What Women Want:
How to Fill Your OB Beds
Presented by:
Dr. Julie Pokela
Market Street Research
and
Brian O’Dea
Newton-Wellesley Hospital
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.
Introduction




The role of obstetrics in a hospital’s 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
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.
Provider
76.3%
Hospital
23.7%
Same time
11.7%
Don't know
2.6%
Primacy of Selecting Provider
Over Hospital

“[Hospital has] a birthing
center . . . that you can
deliver and it’s pretty
much natural. It looks like
a real bedroom. You can
deliver in a whirlpool with
candles. I’ve witnessed a
childbirth like that.
Absolutely beautiful. And
I just chose—I did not
choose that, because I
was staying with my
doctor that I had.”
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
What Is Important to Women
in Selecting Providers?
Most women have an ob/gyn they use for routine gynecological
care, and stay with that provider when they become pregnant.
No
23.7%
Yes
76.3%
Yes
58.5%
No
17.8%
No ob/gyn
23.7%
Did you have an ob/gyn you used for
Did you stay with that ob/gyn for
routine care prior to becoming pregnant?
prenatal care?
Implications

The patients your hospital’s 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 hospital’s
ob/gyns for routine gynecological care

Your hospital’s ob/gyns must have
appointments available for new patients for
routine care in a timely way
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. ‘Let’s talk about it,’ any concerns, and just really
coached me a lot, what I will be expecting, what not to
worry about, he’s 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
“It’s great that there’s these wonderful ob/gyns at
[Hospital] … It’s definitely tempting to tell my sister-inlaw, who’s looking for a new ob/gyn. It’s close to home.
But unless I talk to a woman that went to one of them, it’s
hard. It’s all word of mouth.”
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 women’s
emotional things, and aches and pains, and
she’s 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
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.
“That’s why I didn’t go to [Hospital], because they can’t
always do [epidurals]. They only have an anesthesia team
that’s there during regular business [hours]. That was my
number one factor.”
How Do Women Select a Hospital? (cont.)

There are some factors that are important for patient
satisfaction, but don’t 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 they’re like, ‘Oh, no, you lay in the bed and that’s it.’
I was asking about a water birth because I wanted to get in a tub of some
sort. I mean it’s awful, nothing. They were like, ‘You have an IV, you have
a catheter, that’s 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 don’t want to think about problems with their babies
“I don’t think I even thought [about the nursery]. I think, especially the first
time around, I was just more concerned about myself.”
Case Study: Newton-Wellesley Hospital
Obstetrical Collaboration has
Long Gestation Period
The Market
BIDMC
MetroWest
Mt. Auburn
NEMC
St. E’s
NWH
10 mi
MGH
BWH
Caritas
Norwood
Overview

Birth rate was declining

Reimbursement not keeping pace

Physician challenges

Increasing competition

BWH over capacity

NWH had capacity
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?
Better Together? (cont.)
“What impact does the collaboration with BWH have on your
perception of NWH’s maternity department?”
NWH loyalists
41
NWH/PHS AMC
splitters
30
38
Competing comm
hosp loyalists
20
16
Competing comm
hosp/ PHS AMC
splitters
36
31
39
% of total
PHS AMC loyalists
30
Competing AMC
loyalists
35
14
0
Much more
positive
Somewhat
more positive
58
25
50
75
100
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.
Source: Market Street Study, 2002
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!
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
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.
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
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
The Delivery (cont.)
"The presence of the maternal fetal medicine physicians at NewtonWellesley 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
The Delivery (cont.)
“He collaborated really well
with my Ob…we really liked
the intimacy and connection
with the doctors”
Karen Korn
Ob Patient
Generating Loyalty and
Positive Word-of-Mouth

Patient satisfaction with providers and hospitals
is key for generating loyalty and positive word-ofmouth

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.”
Generating Loyalty and
Positive Word-of-Mouth (cont)

Biggest provider dissatisfier: lack of
personal attention
“She delivered the baby and was gone.
She didn’t 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.”
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 you’re the only one.”
“[They’re 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 don’t 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.”
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, you’re 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
baby’s diaper when my husband went home. Never
came in to check on me. Never asked me if I wanted
anything. Didn’t show me how to bathe [the baby]. I
had never changed a diaper in my life. I had never
bathed a baby.”
Results of Workshop
Participant Survey

Comparison of workshop participant data to
data from new mothers
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
Presenter Contact Information

Julie Pokela, Ph.D., President
Market Street Research, Inc.
413-584-0465
jpokela@marketstreetresearch.com

Brian O’Dea, Director, Marketing and Public
Affairs
Newton-Wellesley Hospital
617-243-5820
bodea@partners.org