing them with the best high-risk resources the Boston area has to offer. Heidi Angle, MD Newton-Wellesley Obstetrics and Gynecology

24. The Delivery (cont.) He collaborated really well with my Ob…we really liked the intimacy and connection with the doctors Karen Korn Ob Patient

25. Generating Loyalty and Positive Word-of-Mouth Patient satisfaction with providers and hospitals is key for generating loyalty and positive word-of- mouth Provider satisfiers: High level of personal attention Good communication and listening skills Having adequate time for appointments I could see the waiting room was full of people waiting for him, but he would come in and act like I was the only thing he had going that day. He would sit there and answer every single question I had and he has never ever made me feel rushed in any way, and I loved that.

26. Generating Loyalty and Positive Word-of-Mouth (cont) Biggest provider dissatisfier: lack of personal attention She delivered the baby and was gone. She didnt check on me. [I would have liked it] if she had come back and checked on me and the baby to make sure we were doing well.

27. Generating Loyalty and Positive Word-of-Mouth (cont) Biggest hospital satisfier: high level of personal attention There could be 20 other women on the floor having a baby all at one time, and they just make you feel like youre the only one. [Theyre the best because of] the way they treat their patients. [They are] always there to talk to you. They explain to you if there are any complications. They dont leave you in the dark. They look out for the needs of the father also they treat them with the same respect they give to the mother.

28. Generating Loyalty and Positive Word-of-Mouth (cont) Biggest hospital dissatisfier: low level of personal attention When I had my first child at HOSPITAL, it was like a baby mill. I gave birth in one room, and the second he was born, man, youre out of there and [they are] rolling another one in. It was my first baby. I had never nursed before, no one told me how to nurse, no one made sure that baby was fed, they made me get out of bed and change the babys diaper when my husband went home. Never came in to check on me. Never asked me if I wanted anything. Didnt show me how to bathe [the baby]. I had never changed a diaper in my life. I had never bathed a baby.

29. Results of Workshop Participant Survey Comparison of workshop participant data to data from new mothers

30. Prototype Questionnaire Copies of a prototype questionnaire are available in the back of the room This questionnaire can be used to assess how women in your market area make decisions in relationship to obstetrics

31. Presenter Contact Information Julie Pokela, Ph.D., President Market Street Research, Inc. 413-584-0465 jpokela@marketstreetresearch.com Brian ODea, Director, Marketing and Public Affairs Newton-Wellesley Hospital 617-243-5820 bodea@partners.org