One‐year audit of complaints made against a University Hospital Surgical Department

Abstract

Background: There is relatively little in the medical literature relating to complaints about the healthcare process. The aim of this study was to report the frequency and content of patient complaints against a University Hospital Surgical Department. In particular, the study aimed to relate the number of complaints to the number of health-care episodes and to determine the frequency of patient safety incidents and subsequent medico-legal action. Methods: Retrospective interrogation of a prospectively maintained Complaints Department database at a University Hospital for the calendar year 2009. Results: Complaints relating to 360 aspects of the health-care journey in 113 patients were made. This translated into one complaint per 400 health-care episodes. Concerns about clinical care were cited in 31%, delays in the health-care process in 30%, communication issues in 19%, the institutional environment in 8% and poor discharge planning in 6%. Overall, 16 complaints (4%) were raised as patient safety incidents. Eighty-three per cent of complaints were addressed by a telephone conversation or a single letter response, 13% by a face-to-face meeting. Two per cent resulted in subsequent medico-legal action. Conclusions: Although perceived in a negative way by health-care professionals, only 1 in 400 health-care episodes resulted in a complaint. Only a small number related to patient safety incidents or resulted in medico-legal instructions. Attention should focus on developing effective strategies to improve patient satisfaction with all aspects of the patient journey.

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

“…However, our analysis also points to three caveats. First, while audited and based on selected evidence, many effective best practices in improving complaints management systems are driven by practical experiences and only documented in the grey literature – they are seldom reported in the academic literature [3,40]. Although methodological rigour of grey literature can be legitimately questioned, we consider these as important sources of evidence which often have high impact on policy and practice.…”

“…Evidence from the Netherlands shows that for complainants, an assurance that their complaint will lead to improvements and change is as important as personal redressal [87]; and that an honest commitment to learning from mistakes, at provider, organisational, and policy levels, is appreciated by patients, and will enhance accountability and improve the care experience [88]. Meanwhile, studies in the UK showed that over half of complaints can be effectively and quickly settled with an apology or an explanation [89] or by a single telephone call or letter-based response [40]. In Vietnam, public hospitals also quickly resolve complaints.…”

“…Well-designed complaint resolution processes provide opportunities to develop appropriate strategies leading to greater patient satisfaction [3,7,64,103–107]. Improved understanding of the reasons for, and nature of, complaints can provide insights into delivery of particularly complex care, detect lapses that providers may have missed, and address these issues before they escalate into substantial problems [8,11,30,40,53]. However, these opportunities can often be missed, because the aim may be to avoid litigation or reputational damage as was found in England and Vietnam respectively [25,53], because of lack of blame-free culture that encourages reporting and learning [75], or because QI interventions are implemented at a single unit level [94] thus preventing systems learning [8,9,94].…”

“…Ensure adequate and timely response to each complaint [3,7,86], even if a simple apology or an explanation [40,89]…”

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

“…78 Montini et al 63 developed arguably the most rigorous coding frame through an analysis of 1216 complaints using seven complaint codes identified in eight articles on malpractice and complaints. Some studies relied on pre-existing institutional frameworks to analyse complaints, 74 or developed their own frameworks based on initial coding and qualitative work. 13 40 68 71 Overall, 38 articles (64%) did not provide a clear rationale for the codes used.…”