Parents whose infant is admitted to a neonatal intensive care unit often experience a sense of exclusion from their role as caregivers and separation from their child. Due to the distressing environment that NICUs can facilitate, many parents suffer from higher rates of postpartum depression and even PTSD as a result. Beth DuFault, an assistant professor of marketing in the School of Business, is collaborating with colleagues from the University of Turku in Finland to improve the parent experience in the NICU. DuFault shares on the episode about one Finnish hospital that has a different approach to an infant's hospital care, one that is more inclusive of parental participation.
Parents whose infant is admitted to a neonatal intensive care unit often experience a sense of exclusion from their role as caregivers and separation from their child. Due to the distressing environment that NICUs can facilitate, many parents suffer from higher rates of postpartum depression and even PTSD as a result.
Beth DuFault, an assistant professor of marketing in the School of Business, is collaborating with colleagues from the University of Turku in Finland to improve the parent experience in the NICU.
DuFault shares on the episode about one Finnish hospital that has a different approach to an infant's hospital care, one that is more inclusive of parental participation.
The UAlbany News Podcast is hosted and produced by Sarah O'Carroll, a Communications Specialist at the University at Albany, State University of New York, with production assistance by Patrick Dodson and Scott Freedman.
Have a comment or question about one of our episodes? You can email us at mediarelations@albany.edu, and you can find us on Twitter @UAlbanyNews.
Sarah O'Carroll:
Welcome to the UAlbany News Podcast. I'm your host Sarah O'Carroll. I have with me Beth DuFault, an assistant professor of marketing in the School of Business. DuFault is collaborating with researchers at the University of Turku to improve the parent and infant experiences of neonatal care in the NICU. Beth, thank you so much for being here.
Beth DuFault:
Thank you very much too.
Sarah O'Carroll:
Alright, so we're here to talk about NICU units and how sometimes parents don't always have the most positive experiences as possible. The NICU, Or newborn intensive care unit, is a scary place for a parent to be. But beyond the obvious reasons of having your child in intensive care, what are some other factors that make the NICU particularly stressful?
Beth DuFault:
Well, it's completely unexpected usually and a surprisingly high percentage of babies actually end up in a special care nursery, approximately 10 percent depending upon the country. The parents don't expect it. We've done a bad job of preparing them for such an eventuality. Even people that work in the hospital themselves, like for instance, I was a respiratory therapist and my baby ended up in the NICU. It was extraordinarily stressful and that was when I knew the acronyms, I knew the alarms, I knew the ventilator settings, et cetera, and I knew that my child would be released within two weeks, but it was still something that stayed with me for the rest of my life as a very stressful experience.
Beth DuFault:
Parents that do not have a medical background, when they hit the NICU, for one thing, it says NICU and there is your baby in this place that you have you have a feeling of dread about. You see the ventilators and they look somewhat monstrous, different tubings all over the place. You hear the sounds of all of the different medical equipment. You hear the nurses and the doctors speaking about your baby in a language that you don't understand. It's a lot of acronyms and long words, Latin-based words. When you work in the NICU, speaking at it from the other side because I was also a respiratory therapist in the NICU, you don't think about these things. You do understand that it's a special world you're in.
Beth DuFault:
But when the parents come in, you think you're being wonderful and straightforward, and of course, you are. You have such a heart for the babies. You have such a heart for the parents. But it's very difficult for the parents as they first hit that doorway to the NICU and come in and see their baby in often a glass box, an islet. They're separated. There's just so much stress of the unknown.
Sarah O'Carroll:
It's such an emotional experience and yet it sounds so medicalized where it's just that isolation factor you mentioned.
Beth DuFault:
Yes. There's research that shows that there is a higher incidence of postpartum depression and there has been recent research that also shows that parents can have something akin to PTSD, post traumatic stress syndrome, where they have flashbacks and stuff of the experience. Here with the parents we interviewed in the US, what we found was that there's kind of this syndrome of once an NICU parent, always an NICU parent. You'll see things like that, Facebook groups or online forum, where people become a community because they had this experience and it becomes such a part of them. They'll say things like, "No one can understand except for somebody who's also been through this experience," which, of course, feels very true.
Beth DuFault:
But this sense of having this birth and post-birth experience, that's very, very stressful and really awful. Even if your baby has had a relatively "easier time," if they've just needed supplemental oxygen, they've only had to be there a couple of days for observation, it's still extraordinarily stressful.
Sarah O'Carroll:
Where the environment is kind of screaming "this is a crisis" no matter how trivial or serious the issue is.
Beth DuFault:
Yes, absolutely.
Sarah O'Carroll:
Okay. You've been working with colleagues from Finland. Can you share a little bit about how you got connected with them and what that partnership looked like?
Beth DuFault:
Yes. I started being very interested in this area of study because I went back to school after working as an RT in the hospital and got my degree in sociology and then went on to a PhD program doing consumer culture theory, consumers and change, looking at the patient experience as a part of that because in the U.S., we're going to a more consumerized medical system where we're really looking at how to make the hospital experience or the medical experience better for consumers, for the people themselves. I thought, well, you know, the NICU is one of those places where, again, you do have to be perfect as a medical provider. You aren't so worried about the parent experience as you are about the baby's outcome necessarily.
Beth DuFault:
However, the parent experience is extremely important because you want the parents to bond with their infants. You need that for the best outcome for the infants and for the parents. They have to be able to come into the unit and to parent their baby so they can bond. Anyway, there's a group called SCENE that we started being aware of that do work across globally looking at how to make the separation less and the closeness more in the in NICU. In this group, we met a neonatologist and her colleagues that work at a hospital in Finland where they've instituted this program called close collaboration with the parents. The more we talked to her, the more we realized that this would be a really good NICU to go study and look at.
Sarah O'Carroll:
Okay. What else drew you to that NICU and can you share a little bit about what you started observing that was different?
Beth DuFault:
Oh, sure. Well, first what we did is we interviewed parents here in the U.S. about their neonatal intensive care unit experience. Here in the U.S, what we observed was over and over the parents, number one, as I said, they seem to think that once an NICU parent, always an NICU parent. They have this almost like a part of their identity that drew from that. They're proud of the competencies they gained with their baby in the NICU because they learned how to be almost a part of the medical team. They knew what the alarms meant. They knew all the language. They could decipher it. We thought that we would see this in the Finnish in NICU. But when we went and we observed in the Finnish NICU, we noticed that it was different in the way they accepted the parents in as part of the team.
Sarah O'Carroll:
As part of the medical team.
Beth DuFault:
Yes, because they weren't medicalized is what we're calling it. They were part of the team. This NICU makes a huge... Their program trains the staff so that they welcome the parents in and the parent is a huge part of the medical team, but their role in the medical team is to be the parent. The staff is trained that the parent's observation about the baby, how the baby looks as an infant, as their child, if the baby is comfortable, if the baby's color is good, if the baby looks to have discomfort of some sort. These non-medicalized words, these parental observations, are as important to this medical staff in the unit as are things like the metrics of medical observations.
Beth DuFault:
They're all important, of course, but the parent has a very specific role of parent who knows their baby better than anyone.
Sarah O'Carroll:
Okay. It's a different kind of involvement. It's not saying you're the parent, so we want you to understand these obscure Latin acronyms or something and then they're trying to decipher, "Okay, so the doctor... I'm seeing these arrows or signals," versus saying, "I know my child from being his or her mother," and then they make their own inferences.
Beth DuFault:
This is absolutely right. We'll see things like... In a regular NICU, you'll see the parents and even the siblings, the older siblings, come running in, but they stop right at the threshold of the NICU or right at the door of the baby's room waiting until the nurses look up or down or whatever. There's a real sense of separation. But in this NICU, I would watch things like at rounds, for instance, when the doctors and nurses are telling... They're giving reports and they're telling what had happened on the prior shift going forward for the second shift. It's like what were the plans, making medical plans for the baby. The parents would walk in. They would see the team around the baby, and they'd just push the medical team to the side because they knew that their baby needed...
Beth DuFault:
They were uncomfortable and they needed their diaper changed or something. Just push them to the side and go in and change the diaper. The medical team opened up and allowed for that because the parent has such a revered role in this program that they felt comfortable doing this.
Sarah O'Carroll:
In the study, you talk a lot about co-creation.
Beth DuFault:
Oh, sure.
Sarah O'Carroll:
Can you give me a breakdown of what co-creation means?
Beth DuFault:
Yes. Well, I'm studying this from a really interesting standpoint. I am not a medical practitioner anymore. I am a business school professor. Specifically I study services marketing and consumer behavior and consumer culture theory and looking at the medical system going towards a more consumer focus, et cetera. One of the things we look at with patient experience is this idea of co-creation. This is the idea that consumption and production, the people that are making things, the people that are consuming them, the people that are providing experiences, the people that are enjoying them, this happens together. There's value created from the production side and the consumption side. Basically that's co-creation. In a hospital setting, in a service setting, co-creation often happens...
Beth DuFault:
We call it the service scape. This is everything in the area of service delivery. The beds, the floors, the alarms, the lights, the babies, the nurses, all of this, this is the service scape there. The parents and the staff and the babies are all co-creating this NICU environment. Well, in traditional NICUs, what we noticed was this co-creation. There's this line that's difficult for parents to cross to get in the first place to be part of this. We have a quote from one of the staff members from the United States. He said, "It's like the parents need a guide book. This is our land. This is our language. These are our laws. If you follow this, this'll be okay. You can stay here. You can't go there. You can say this. You don't want to interrupt this."
Beth DuFault:
We see that very much so, and the parents do, again, what we called medicalization where they medicalize themselves to learn how to "fit in" and how to add value to the service scape, how to fit in to do something for their baby that's going to help instead of mess things up for the staff, so they aren't in the way. They know where to sit. They know which hours to come in. They know how to touch their baby or not. They know how they can be helpful medically. A Lot of the parents become very proud of this. They're really proud of their competencies learning all of this new stuff. It's actually pretty incredible. Some of the parents that we interviewed way even after they'd been in the NICU, they have an immense amount of medical knowledge.
Beth DuFault:
It's like their terminology is perfect, their awareness is fantastic. Some of them go on and work in the NICU. They become different types of roles. They might go back to school to become actually a medical person, or they might do medical records or something, but some way to transfer those skill sets that they gained into something that they can use in their everyday life.
Sarah O'Carroll:
Okay.
Beth DuFault:
But in the Finnish NICU, the parents did not do this as part of their co-creative role. They were parents. They were trained not to really even look at the alarms, but to look at their baby instead. Not to tell the nurses, "It looks like their heart rate is up," but to tell the nurses he's squirming and he looks really uncomfortable. That type of a thing. They did not develop this medicalization, and also they did not have the horrible stress when they talked to us about their experience in the NICU. We were shocked about that.
Sarah O'Carroll:
Because it sounds like at first when you're saying about these new competencies that that could be you're proud of your new skills, that's a good thing, but then it would also lead to a lot of stress because you're not only trying to be helpful, but you're trying to really adjust in this new world as you're describing the service scape. That would be a burden to not just be yourself, but trying to now mold yourself into a different role that could be more helpful, anything to help you child.
Beth DuFault:
Yes. We feel that that... Some parents can do that. They have innate competencies and maybe they haven't done it before, but they find that they're actually really good at it and they enjoy it. Some parents just cannot. It isn't something that aligns with their innate capabilities. That's really stressful. Also, we have this whole culture where it's that What to Expect When You're Expecting book. For months they have expected this cultural script of what is going to happen after their baby is born. It does not include going to the NICU and looking at alarms and trying to figure out how your baby is doing medically and stuff like that. The role alignment for this co-creative role, there's no alignment at all. We think that that's very stressful.
Beth DuFault:
We think that the NICU in Turku, in Finland with this close collaboration with the parents program is less stressful for the parents because their co-creative role is well aligned with what they were expecting. They expected to be a parent. The staff in this NICU is training them to be a parent just in this extraordinary set of circumstances. It's still aligned with what they had expected prior to their baby being born.
Sarah O'Carroll:
It sounds like we do not need a lot of help books on how to succeed in the NICU for parents. It sounds like we need to be more like this program and more like the hospitals in Finland. If you were to make some takeaways or can you share any implications that this study might have?
Beth DuFault:
The Finnish system is obviously extraordinarily different than the U.S. system. There's parental leave both for the father and for the mother. There is the healthcare that's available and provided, so there isn't stress about medical bills, which you cannot... There's no way to overestimate how important that is. However, in our research, we've discovered that other NICUs in Nordic countries do have very stressed parents. There's a great piece. It was in Harvard Business, HBR, and it was When the Customer Is Stressed. It's by Barry Davis and Wilmet. They're talking about stressed customer situations, really perfect storms for them, this black box of service delivery where you don't know what's happening, super high stress, big stakes outcome.
Beth DuFault:
Their context that they looked at, they looked at breast cancer patients in their families. This stressed customer, we know it exist across cultures and across countries, and we know that if we had been or we think strongly that we had been in a different NICU that was not using this type of a program in Finland, that we would've seen a completely different type of parent interaction and a different type of co-creative role and alignment and et cetera. What we are working toward now is to do a comparative study to see parents in the U.S. and to look at the alignment of their role in the NICU with their parental expectations and see if that indeed does reduce the stressed customer aspect of the NICU parent across cultures in different hospitals.
Sarah O'Carroll:
That's really interesting. I remember you sharing on the way to the studio that you're going to be presenting about this work.
Beth DuFault:
Yes.
Sarah O'Carroll:
I'd like to ask when you are thinking of completing this and what that timeline looks like for you right now.
Beth DuFault:
We're going to be presenting this work at a conference in Budapest in November. There's the organization, the Separation and Closeness in Neonatal Environment. This is a global organization with people that are all working towards improving the parental and the baby experience in the NICU. When we present our work, we will be talking to different neonatologist at different hospitals and seeing where we can extend our observations.
Sarah O'Carroll:
It sounds like the biggest or one of the bigger impacts of this study is just asking more questions and looking at it more like a customer experience because perhaps some of us think of hospitals as more transactional, that you are here to get better and then leave and not thinking of all of the things that might make it more positive.
Beth DuFault:
That's such a good point too. On another project, we're looking at some of the billion dollar healthcare systems across the U.S. We're talking to everyone in the organizations, from the CEOs to the higher level managers, to the middle managers, to the front line staff, to patients, and we're trying to see how organizations in the healthcare system in the U.S. move towards a consumer customer centricity. It's not a patient centricity because obviously if you're patient centric... If you're a healthcare provider, you are patient centric. You are trying to make the patient better. What we're looking at is customer centricity to see how we can make it a better experience for the patients themselves.
Beth DuFault:
It kind of is difficult because sometimes people don't want to be customers when they're seeking healthcare. They just want to be taken care of because they don't understand the ins and outs, but other times they want to have consumer rights and-
Sarah O'Carroll:
Expectations.
Beth DuFault:
Yes. They want their care when they want it, where they want it. The millennials now it's like they want to be able to text their doctor and get prescriptions texted to the pharmacy. There is so much disruption going on now in the healthcare system in the U.S. For instance, the popup clinics that have no affiliation with any hospitals. There are a lot of younger people that use this as their primary care physician because they really don't want to have to go through all of those hoops that you have to do with your insurance and your primary care physician and et cetera. I was at the hair salon this morning and all of the gals there were talking about a story today in the news about Groupon where you can buy breast cancer mammograms and things on Groupon to go get this stuff done.
Beth DuFault:
These disruptions, they are really pointing out a lot of ways that the healthcare system could and perhaps should be a lot more consumer centric.
Sarah O'Carroll:
Well, that's really fascinating. Beth, thank you so much for sharing about this work.
Beth DuFault:
Thank you too. Thank you for having me.
Sarah O'Carroll:
Thank you for listening to the UAlbany News Podcast. I'm your host Sarah O'Carroll and that was Beth Dafoe of the school of business. You can let us know what you thought of the episode by emailing us at mediarelations@albany.edu or you can find us on Twitter at UAlbany News.