Patients do not always complain when they are dissatisfied: implications for service quality and patient safety

Impact Analysis of COVID-19 Pandemic on Hospital Reviews on Dianping Website in Shanghai, China: Empirical Study

BACKGROUND

In the era of the internet, individuals have increasingly accustomed themselves to gathering necessary information and expressing their opinions on public web-based platforms. The health care sector is no exception, as these comments, to a certain extent, influence people's health care decisions. During the onset of the COVID-19 pandemic, how the medical experience of Chinese patients and their evaluations of hospitals have changed remains to be studied. Therefore, we plan to collect patient medical visit data from the internet to reflect the current status of medical relationships under specific circumstances.

OBJECTIVE

This study aims to explore the differences in patient comments across various stages (during, before, and after) of the COVID-19 pandemic, as well as among different types of hospitals (children's hospitals, maternity hospitals, and tumor hospitals). Additionally, by leveraging ChatGPT (OpenAI), the study categorizes the elements of negative hospital evaluations. An analysis is conducted on the acquired data, and potential solutions that could improve patient satisfaction are proposed. This study is intended to assist hospital managers in providing a better experience for patients who are seeking care amid an emergent public health crisis.

METHODS

Selecting the top 50 comprehensive hospitals nationwide and the top specialized hospitals (children's hospitals, tumor hospitals, and maternity hospitals), we collected patient reviews from these hospitals on the Dianping website. Using ChatGPT, we classified the content of negative reviews. Additionally, we conducted statistical analysis using SPSS (IBM Corp) to examine the scoring and composition of negative evaluations.

RESULTS

A total of 30,317 pieces of effective comment information were collected from January 1, 2018, to August 15, 2023, including 7696 pieces of negative comment information. Manual inspection results indicated that ChatGPT had an accuracy rate of 92.05%. The F1-score was 0.914. The analysis of this data revealed a significant correlation between the comments and ratings received by hospitals during the pandemic. Overall, there was a significant increase in average comment scores during the outbreak (P<.001). Furthermore, there were notable differences in the composition of negative comments among different types of hospitals (P<.001). Children's hospitals received sensitive feedback regarding waiting times and treatment effectiveness, while patients at maternity hospitals showed a greater concern for the attitude of health care providers. Patients at tumor hospitals expressed a desire for timely examinations and treatments, especially during the pandemic period.

CONCLUSIONS

The COVID-19 pandemic had some association with patient comment scores. There were variations in the scores and content of comments among different types of specialized hospitals. Using ChatGPT to analyze patient comment content represents an innovative approach for statistically assessing factors contributing to patient dissatisfaction. The findings of this study could provide valuable insights for hospital administrators to foster more harmonious physician-patient relationships and enhance hospital performance during public health emergencies.

Perspectives of Healthcare Professionals on Clinician-Patient Communication of Cardiovascular Disease Risk

When the consultation is predominantly verbal, existing research in clinician-patient communication indicates that many patients struggle to understand and recall medical consultations or may not understand the extent of their illness or the purpose of their treatment plan. When the clinician-patient discussion centers around the risk of a repeated cardiovascular disease (CVD) related event, qualitatively assessing what factors affect the communication of this risk may guide the creation of effective communication solutions. Semi-structured interviews were conducted with 17 clinicians treating patients at stages along the cardiac rehabilitation patients' journey. Thematic analysis identified factors that prevent patients from understanding the risk they face of experiencing a repeated cardiac event. Results indicate a clearer understanding of the cardiac rehabilitation patient journey by means of a patient journey map; an overview of how CVD risk is currently communicated; and the factors that affect communication of these risks in the form of themes and sub-themes. Findings shape the proposal of an evidence informed model of opportunities for enhanced digital media supported communication in cardiac rehabilitation.

Complaint behaviour among healthcare users: self-reported complaint experience and complaint proneness in adult men

AIMS

When patients are harmed by, or dissatisfied with, healthcare, only a minority will lodge a complaint or file a claim for compensation. This survey aimed to investigate complaint behaviour and inequalities in complaints using self-reports and hypothetical case vignettes.

METHODS

Cross-sectional, web-based survey among 6755 Danish men aged 45-70 years (response rate=30%). Participants reported their lifetime complaint experience and the likelihood that they would complain in response to hypothetical case vignettes.

RESULTS

Overall, 4.8% of participants had complained about healthcare. Predictors were younger age (OR 2.08, 95% CI 1.32 to 3.27, p=0.002 45-50 years compared with 65-70 years), chronic illness (OR 1.49, 95% CI 1.12 to 1.98, p=0.006), rural residence (OR 2.11, 95% CI 1.20 to 3.73, p=0.010 comparing least and most populated areas), high healthcare utilisation (OR 1.55, 95% CI 1.18 to 2.03, p=0.002 primary care, and OR 1.97, 95% CI 1.52 to 2.55, p=0.000 hospital care) and decreased agreeableness on the 10-item Big Five personality inventory (OR 0.91, 95% CI 0.83 to 0.99, p=0.034). Complaint experience was associated with increased wish to complain about the treatment in the hypothetical vignettes (p=0.006).

CONCLUSIONS

Roughly 1 in 20 men reported having complained about healthcare. Complaints were more common among men who were younger, living in rural areas, diagnosed with chronic illness and high users of healthcare services. Prior complaint experience may be associated with a higher proclivity for complaining about future healthcare. Findings suggest differences in the way healthcare users respond to care experiences, pointing to the importance of aligning expectations and providing clear information about treatment options.

Improving the perception of respect for and the dignity of inpatients: a systematic review

OBJECTIVES

The aim of this systematic review is to find evidence to determine which strategies are effective for improving hospitalised patients' perception of respect and dignity.

METHODS

A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The MEDLINE/PubMed, PsycINFO and Cochrane Library databases were searched on 9 March 2021. Observational studies, prospective studies, retrospective studies, controlled trials and randomised controlled trials with interventions focused on improving respect for patients and maintaining their dignity were included. Case reports, editorials, opinion articles, studies <10 subjects, responses/replies to authors, responses/replies to editors and review articles were excluded. The study population included inpatients at any health facility. Two evaluators assessed risk of bias according to the Cochrane Handbook of Systematic Reviews of Interventions criteria: allocation, randomisation, blinding and internal validity. The reviewers were blinded during the selection of studies as well as during the quality appraisal. Disagreements were resolved by consensus.

RESULTS

2515 articles were retrieved from databases and 44 articles were included in this review. We conducted a quality appraisal of the studies (27 qualitative studies, 14 cross-sectional studies, 1 cohort study, 1 quali-quantitative study and 1 convergent parallel mixed-method study).

DISCUSSION

A limitation of this study is that it may not be generalisable to all cultures. Most of the included studies are of good quality according to the quality appraisal. To improve medical and hospital care in most countries, it is necessary to improve the training of doctors and other health professionals.

CONCLUSION

Many strategies could improve the perception of respect for and the dignity of the inpatient. The lack of interventional studies in this field has led to a gap in knowledge to be filled with better designed studies and effect measurements.

PROSPERO REGISTRATION NUMBER

CRD42021241805.

Effects of training oncology physicians advising patients on complementary and integrative therapies on patient-reported outcomes: A multicenter, cluster-randomized trial

BACKGROUND

Many patients with cancer do not disclose complementary medicine use but want their physician's advice on this matter. This study evaluated whether using blended learning (e-learning plus a workshop) to train oncology physicians in providing advice on complementary and integrative medicine (CIM) therapies to their patients with cancer, in addition to distributing an information leaflet on reputable CIM websites, had different effects on patient-reported outcomes for the consultation than only distributing the leaflet.

METHODS

In this multicenter, cluster-randomized trial, patients from private practices/hospital departments, recruited by 48 oncology physicians randomly allocated to an intervention group (CIM consultation plus information leaflet) or a control group (information leaflet), received CIM information. Patient-reported outcomes included satisfaction (Patient Satisfaction With Information on Cancer Treatment), readiness to make a decision (Preparation for Decision Making), and physician-patient communication (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and Communication 26 [EORTC QLQ-COMU26]) for the consultation. Qualitative interviews were conducted with a physician subsample.

RESULTS

A total of 291 patients (128 in the intervention group and 169 in the control group) advised by 41 physicians participated. Patients in the intervention group rated physician-patient communication higher on all EORTC QLQ-COMU26 scales (mean total score, 84.3 [95% CI, 79.5-89.2] vs 73.6 [95% CI, 69.3-78.0]; P = .002), were more satisfied with the advice (mean, 4.2 [95% CI, 4.0-4.4] vs 3.7 [95% CI, 3.5-3.8]; P < .001), and were readier to make a decision (mean, 63.5 [95% CI, 57.4-69.6] vs 53.2 [95% CI, 47.8-58.7]; P = .016) than the control group. Physicians who reported patients in both settings seemed satisfied with the advice given.

CONCLUSIONS

This study evaluated a novel education intervention for training oncology physicians in providing CIM advice in routine care. Providing structured CIM consultations had positive effects on patient satisfaction, readiness to make decisions, and physician-patient communication.

Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation

Background

Patient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.

Objective

To systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.

Methods

We reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.

Results

In cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.

Conclusions

Analysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.

Patient safety in hospital care: a review of the patient's perspective

The goal was to review the literature on incidents and adverse events and their contributing factors in hospital care, described according to the patient's perspective. A review was carried out of articles published in the MEDLINE, Scopus and LILACS databases between 2008 and 2019. From the 2,686 studies initially found, 167 were pre-selected for reading and then 24 were selected and classified based on a thematic analysis of their content. Four categories resulted from the information extracted from the 24 articles: terminology used to define incidents and adverse events, especially different terms such as error and medical error; incidents and adverse events identified by patients, family members and caregivers related to medication, surgery, health care-related infections, falls and pressure injuries; patients' perception of factors that contribute to unsafe care, especially problems related to communication, hand washing and patient identification; suggestions from patients to prevent the occurrence of incidents and adverse events, including training staff, drawing up checklists, listening to patients and adapting the environment. Patients were able to identify incidents, adverse events and contributing factors in health care. Alongside information from staff, their reports can potentially contribute to the provision of safer health care.

Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights

Introduction

A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling.

Aim

To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement.

Method

Literature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances.

Results

A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture.

Discussion

If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.

Online communities as a new source of exploring patient dissatisfaction

PURPOSE

The purpose of this paper is to analyse whether internet forums are an appropriate source for identification of causes of dissatisfaction of patients with non-medical aspects of healthcare services.

DESIGN/METHODOLOGY/APPROACH

Based on the guidelines of netnography qualitative research the authors identify relevant posts or comments on selected online forums in which web users show their dissatisfaction with healthcare services. Five popular Slovenian forums representing different interest communities have been chosen and 42 forums' topics have been reviewed.

FINDINGS

Online communities have an important role in exploring patient dissatisfaction. Through content analysis comments were coded into meaningful categories and subcategories.

RESEARCH LIMITATIONS/IMPLICATIONS

Some comments were more explicit, while others have provided general and looser reasons for dissatisfaction, and in such cases coding and content analysis of comments was more difficult.

PRACTICAL IMPLICATIONS

Contents expressed within online communities are helpful in designing improvement activities since they enable determination of concrete relevant measures aiming at eliminating and preventing the established causes of discontent, such as instituting new policies, introducing training programs, determining desired changes in culture.

ORIGINALITY/VALUE

Usefulness of the netnography as a qualitative method of research is confirmed through confirmation that causes of dissatisfaction of Slovenian patients, which have been identified in the authors research are similar to those identified in previous research in the field of patient satisfaction conducted in Slovenia. Results constitute a new form of researching patient dissatisfaction and expose the specific causes of patient dissatisfaction with healthcare services in Slovenia.

A strategic and good governance perspective on handling patient complaints

Purpose

The patient complaint is one of the main procedures of exercising patient’s rights in the Finnish health care system. Such complaints typically concern the quality of care and/or patient safety. The purpose of this paper is to examine the types of patient complaints received by a specialized medical care organization and the kinds of responses given by the organization’s personnel. The organization’s strategy and good governance principles provide the framework for understanding the organization’s action.

Design/methodology/approach

This study’s data comprise patient complaints and the responses from personnel of a specialized medical care organization from the start of 2012 to the end of January 2014. The data were analyzed through qualitative data analysis.

Findings

The results show many unwanted grievances, but also reveal the procedures employed to improve health care processes. The results are related to patients’ care experiences, provision of information, personnel’s professional skills and the approach to patient complaints handling. The integrative result of the analysis was to find consensus between the patients’ expectations and personnel’s evaluation of patients’ needs.

Originality/value

Few prior studies have examined patient complaints related to both strategy and good governance. Patient complaints were found to have several confluences with an organization’s strategic goals, objectives and good governance principles. The study recommends further research on personnel procedures for patient complaints handling, with a view to influencing strategic planning and implementation of strategies of organizations.

Healthcare service failure: how dissatisfied patients respond to poor service quality

Purpose

Few scholars have so far explored how healthcare service quality affects patient dissatisfaction, leading to negative behavior responses when a healthcare service fails. The purpose of this paper is to examine how different service quality attributes affect patient dissatisfaction leading to a variety of asymmetric negative behavior responses.

Design/methodology/approach

Following a survey of 453 dissatisfied outpatients in Korea, structural equation modeling with a series of post hoc analyses is used to test the research model. It consists of five hypotheses.

Findings

Outcome quality is found to be the most significant variable affecting patient dissatisfaction, followed by administrative quality, interactive quality, and environmental quality. Dissatisfied patients tend to engage more in active behaviors (e.g. negative word-of-mouth, switching, and complaining) than in remaining passive in a non-linear way. Also, the mediating role of dissatisfaction is found to be significant.

Research limitations/implications

This paper has empirically identified the most significant service quality attributes that lead to dissatisfied patients and negative behaviors on their part. These findings indicate that different quality attributes of service failure lead to different actions. However, this study has suffered from a few limitations as a result of its research context and scope.

Originality/value

This paper is one of the very few empirical studies examining the relationships among the output and process quality attributes, patient dissatisfaction, and actual behaviors in a healthcare service failure context.

Unhappy Patients Are Not Alike: Content Analysis of the Negative Comments from China's Good Doctor Website

BACKGROUND

With the rise in popularity of Web 2.0 technologies, the sharing of patient experiences about physicians on online forums and medical websites has become a common practice. However, negative comments posted by patients are considered to be more influential by other patients and physicians than those that are satisfactory.

OBJECTIVE

The aim of this study was to analyze negative comments posted online about physicians and to identify possible solutions to improve patient satisfaction, as well as their relationship with physicians.

METHODS

A Java-based program was developed to collect patient comments on the Good Doctor website, one of the most popular online health communities in China. A total of 3012 negative comments concerning 1029 physicians (mean 2.93 [SD 4.14]) from 5 highly ranked hospitals in Beijing were extracted for content analysis. An initial coding framework was constructed with 2 research assistants involved in the codification.

RESULTS

Analysis, based on the collected 3012 negative comments, revealed that unhappy patients are not alike and that their complaints cover a wide range of issues experienced throughout the whole process of medical consultation. Among them, physicians in Obstetrics and Gynecology (606/3012, 20.12%; P=.001) and Internal Medicine (487/3012, 16.17%; P=.80) received the most negative comments. For negative comments per physician, Dermatology and Sexually Transmitted Diseases (mean 5.72, P<.001) and Andrology (mean 5, P=.02) ranked the highest. Complaints relating to insufficient medical consultation duration (577/3012, 19.16%), physician impatience (527/3012, 17.50%), and perceived poor therapeutic effect (370/3012, 12.28%) received the highest number of negative comments. Specific groups of people, such as those accompanying older patients or children, traveling patients, or very important person registrants, were shown to demonstrate little tolerance for poor medical service.

CONCLUSIONS

Analysis of online patient complaints provides an innovative approach to understand factors associated with patient dissatisfaction. The outcomes of this study could be of benefit to hospitals or physicians seeking to improve their delivery of patient-centered services. Patients are expected to be more understanding of overloaded physicians' workloads, which are impacted by China's stretched medical resources, as efforts are made to build more harmonious physician-patient relationships.

A meta-ethnography of the facilitators and barriers to successful implementation of patient complaints processes in health-care settings

Objective

To synthesize experiences of the patient complaints process for patients and health‐care professionals to identify facilitators and barriers in the successful implementation of patient complaints processes. This will assist the development of cultural change programmes, enabling complaints managers to incorporate stakeholder perspectives into future care.

Design

Systematic literature search and meta‐ethnography, comprising reciprocal syntheses of “patient” and “professional” qualitative studies, combined to form a “line‐of‐argument” embodying both perspectives.

Data sources

MEDLINE, CINAHL and PsycINFO (database inception to April 2015) were searched to identify international literature in primary and secondary health‐care settings, involving qualitative data collection and analysis. Further studies were identified from hand‐searching relevant journals, contacting authors, article reference lists and Google Scholar.

Results

A total of 13 papers, reporting 9 studies from the United Kingdom, Sweden, Australia and New Zealand, were included in the synthesis. Facilitators and barriers to the successful implementation of patient complaints processes were identified across the perspectives of both patients and health‐care professionals. Patients sought to individualize the complaints process by targeting specific professionals who engaged in practices that undermined the identity of patients. In contrast, professionals obscured their own individualism through maintaining a collective identity and withholding personal judgement in relation to patient complaints.

Conclusions

Complainants recognized health‐care professionals as bearers of individual accountability for unsatisfactory care, in opposition to the stance of collective responsibility endorsed by professionals. Implementation of patient complaints processes must reconcile the need for individualized resolution, whilst striving to improve the future provision of health care through a collaborative approach between patients and professionals.

Patients' perceptions of transgressive behaviour in care relationships with nurses: a qualitative study

AIM

To gain insight in the onset and meaning of transgressive behaviour in care relationships with nurses, from the perspective of patients.

BACKGROUND

Aggression and transgressive behaviour in health care have been a focus of research over the last decades. Most studies describe staff experiences on patient aggression. Patient' perspectives on aggression and transgressive behaviour in interactions with nurses are rarely sought.

DESIGN

Qualitative interview study.

METHODS

Twenty patients were purposefully sampled from six wards of two general hospitals. Semi-structured interviews were carried out in 2011. Data were analysed using the constant comparative method influenced by the grounded theory approach.

FINDINGS

On elaborating on what constitutes experiences of transgressive behaviour, patients employ a framework of suppositions towards hospital care and nurse-patient relationships. This framework leads to implicit ideas on how competent professional caregivers will be and on how relationships with nurses will be characterized as normal human interactions. When these anticipated ideas are not met, patients feel obliged to address this discrepancy by adjusting their expectations or behaviour. Patients become more vigilant with regard to care given by nurses; search for own solutions; make excuses for nurses or reprioritize their expectations. Because of this adjustment, perceptions of transgressive behaviour are reinforced, mitigated or put into perspective.

CONCLUSION

Patients adjust their behaviour based on what they experience in care relationships with nurses or the hospital care. It is crucial that patients feel free to discuss their assumptions or untoward needs and nurses learn to understand and reflect on those experiences.