A study of complaints by patients of different age groups in an NHS trust

Integrated care pathways

Integrated care pathways (ICPs) offer a system of multidisciplinary care planning based around the principle of clinical audit and on the knowledge and practice of local clinical staff. The system offers a set of guiding principles, based on the fact that, because knowledge and practice change continually when caring for patients, clinical records should be flexible and dynamic to accommodate these changes. Benefits to be gained from implementing ICPs include improvements in communication between all disciplines involved, as well as between patients and carers. Optimal levels of free text are ensured through the pre-printed record having an outcomes-based focus and through incorporating the idea of exception-based recording. Issues to be considered include individuality and confidentiality. Benefits to be gained include increased patient satisfaction, a reduction in documentation and inappropriate lengths of stay.

For what reasons do patients file a complaint? A retrospective study on patient rights units' registries

BACKGROUND

In 2004, Patient Rights Units were established in all public hospitals in Turkey to allow patients to voice their complaints about services.

AIMS

To determine what violations are reflected into the complaint mechanism, the pattern over time, and patients' expectations of the services.

STUDY DESIGN

Descriptive study.

METHODS

A retrospective study performed using the complaint database of the Istanbul Health Directorate, from 2005 to 2011.

RESULTS

The results indicate that people who are older than 40 years, women, and those with less than high school education are the most common patients in these units. A total of 218,186 complaints were filed. Each year, the number of complaints increased compared to the previous year, and nearly half of the applications were made in 2010 and 2011 (48.9%). The three most frequent complaints were "not benefiting from services in general" (35.4%), "not being treated in a respectable manner and in comfortable conditions" (17.8%), and "not being properly informed" (13.5%). Two-thirds of the overall applications were found in favour of the patients (63.3%), and but this rate has decreased over the years.

CONCLUSION

Patients would like to be treated in a manner that respects their human dignity. Educating healthcare workers on communication skills might be a useful initiative. More importantly, health policies and the organisation of services should prioritise patient rights. It is only then would be possible to exercise patient rights in reality.

Patient complaints in healthcare systems: a systematic review and coding taxonomy

Background

Patient complaints have been identified as a valuable resource for monitoring and improving patient safety. This article critically reviews the literature on patient complaints, and synthesises the research findings to develop a coding taxonomy for analysing patient complaints.

Methods

The PubMed, Science Direct and Medline databases were systematically investigated to identify patient complaint research studies. Publications were included if they reported primary quantitative data on the content of patient-initiated complaints. Data were extracted and synthesised on (1) basic study characteristics; (2) methodological details; and (3) the issues patients complained about.

Results

59 studies, reporting 88 069 patient complaints, were included. Patient complaint coding methodologies varied considerably (eg, in attributing single or multiple causes to complaints). In total, 113 551 issues were found to underlie the patient complaints. These were analysed using 205 different analytical codes which when combined represented 29 subcategories of complaint issue. The most common issues complained about were ‘treatment’ (15.6%) and ‘communication’ (13.7%). To develop a patient complaint coding taxonomy, the subcategories were thematically grouped into seven categories, and then three conceptually distinct domains. The first domain related to complaints on the safety and quality of clinical care (representing 33.7% of complaint issues), the second to the management of healthcare organisations (35.1%) and the third to problems in healthcare staff–patient relationships (29.1%).

Conclusions

Rigorous analyses of patient complaints will help to identify problems in patient safety. To achieve this, it is necessary to standardise how patient complaints are analysed and interpreted. Through synthesising data from 59 patient complaint studies, we propose a coding taxonomy for supporting future research and practice in the analysis of patient complaint data.

An exploratory study of complaints handling and nature

Different countries have different complaints handling systems. This study reveals general pathways to handling complaints that provide an overview at the case hospital as well as a general complaints handling picture in Taiwan. It explores hospital complaints and how hospital staff handle them. A large teaching hospital in Taiwan was purposefully chosen as a case study. Data were collected through in-depth interviews, document analysis and interrogating a 3-year complaints archive. The study found that dissatisfaction with 'humaneness' and 'care/treatment' commonly causes the case hospital patients to complain. Understanding complaint patterns, therefore, can help hospital managers improve organizational performance, which shows that certain service provision needs to be prioritized if hospital staff intend to improve service quality.

Factors influencing the pathways in response to complaints

PURPOSE

The purpose of this paper is to explore hospital staff response to patient complaints and the factors influencing the response pathway.

DESIGN/METHODOLOGY/APPROACH

The paper uses an exploratory study in a large Taiwanese hospital purposefully chosen as a case study site. The critical incident technique (CIT) is implemented, using a questionnaire along with non-participant observations in which the results have been triangulated. A total of 59 cases were collected.

FINDINGS

The study found when facing "humaneness" complaints, hospital staff attempted to investigate the event and then explain the facts to the complainant or empathise with him/her and then refer the problem to the relevant unit. In response to complaints combining "communication" and "care/treatment and humaneness", staff tended to investigate the event's details and then directly explain them to the complainant. When complaints involved "care/treatment", staff tended to empathise with the complainant, investigate the facts and explain them to the complainant. Additionally, the organisational response to complaints was influenced by who made complaints; its type, severity, complaining method and patient status.

RESEARCH LIMITATIONS/IMPLICATIONS

The literature revealed that the case study is the most common organisational study method. However, this approach is criticised for not offering findings that can be generalised.

PRACTICAL IMPLICATIONS

Complaint nature is the major factor influencing the response pathway. If healthcare managers intend to reduce complaint rates then they need to carefully classify the complaint's nature. Different complaints have different handling procedures and guidelines to help managers resolve complaints in the first place.

ORIGINALITY/VALUE

There are extensive studies focusing on investigating complaints and their resolution. These studies tend not to demonstrate various means of handling patient complaints. Neither do they describe how different complaints might lead to different outcomes. Therefore, this paper explores hospital staff response to patient complaints and the factors influencing the pathways in response to complaints.

The use of patient complaints to drive quality improvement: an exploratory study in Taiwan

This study aims to investigate the nature and resolutions of patient complaints and further to explore the use of complaints to drive quality improvement in a selected hospital in Taiwan. A teaching hospital (i.e. the Case Hospital) in Taiwan was purposefully chosen for a case study. The author conducted the critical incident technique (CIT) using questionnaires to obtain information about the complaints and the process of their resolutions. To enhance the reliability of the study, the author also conducted non-participant observations as an outsider at the Case Hospital. In this study, 59 complainants registered 87 complaints. The CIT found that care/treatment, humaneness and communication were the most common causes of complaints. The response time of patient complaints averaged 1.76 days, except for five cases in which response time was not reported. The majority of complaints were resolved within three days. Moreover, this study found that of 149 resolutions, 105 taken by the hospital involved an explanation of the facts to complainants ( n = 41), investigation of events ( n = 33) and empathy with complainants ( n = 31). The lack of any systematic use of complaints data was one of the most crucial failures of the Case Hospital. Instead of attempting to use such data as the basis for initiating quality improvement measures, complaints were consigned to a ‘black hole’ where their existence was conveniently forgotten. Based on this study, the author suggests ways to strengthen the capacity of the hospital in terms of using patient feedback and complaints to improve the quality.

Responsive consumerism: empowerment in markets for health plans

CONTEXT

American health policy is increasingly relying on consumerism to improve its performance. This article examines a neglected aspect of medical consumerism: the extent to which consumers respond to problems with their health plans.

METHODS

Using a telephone survey of five thousand consumers conducted in 2002, this article assesses how frequently consumers voice formal grievances or exit from their health plan in response to problems of differing severity. This article also examines the potential impact of this responsiveness on both individuals and the market. In addition, using cross-group comparisons of means and regressions, it looks at how the responses of "empowered" consumers compared with those who are "less empowered."

FINDINGS

The vast majority of consumers do not formally voice their complaints or exit health plans, even in response to problems with significant consequences. "Empowered" consumers are only minimally more likely to formally voice and no more likely to leave their plan. Moreover, given the greater prevalence of trivial problems, consumers are much more likely to complain or leave their plans because of problems that are not severe. Greater empowerment does not alleviate this.

CONCLUSIONS

While much of the attention on consumerism has focused on prospective choice, understanding how consumers respond to problems is equally, if not more, important. Relying on consumers' responses as a means to protect individual consumers or influence the market for health plans is unlikely to be successful in its current form.

A 22 month study of patient complaints at a National Health Service hospital

Patient complaints are an important source of information for service improvements. We audited patient complaints made about medical care in a National Health Service District general hospital over a 22 month period. Complaints were about medical care, nursing care, attitudes of staff, poor communication, clinical delay (9%) and hospital environment. The complaints department closed 66% complaints within 20 days. The majority of the complaints were directly related to clinical care, poor communication, attitudes of staff and nursing care. However, 99% of patients were satisfied with an explanation and an apology indicating that almost all have been due to a lack of good communication than due to real deficiencies in the clinical care. The hospital management has investigated the majority of cases within 20 days and has made several policy changes after the investigations.

“To protect or not to protect?” Complaining vulnerable adults? That is the challenge

Purpose

Hidden camera television documentaries filmed in care home settings have shown evidence of the abuse of vulnerable adults, been widely discussed in the mass media and have brought the attention of the mass population to the importance of these issues. Governmental documents have also emphasised the need to protect vulnerable adults. It is therefore known that vulnerable adults exist and require protection from abuse in any shape or form. However, this paper aims to argue that protecting vulnerable adults and the current mechanisms for encouraging such individuals to make their views known to services are not mutually compatible. The main technique vulnerable adults may use, the complaints procedure, currently may not be sufficient to enable vulnerable adults to express themselves and their anxieties adequately.

Design/methodology/approach

The paper provides a case study which clearly demonstrates the nature of the problems, and then recognises and describes a number of levels which could be explored to learn more about these issues.

Research limitations/implications

Potential solutions are explored by the authors, who draw conclusions about the need for further research into this area.

Originality/value

This paper defines a gap between adult protection and complaints procedures, questioning both their efficacy and abilities to meet their stated aims. The paper also highlights that the nature of these may not sufficiently enable complaining vulnerable adults to express their views of services.

Voices unheard: barriers to expressing dissatisfaction to health plans

Consumers dissatisfied with their health plan can either "exit" (switch service providers) or "voice" (complain to the current provider). Policymakers' efforts to help consumers voice their dissatisfaction to health plans or external mediators have been disappointing, in part because little is known about the determinants of voice. This article represents the first comprehensive assessment of voicing in response to problematic experiences with health plans. A national consumer survey from 1999 is used to test hypotheses about characteristics of problems, patients, and settings that might inhibit voice and assess state regulations intended to enhance voice. Although problems associated with plans led to more voice than exit, voice is circumscribed by several factors: certain groups, such as racial minorities, do not express their grievances as often; episodes with severe health consequences for patients are not reported as regularly. The findings suggest that even though regulatory initiatives have not increased the frequency of voice, they have made grievances more effective, at least in jurisdictions where citizens know about the laws.

The grid that bridges the gap

Since the introduction of the Diploma in Higher Education in Nursing Studies (Dip HE NS) at this Faculty, course evaluations have consistently reported students' fears and apprehensions which result from their perceived lack of practical ability. Their experiences are supported by accounts from other nursing faculty (Elkan et al. 1993, Jowett & Walton 1994). In 1994, following analysis of course evaluations and a review of the literature on skill acquisition, experiential skills teaching was resumed within the faculty setting. This was after a period in the late 1980s when the cultural thinking was that 'practice suites' were to be frowned upon, and that skills were best taught in practice placements. Despite rigorous literature reviews (Love et al. 1989, Knight 1996) there appears to be no research to support the dismantling of practice suites. A structured approach to teaching skills now takes place in a purpose built Skills Centre. The approach used is based on a model by Gentile (1972), which is founded upon the theoretical principles of skill acquisition. It provides a blueprint for the teaching and transference of skills, and implicit in the model is the use of skill analysis. This involves demonstration of a skill by the facilitator, followed by analysis of it by the student into its component parts; this is followed by practise. The authors were concerned, however, that the use of skill analysis to teach skills should not be reduced to a presentation of a succession of isolated tasks. The authors were also aware that a nursing skill often has a tendency to be viewed purely within the psychomotor domain, with little attention paid to the knowledge base which underpins the skill. This viewpoint may contribute to the notion of a theory-practice gap. In response to these concerns, the authors have developed the Skill Grid. The grid incorporates skill analysis with Carper's theoretical framework: Fundamental Ways of Knowing (Carper 1975). The authors believe that knowledge which exemplifies nursing practice has many dimensions, and that it is crucial for students to explore the derivation of knowledge from an ontological perspective. Carper's framework will enable consideration of knowledge originating not only from empirical, but also aesthetic, personal and ethical sources. An essential feature of the grid is the attempt to link knowledge with practice by demonstrating how Carper's framework, which identifies sources of knowledge, can form the basis for the acquisition of skill. The authors have also incorporated problem-based learning into their teaching, so that the skills are practised within a patient/client orientated situation.

A task-based approach to defining the role of the nurse practitioner: the views of UK acute and primary sector nurses

There exists within the United Kingdom considerable confusion relating to the definition and occupational boundaries of the nurse practitioner (NP). In consequence, the clinical practice and training of the NP remain unregulated, unstandardized and heavily dependent on local forces. Such a situation is regrettable, particularly in view of the potential value the nurse practitioner has for health care provision and also for influencing national policy decisions. It is conceivable that one reason for the current failure to reach agreement over the role definition of the nurse practitioner relates to the fact that their essential job functions depend upon the context in which the nurse practitioner operates, with primary-based practice differing from acute sector service delivery in sufficient critical ways as to make a generic, inclusive definition impossible. To investigate the veracity of this view, two cohorts of United Kingdom nurses were sampled, one of which worked within the acute sector (n = 49) and the other in the community (n = 420). These groups were surveyed using a unique training needs analysis instrument that had been developed along formal psychometric principles. Both groups perceived advanced clinical activities, including examination and diagnosis, and a range of research activities to be central to the role of the nurse practitioner. The primary sample, however, reported business and management activities as essential tasks, while the acute sector nurses regarded high levels of communication skills, autonomy and risk management to be more important. The implications of the similarities and differences between the two data sets are discussed with reference to different clinical domains.