Supplementary Material for: Perceived quality of care among staff and patients before and after implementation of a comprehensive quality improvement project in Xiangkhouang Provincial Hospital, Lao PDR

Introduction: Perceived service quality is an essential indicator for healthcare improvement. This study assessed short-term changes in patient and provider perceptions following a quality improvement intervention aimed at enhancing Comprehensive Emergency Obstetric Care (CEmOC). Methods: The Mothers and Newborns under Guided Oversight (MANGO) project was implemented in June 2024 at Xiengkhuang Provincial Hospital, Lao PDR. Surveys on perceived service quality and working conditions were administered to obstetric and pediatric patients (or their guardians) and healthcare providers before and after the intervention. Chi-square tests were used to compare pre- and post-implementation responses. Results: A total of 222 participants completed the baseline survey and 221 completed the follow-up survey. Post-implementation, improvements were observed in communication (56.4% vs. 87.4%, p<0.001) and respect (88.2% vs. 98.2%, p<0.001). However, fewer patients reported a clean hospital environment (90.9% vs. 66.7%, p<0.001) and overall satisfaction with the service quality (90.9% vs. 82.9%, p<0.001) at follow-up. Among the 112 hospital staff surveyed at baseline, a majority reported challenges such as medical supply shortages (68.8%) and infection control (62.5%). After the intervention, there was no significant improvement in staff perceptions of service quality, and the proportion reporting a high workload increased significantly from 57.1% to 78.2% (p<0.001). Conclusion: Despite improvements in specific aspects of patient experience, overall patient satisfaction declined and staff workload concerns intensified following the intervention. These findings indicate that more targeted strategies are necessary to address the emerging operational challenges in the enhancement of CEmOC.