Getting the whole story: Integrating patient complaints and staff reports of unsafe care

Abstract

Objective It is increasingly recognized that patient safety requires heterogeneous insights from a range of stakeholders, yet incident reporting systems in health care still primarily rely on staff perspectives. This paper examines the potential of combining insights from patient complaints and staff incident reports for a more comprehensive understanding of the causes and severity of harm. Methods Using five years of patient complaints and staff incident reporting data at a large multi-site hospital in London (in the United Kingdom), this study conducted retrospective patient-level data linkage to identify overlapping reports. Using a combination of quantitative coding and in-depth qualitative analysis, we then compared level of harm reported, identified descriptions of adjacent events missed by the other party and examined combined narratives of mutually identified events. Results Incidents where complaints and incident reports overlapped (n = 446, reported in 7.6%’ of all complaints and 0.6% of all incident reports) represented a small but critical area of investigation, with significantly higher rates of Serious Incidents and severe harm. Linked complaints described greater harm from safety incidents in 60% of cases, reported many surrounding safety events missed by staff (n = 582), and provided contesting stories of why problems occurred in 46% cases, and complementary accounts in 26% cases. Conclusions This study demonstrates the value of using patient complaints to supplement, test, and challenge staff reports, including to provide greater insight on the many potential factors that may give rise to unsafe care. Accordingly, we propose that a more holistic analysis of critical safety incidents can be achieved through combining heterogeneous data from different viewpoints, such as through the integration of patient complaints and staff incident reporting data.

How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory

“…This finding echoes previous work demonstrating that patients frequently report issues around ‘unsafe care’ that healthcare professionals would consider to be inconsequential 19. Patient-reported safety concerns include physical discomfort (eg, noise, light, food), lack of security (including fear of other patients), uncertainty (eg, about discharge), process failures (delays or omissions) and patient–provider interactions (eg, poor communication/lack of compassion) 8 19–21…”

“…Our study indicates that patients monitor certain aspects of hospital care, including staff undertaking clinical procedures and observing organisational-level processes, such as cleaning. The findings of this study and others demonstrate that, through their observations, patients provide valuable insights into safety that could complement existing patient safety measurements 8 21. Importantly, our study highlights that patients do not necessarily express safety concerns using the language of the clinical risk paradigm.…”

Pediatric nurse-patient communication practices at Pentecost Hospital, Madina: A qualitative study

“…This is because patient complaints can provide important and additional information to healthcare delivery on how to improve patient safety and comfort, hence should be given the appropriate response in order to make them comfortable. This is in agreement with a study conducted in the United Kingdom among 446 nurses where participants indicated that they reported patients’ complaints about prompt feedback [ 32 ]. In reporting patients’ complaints, nurses indicated that the right procedure should be followed in order to prevent conflict between patients and the staff involved.…”

Investigation of Complaints Received from Affiliated Centres in the Treatment Supervision Department of the Iran University of Medical Sciences in 2020

“…Considering that each complaint is considered as a valuable opportunity to find a way to improve the quality of service that patients receive, it can be done by combining heterogeneous data from different perspectives, including by integrating patient complaints and incident report data. Staff achieved a more comprehensive analysis of critical safety incidents (8).…”