Patient complaints reveal quality and safety 'blind spots' in healthcare delivery
Healthcare complaints made by patients can provide unique insight on aspects of healthcare delivery not easily evaluated by hospitals, a new study from the London School of Economics and Political Science (LSE) has found.
The study, published in the Milbank Quarterly, analysed over 1,000 complaints from patients across the UK and found they highlighted quality and safety issues difficult to capture through staff reports, surveys and hospital inspections.
The researchers found complaints were particularly valuable in identifying problems before admission to hospital—such as cancelled medical appointments—or after discharge, such as a lack of follow up care. A third (32 per cent) of the 2,074 problems reviewed by the study occurred either during admission or after discharge which, because they take place outside hospital, are often not monitored by other means.
Patients were also uniquely placed to report cases where there was an omission of care such as neglect of patient hygiene. Errors of omission are notoriously difficult to detect as people rarely observe or take responsibility for what has not happened.
Commenting, Dr. Alex Gillespie from the Department of Psychological and Behavioral Science at LSE, said: "Over one third of the problems reported in complaints were omissions, usually staff not doing something, and, remarkably, when omissions occur, it is often patients who compensate and error-correct, for example, following up appointments, ensuring care plans are followed, and even providing basic hygiene on the ward. Complaints thus provide unique insight into what is not done and the largely invisible processes of correcting these errors."
As the researchers highlight, despite containing valuable information on quality and safety, healthcare complaints are currently under-utilised with their potential for improving health services going untapped – often because the complex nature of complaints makes them hard to codify and manage.
To address this, the researchers developed the Healthcare Complaints Analysis Tool (HCAT) to analyse and systemise complaints. HCAT conceptualises complaints in clinical, management and relationship domains, using seven categories: quality, safety, environment, institutional processes, listening, communication, and respect and patient rights.It also identifies problems at different levels of severity, enabling complaints to be organised by their level of seriousness. This coding system is designed to be able to extract the unique insights available in complaints.
Dr. Tom Reader said: "Healthcare complaints provide hospitals with valuable and unique information for improving healthcare delivery, and policymakers have a responsibility to ensure patient experiences are analysed and learnt from."