[Analysis of patient complaints in Primary Care: An opportunity to improve clinical safety]

Analysis on 1481 case of medical complaints in a Tertiary Hospital in Fujian Province: A 5-year retrospective study

This study aims to review the 1481 cases of medical complaints from Fujian Provincial Jinshan Hospital in the past 5 years for providing a reference for new hospitals to deal with medical complaints, optimize medical procedures, improve medical quality, and enhance patient experience. The medical complaint information received by the hospital's medical department and service center accepted and transferred by the health administrative department in the past 5 years was systematically reviewed and statistically analyzed by using hierarchical clustering method. The transfer of the health administration department (61.5%) and the acceptance of the service center (28.9%) were the main sources of medical complaints in hospital. The incidence of medical complaints per 10,000 patients in the hospital was between 3 and 6. The maximum number of complaints was 2017 (5.28 cases/10,000 population), and the least was in 2019 (3.2 cases/10,000 population). The median of complaints was 25, and May to Sep was the period of high incidence of medical complaints each year. In 5 years, the month with the largest number of complaints was May 2020 (41 cases), followed by August 2017(40 cases), and the month with the least number was November 2020 (11 cases). In the past 5 years, the hospital's medical complaints were mainly in 4 aspects: medical process (n = 329, 22.2%), medical environment (n = 282, 19%), humanistic care (n = 277, 18.7%), and medical management (n = 209, 14.1%). The most frequent complaints were in clinical departments, among which the emergency, outpatient, and pediatric departments accounted for more than 50%. The top 3 complaints were doctors (n = 778, 53%), logistics (n = 284, 19%), and nurses (n = 239, 16%). The main way to resolve complaints was letter and telephone feedback (n = 1372, 92.6%). Our research recommends that new hospitals change their concepts, pay more attention to the services and quality of medical resources and logistical support, follow the best practices of patient-centered, perfect various medical complaint channels, and establish multiple methods. They should also properly accept and dispose medical complaints, improve the timeliness and feedback efficiency of responding to medical complaints, strengthen communication, exchange, and dialogue, and improve patients' medical experience and sense of gain.

Collecting Patient Feedback as a Means of Monitoring Patient Experience and Hospital Service Quality - Learning from a Government-led Initiative

PURPOSE

Patient feedback plays a significant role in hospital service improvement. However, how to encourage patient feedback that can guide hospital service improvement is still being explored. By examining patient feedback data related to a tertiary hospital in China that was collected from the "12345" Government Service Convenience Hotline (GSCH), the paper discusses the learnings from GSCH in encouraging patient feedback and how quality improvement initiatives have effected the number and types of complaints made by patients and their families via GSCH.

METHODS

The study retrospectively collected and analyzed complaints on a Tertiary General University-affiliated hospital made via GSCH between 2016 and 2020. Patient care process-related complaints were coded using the health care complaint analysis tool (HCAT) and other complaint data were categorized based on the nature of the complaints. The autoregressive integrated moving average (ARIMA) models and mosaic plots were used to observe complaints trends and different complaint variables, respectively. The relationship between various quality improvement initiatives introduced since 2018 and patient complaints was also tested.

RESULTS

Close to 67% (n=2688) of calls made to the GSCH hotlines about the hospital were classified as a complaint including 60.6% vs 39.4% related to patient care process and nonpatient care process, respectively. For patient care process-related complaints, specifically against departments and personnel, 57.72% (n=961) were on clinical departments and 55.87% (n=471) were on doctors. Comparing the proportion of the complaint data in different categories in the two-year period of 2017-2018 and 2019-2020, an increase in management problems (47.73% vs 58.50%, P<0.001) and decrease in relationship problems (33.65% vs 25.69%, P=0.002) were recorded.

CONCLUSION

A unified, transparent, and impartial GSCH platform greatly encourages feedback from patients and families. Feedbacks provide evidence to guide health care organizations in improving the overall experience of patients and the quality of services that they provide.

[Patient participation through active listening. About the remodeling of an extractions service]

BACKGROUND AND OBJECTIVE

From listening to patients there arises the possibility of improving both the care and the health infrastructure that users frequent. Our purpose of study was to explore the perception of users about the means and the care received involved in a hospital service through active listening, and to evaluate the satisfaction perceived after the opening of the renovated area.

METHODS

A mixed methodology evaluative investigation was carried out within the context of the Extraction Service of the Costa del Sol Hospital, using qualitative methodology to assess the perception of users, and quantitative methodology through a satisfaction survey to identify the change after remodeling of the area.

RESULTS

Through a qualitative approach, improvements have been identified in terms of the internal and external infrastructure of the center, highlighting the need to personalize spaces depending on the profile of the patient attended. In evaluating the impact after remodeling the area, patients have a higher overall satisfaction both from the healthcare professionals who attend them and from the healthcare center.

CONCLUSIONS

Through the use of a mixed methodology, useful information has been incorporated for a project to improve a hospital infrastructure, and a subsequent evaluation of the positive impact on the satisfaction perceived by users after remodeling.

Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective

The aim of this empirical research was to provide useful information for health system managers on the costs and investments involved in improving the quality of the National Health Service (NHS) based on patient assessments and from a gender perspective, i.e., without assuming that the perceived experience is identical for men and women. A cross-sectional study of 31 variables was applied using partial least squares structural equation modeling (PLS-SEM) as a research tool. The data were obtained from the Spanish Ministry of Health, Consumption, and Social Welfare for the entire Spanish territory between 2005 and 2018. The influence of expenditure, resource allocation, and mortality was hypothesized with regard to patient satisfaction according to disconfirmation theory. Patient satisfaction reflects clinical effectiveness, and therefore is a measure of health system quality. The results show that women are more sensitive to public investment in health than men, i.e., an increase in the level of spending and resources increases satisfaction more in women. In both sexes, the level of expenditure has a direct influence on patient satisfaction, and therefore on the quality of the healthcare system. It is important to increase spending on primary care, especially on specialized medical care and diagnostic equipment. However, reducing the use of drugs in favor of alternative treatments or therapies is considered to be positive. Likewise, spending has an impact on available resources, and these, in turn, have a positive influence on the level of use and a negative impact on mortality. Resources, especially healthcare staff, nuclear magnetic resonance equipment, and the number of posts in day hospitals, increase patients’ positive perception of the NHS.

[Outcome of complaints by patients due to the refusal of Primary Care Physicians to agree to a treatment request]

OBJECTIVE

To analyse the frequency of complaints due to the refusal of Primary Care Physicians to indicate a diagnostic test, treatment, or referral requested by a patient.

METHODS

Observational, retrospective study was conducted by analysing the complaints filed in a Primary Care Area during the years 2016, 2017, and 2018.

RESULTS

A total of 378 complaints were included. Of these, 30 (8%) were justified in the refusal by the doctors to a request of the patient (28 addressed to general practitioners and 2 to paediatricians). The most frequent related to the request was for a treatment (18 [60%]) followed by the request for diagnostic tests (9 [30%]). While the total number of claims increased by 151%, the relative weight of the claims for not responding to a patient's request was reduced (2016, 8/70, 11.4%; 2017, 11/132, 8.3%; and 2018, 11/176, 6.3%). No professional liability claims were filed.

CONCLUSIONS

Complaints for rejecting patient requests increased slightly, but tends to decrease their relative weight when considering the volume of complaints.

Patient Satisfaction in the Spanish National Health Service: Partial Least Squares Structural Equation Modeling

The aim of this article was to determine which key indicators influence patient satisfaction with the Spanish NHS to provide useful information for policy decision-making. A total of 33 variables for each of the 17 Spanish autonomous communities were collected from the statistical portal of the Spanish Ministry of Health, Social Services, and Equality between 2005 and 2016. A cross-sectional study was applied using Partial Least Squares to a Structural Equation Model (PLS-SEM). The influence of expenditures, resource allocation, and safety were hypothesized about patient satisfaction. Gross Domestic Product (GDP) and life expectancy were used as control variables. Moreover, the influence of resource allocation on use was tested. The model explained 57.1% of patient satisfaction with the Spanish NHS. It was positively influenced mainly by resource allocation and expenditures, followed by safety and life expectancy. Additionally, resources directly influenced the level of use. The number of hospital beds, hemodialysis equipment, rate of adverse drug reactions, and expenditure positively influenced patient satisfaction. In contrast, the number of posts in day hospitals, the hospital infection rate, and the percentage of pharmacy spending negatively influenced patient satisfaction.

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

BACKGROUND

Information from patient complaints - a widely accepted measure of patient satisfaction with services - can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems.

OBJECTIVES

The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research.

METHODS

We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands.

RESULTS

Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients' awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context.

CONCLUSIONS

Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.