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Dajem ZA. Patient Complaints to the Saudi Medical Call Center: Representative Response Strategies. HEALTH COMMUNICATION 2024; 39:863-875. [PMID: 36973861 DOI: 10.1080/10410236.2023.2189997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study aims to investigate the strategies and modifications employed by the Complaint Unit Representatives (CURs) in response to complaints recorded in the formal workplace of a medical institution in the Saudi Ministry of Health (MOH). A pragmatic discourse analytic approach was adopted to construct an analytical framework for authentic spoken complaint responses in the Saudi medical institution context. The data were randomly collected from 80 recorded phone conversations between patients and the CURs. It was transcribed verbatim, imported into MAXQDA for qualitative analysis of codes categorizations, and then into SPSS for statistical analysis. The findings showed that the staff employed a balance of transactional and interpersonal approaches in their response strategies, which varied in both quantity and quality depending on the phase or the major sequence of the moves made in the complaint call. Specifically, more transactional strategies were used during the main portion of a complaint and in the medial phase, while more interpersonal strategies were employed during the initial and the final phases of the call. The findings also showed that the CURs tended to downgrade and mitigate their responses to patients' complaints, and they never used upgraders. The influence of the religious culture was also noticeable in their use of downgraders, including optimistic devices and religious expressions. These findings reveal practical implications that can aid the quality team of the Complaint Unit (CU) in assessing the effectiveness and efficiency of the CURs' response strategies when handling complaints, and in providing more effective communication training as needed.
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Affiliation(s)
- Zenah Ayed Dajem
- Department of English Language, College of Sciences and Arts, King Khalid University
- Department of English Language and Literature, College of Humanities and Social Sciences, King Saud University
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Gyberg A, Brezicka T, Wijk H, Ulin K. Struggling for access to appropriate healthcare services: A qualitative content analysis of patient complaints. J Adv Nurs 2023; 79:3748-3759. [PMID: 37128937 DOI: 10.1111/jan.15688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 03/27/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
AIM This study aimed to describe circumstances concerning access for patients and relatives to take part in patient health and safety in a hospital setting. DESIGN This study used a qualitative descriptive design and was conducted at a Swedish university hospital. METHOD The 79 complaints reported by patients and relatives included in this study were registered between January 2017 and June 2019. These complaints were classified as concerning access to healthcare services. Data were analysed using qualitative content analysis. RESULTS The overarching theme, struggling for access as a human being in the healthcare system, encompassed three themes describing patients' and relatives' needs. The three themes were (1) navigating through the healthcare organization, (2) making sense of self and what is going on and (3) being acknowledged as having needs. CONCLUSION Patients and relatives continuously participate in various ways in healthcare to promote health and prevent patient harm. Our findings contribute important knowledge about the meaning of access from a broad healthcare system perspective. Access was restricted in terms of appropriateness in how patients' needs were met. This restriction of access risked the deterioration of patient health and safety. IMPACT Patients and relatives play an active part in patient health and safety, although their attempts are sometimes hindered. Restrictions in the appropriateness of access prevented patients and relatives from taking part in patient health and safety, which appeared to mean that they had to adapt and expend effort to the point that it negatively affected their health and everyday life. These findings concern all patients, relatives and healthcare professionals in hospital-associated settings. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Anna Gyberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Brezicka
- Department of Quality Assurance, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Quality Assurance, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center of Health Care Architecture, Chalmers University, Gothenburg, Sweden
| | - Kerstin Ulin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bie Bogh S, Fryd Birkeland S, Maj-Britt Hansen S, Alexandrovna Tchijevitch O, Hallas J, Morsø L. Harnessing patient complaints to systematically monitoring healthcare concerns through disproportionality analysis. Int J Qual Health Care 2023; 35:mzad062. [PMID: 37556110 DOI: 10.1093/intqhc/mzad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
Staff observations are the most common source of data for driving improvements in care. However, the patient perspective should also be considered, and healthcare complaints offer concrete details that health organizations might otherwise overlook and that can highlight areas for learning and improvement in the healthcare system. However, because of the diverse nature of patient complaints, systematic analyses can be challenging. This study aimed to identify and prioritize areas for improvement using a data-driven approach to analysing patient complaints. The Danish version of the Healthcare Complaints Analysis Tool was used to categorize the content of complaint letters. All complaints managed by the national complaints authority, compensation claims to the Patient Compensation Association, and locally managed complaints that were filed directly at Odense University Hospital from 2017 to 2021 were included. Proportional reporting ratios (PRRs) were used to measure and display the top five signals of disproportionality and rank them by excess complaints at the hospital level and when divided into department types. The study included 6366 complaints containing 13 156 problems (on average, 2.1 problems mentioned per complaint letter). Surgical departments had the highest number of complaints (3818), followed by medical (1059), service (439), and emergency departments (239). Signal 1 of disproportionality, relating to quality problems during ward procedures, had the highest excess reporting of 1043 complaints at the hospital level and a PRR of 1.61 and was present in all department types. Signal 2, relating to safety problems during the examination and diagnosis stage, had an excess reporting of 699 problems and a PRR of 1.86 and was also present in all department types. Signal 3, relating to institutional problems during admission, had the highest PRR of 3.54 and was found in most department types. Signals 4 and 5, relating to environmental problems during ward procedures and care on the ward, respectively, had PRRs of 1.5 and 1.84 and were present in most department types. The study found that analysing patient complaints can identify potential areas for hospital improvement. The study identified recurring issues in multiple departments, including quality problems during ward procedures, safety problems during the examination, institutional problems during admission, and environmental problems on the ward. The study highlights disproportionality analysis of complaints as a valuable tool to monitor patient concerns systematically.
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Affiliation(s)
- Søren Bie Bogh
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
| | - Søren Fryd Birkeland
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
- Department of Regional Health Research, Faculty of Health Science, Forensic Mental Health Research Unit Middelfart (RFM), University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense 5000, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, Middelfart 5500, Denmark
| | - Sebrina Maj-Britt Hansen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
| | - Olga Alexandrovna Tchijevitch
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
| | - Jesper Hallas
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Denmark
| | - Lars Morsø
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
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Eriksen AA, Fegran L, Fredwall TE, Larsen IB. Patients' negative experiences with health care settings brought to light by formal complaints: A qualitative metasynthesis. J Clin Nurs 2023; 32:5816-5835. [PMID: 36975841 DOI: 10.1111/jocn.16704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Narratives of negative patient experiences expressed in complaints can help health care professionals reflect on their practices. AIMS To synthesise evidence from qualitative primary studies on patients' negative experiences with different health care settings and to obtain a detailed picture of what patients find problematic while receiving health care. DESIGN Metasynthesis inspired by Sandelowski and Barroso. METHODS A protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO). A systematic search was conducted in CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycInfo (Ovid) and Scopus, on 20.04.2021. Backward and forward citations of included reports were searched for relevant studies and the search was completed in March 2022. Two researchers independently screened and appraised the included reports. A metasynthesis using reflexive thematic analysis and a metasummary were conducted. RESULTS Twenty-four reports were included, and four main themes were extracted from the metasynthesis: (1) problems with access to health care services; (2) failure to acquire information about diagnosis, treatment and the expected patient role; (3) experiencing inappropriate care and bad treatment; (4) problems with trusting health care service providers. CONCLUSIONS Negative patient experiences impact patients' physical and psychological health, leading to suffering and hampering patients from involving themselves in their health care. RELEVANCE TO CLINICAL PRACTICE Narratives of negative patient experiences aggregated from the findings provide knowledge about what patients need and expect from health care providers. These narratives can help health care professionals reflect on the way they interact with patients and improve their practice. Health care organisations need to prioritise patient participation. REPORTING METHOD Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION Findings were presented and discussed in a meeting with a reference group representing patients, health care professionals and the public.
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Affiliation(s)
- Alison Axisa Eriksen
- Centre for Care Research, Faculty of Health and Sports Sciences, University of Agder, Box 509, 4898, Grimstad, Norway
| | - Liv Fegran
- Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, Box 422, 4604, Kristiansand, Norway
| | - Terje Emil Fredwall
- Centre for Care Research, Faculty of Health and Sports Sciences, University of Agder, Box 509, 4898, Grimstad, Norway
| | - Inger Beate Larsen
- Department of Psychosocial Health, Faculty of Health and Sports Sciences, University of Agder, Box 509, 4898, Grimstad, Norway
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Jiang J, Huang F, Li H. Analysis on 1481 case of medical complaints in a Tertiary Hospital in Fujian Province: A 5-year retrospective study. Medicine (Baltimore) 2023; 102:e34107. [PMID: 37390291 PMCID: PMC10313276 DOI: 10.1097/md.0000000000034107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/05/2023] [Indexed: 07/02/2023] Open
Abstract
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.
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Affiliation(s)
- Jian Jiang
- The School of Public Health, Fujian Medical University, Fuzhou, China
- Fujian Provincial Hospital, Fuzhou, China
| | | | - Huiting Li
- Fujian Provincial Hospital, Fuzhou, China
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Shields MC, Hollander MA. Complaints, Restraint, and Seclusion in Massachusetts Inpatient Psychiatric Facilities, 2008-2018. J Patient Exp 2023; 10:23743735231179072. [PMID: 37323757 PMCID: PMC10265359 DOI: 10.1177/23743735231179072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
There has been limited research on the quality of inpatient psychiatry, yet policies to expand access have increased, such as the use of Medicaid Section 1115 waivers for treatment in "Institutions for Mental Disease" (IMD). Using data from public records requests, we evaluated complaints, restraint, and seclusion from inpatient psychiatric facilities in Massachusetts occurring from 2008 to 2018, and compared differences in the rates of these events by IMD status. There were 17,962 total complaints, with 48.9% related to safety and 19.9% related to abuse (sexual, physical, verbal), and 92,670 episodes of restraint and seclusion. On average, for every 30 census days in a given facility, restraint, and seclusion occurred 7.47 and 1.81 times, respectively, and a complaint was filed 0.94 times. IMDs had 47.8%, 68.3%, 276.9%, 284.8%, 183.6%, and 236.1% greater rates of restraint, seclusion, overall complaints, substantiated complaints, safety-related complaints, and abuse-related complaints, respectively, compared to non-IMDs. This is the first known study to describe complaints from United States inpatient psychiatric facilities. Policies should strengthen the implementation of patients' rights and patient-centeredness, as well as external critical-incident-reporting systems.
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Affiliation(s)
| | - Mara A.G. Hollander
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, USA
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Grandizio LC, Barreto Rocha DF, Hayes D, Warnick EP, Doyle CM, Suk M, Klena JC, Horwitz DS. An Analysis of Formal Patient Complaints, Risk, and Malpractice Events Involving Orthopedic Trauma Surgeons During a 10-Year Period. Orthopedics 2023; 46:121-127. [PMID: 36476241 DOI: 10.3928/01477447-20221129-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Formal patient complaints and malpractice events involving orthopedic trauma surgeons (OTSs) can have substantial career implications. Our purpose was to analyze formal patient complaints, risk events, and malpractice events against OTSs during a 10-year period. We reviewed all formal patient complaints within our institution's patient advocacy database involving 9 fellowship-trained OTSs throughout a decade. Complaints were categorized using the Patient Complaint Analysis System. Potential risk and malpractice events involving the OTSs were recorded. A control group of all patients seen by the surgeons during the study period was created. Demographics between patients with complaints and the control group were analyzed, as were malpractice, risk, and complaint rates between the surgeons. Of 33,770 patients, 136 filed a formal complaint (0.40%). There were 29 malpractice claims and 2 malpractice lawsuits. The care and treatment domain accounted for the highest percentage of complaints (36%), followed by the access and availability domain (26%). Results of the logistic regression analysis indicated that private insurance (odds ratio, 1.58) and operative treatment (odds ratio, 3.65) were significantly associated with complaints. Despite statistically significant differences in the rates of complaint and risk events between surgeons, malpractice events did not differ. The rate of patient complaints within a large orthopedic trauma practice during a 10-year period was 0.40%. Patients with private insurance and those treated operatively were more likely to file a complaint. Whereas complaint rates among surgeons varied, there was no significant difference in the rate of malpractice events. Understanding patient complaint rates and categorizations may allow surgeons to target areas for improvement. [Orthopedics. 2023;46(2):121-127.].
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Wu J, Zhang G, Xing Y, Liu Y, Zhang Z, Dong Y, Herrera-Viedma E. A sentiment analysis driven method based on public and personal preferences with correlated attributes to select online doctors. APPL INTELL 2023; 53:1-22. [PMID: 36844914 PMCID: PMC9940095 DOI: 10.1007/s10489-023-04485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/25/2023]
Abstract
This paper proposes a method to assist patients in finding the most appropriate doctor for online medical consultation. To do that, it constructs an online doctor selection decision-making method that considers the correlation attributes, in which the measure of attribute correlation is derived from the history real decision data. To combine public and personal preference with correlated attributes, it proposes a Choquet integral based comprehensive online doctor ranking method. In detail, a two stage classification model based on BERT (Bidirectional Encoder Representations from Transformers) is used to extract service features from unstructured text reviews. Then, 2-additive fuzzy measure is adopted to represent the patient public group aggregated attribute preference. Next, a novel optimization model is proposed to combine the public preference and personal preference. Finally, a case study of dxy.com is carried out to illustrate the procedure of the method. The comparison result between proposed method and other traditional MADM (multi-attribute decision-making) methods prove its rationality.
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Affiliation(s)
- Jian Wu
- School of Economics and Management, Shanghai Maritime University, Shanghai, 201306 China
- Center for Artificial Intelligence and Decision Sciences, Shanghai Maritime University, Shanghai, 201306 China
| | - Guangyin Zhang
- School of Economics and Management, Shanghai Maritime University, Shanghai, 201306 China
- Center for Artificial Intelligence and Decision Sciences, Shanghai Maritime University, Shanghai, 201306 China
| | - Yumei Xing
- School of Economics and Management, Shanghai Maritime University, Shanghai, 201306 China
- Center for Artificial Intelligence and Decision Sciences, Shanghai Maritime University, Shanghai, 201306 China
| | - Yujia Liu
- School of Economics and Management, Shanghai Maritime University, Shanghai, 201306 China
- Center for Artificial Intelligence and Decision Sciences, Shanghai Maritime University, Shanghai, 201306 China
| | - Zhen Zhang
- Institute of Systems Engineering, Dalian University of Technology, Dalian, 116024 China
| | - Yucheng Dong
- Business School, Sichuan University, Chengdu, 610065 China
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Adams C, Walpola R, Schembri AM, Harrison R. The ultimate question? Evaluating the use of Net Promoter Score in healthcare: A systematic review. Health Expect 2022; 25:2328-2339. [PMID: 35985676 PMCID: PMC9615049 DOI: 10.1111/hex.13577] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/29/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Patient experience is a complex phenomenon that presents challenges for appropriate and effective measurement. With the lack of a standardized measurement approach, efforts have been made to simplify the evaluation and reporting of patient experience by using single‐item measures, such as the Net Promoter Score (NPS). Although NPS is widely used in many countries, there has been little research to validate its effectiveness and value in the healthcare setting. The aim of this study was to systematically evaluate the evidence that is available about the application of NPS in healthcare settings. Methods Studies were identified using words and synonyms that relate to NPS, which was applied to five electronic databases: Medline, CINAHL, Proquest, Business Journal Premium, and Scopus. Titles and abstracts between January 2005 and September 2020 were screened for relevance, with the inclusion of quantitative and qualitative studies in the healthcare setting that evaluated the use of NPS to measure patient experience. Results Twelve studies met the inclusion criteria. Four studies identified benefits associated with using NPS, such as ease of use, high completion rates and being well‐understood by a range of patients. Three studies questioned the usefulness of the NPS recommendation question in healthcare settings, particularly when respondents are unable to select their service provider. The free‐text comments section, which provides additional detail and contextual cues, was viewed positively by patients and staff in 4 of 12 studies. According to these studies, NPS can be influenced by a wide range of variables, such as age, condition/disease, intervention and cultural variation; therefore, caution should be taken when using NPS for comparisons. Four studies concluded that NPS adds minimal value to healthcare improvement. Conclusion The literature suggests that many of the proposed benefits of using NPS are not supported by research. NPS may not be sufficient as a stand‐alone metric and may be better used in conjunction with a larger survey. NPS may be more suited for use in certain healthcare settings, for example, where patients have a choice of provider. Staff attitudes towards the use of NPS for patient surveying are mixed. More research is needed to validate the use of NPS as a primary metric of patient experience. Patient or Public Contribution Consumer representatives were provided with the research findings and their feedback was sought about the study. Consumers commented that they found the results to be useful and felt that this study highlighted important considerations when NPS data is used to evaluate patient experience.
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Affiliation(s)
- Corey Adams
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | - Ramesh Walpola
- School of Population Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Anthony M Schembri
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Reema Harrison
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Küster-Boluda A, Vila-López N, Küster-Boluda I. A century of research on complaints: longitudinal bibliometric analysis of WoS (1900–2019). TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2022. [DOI: 10.1080/14783363.2022.2030213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amparo Küster-Boluda
- Faculty of Economics, Marketing, University of Valencia, Avda Tarongers sn 46022, Valencia, Spain
| | - Natalia Vila-López
- Faculty of Economics, Marketing, University of Valencia, Avda Tarongers sn 46022, Valencia, Spain
| | - Inés Küster-Boluda
- Faculty of Economics, Marketing, University of Valencia, Avda Tarongers sn 46022, Valencia, Spain
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Morsø L, Birkeland S, Walløe S, Gudex C, Brabrand M, Mikkelsen KL, Bogh SB. Compensation Claims in Danish Emergency Care: Identifying Hot Spots and Blind Spots in the Quality of Care. Jt Comm J Qual Patient Saf 2022; 48:271-279. [DOI: 10.1016/j.jcjq.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
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12
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Rogers CW, Murphy LA, Murphy RA, Malouf KA, Natsume RE, Ward BD, Tansey C, Nakamura RK. An analysis of client complaints and their effects on veterinary support staff. Vet Med Sci 2022; 8:925-934. [PMID: 35044103 PMCID: PMC8959328 DOI: 10.1002/vms3.725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Veterinarians and support staff have been reporting the negative mental health effects from client complaints (CC). A previous study was performed evaluating these effects in veterinarians however no such study has been performed on veterinary support staff (VSS). Objectiv The purpose of this study was to investigate the frequency and effects of CCs on VSS. Methods A cross sectional anonymous survey using a web‐based questionnaire was created evaluating the frequency, type, and effects from CC. The survey was distributed to five different VSS Facebook groups and respondents provided demographic information and reported the frequency and effects of such complaints. Results A total of 681 questionnaires were collected during the study period but 130 were incomplete and were excluded from analysis. This resulted in 551 completed questionnaires available for review. One hundred and ninety (34.4%) VSS reported being subject to a CC in the previous 6 months with cost of care the most common reason (78.6%). Two hundred and sixty VSS (47.2%) reported feeling depressed because of CCs made against them, 295 VSS (53.5%) stated CCs negatively affected their enjoyment of their job, and 146 (26.5%) have considered changing their career because of CCs. Conclusions CC have detrimental effects on VSS career satisfaction, mental health and hospital practices. Further studies are warranted to mitigate the detrimental effects of CCs.
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Affiliation(s)
| | - Lisa A Murphy
- Friendship Hospital for Animals, Washington, District of Colombia, USA
| | | | - Kylee A Malouf
- Midwestern University College of Pharmacy, Downers Grove, Illinois, USA
| | - Rachel E Natsume
- University of Sydney School of Veterinary Medicine, Camden, New South Wales, Australia
| | - Briana D Ward
- Philadelphia Osteopathic School of Medicine, Philadelphia, Pennsylvania, USA
| | - Colleen Tansey
- VCA West Los Angeles Animal Hospital, Los Angeles, California, USA
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Martinez W, Pichert JW, Hickson GB, Braddy CH, Brown AJ, Catron TF, Moore IN, Stampfle MR, Webb LE, Cooper WO. Qualitative Content Analysis of Coworkers' Safety Reports of Unprofessional Behavior by Physicians and Advanced Practice Professionals. J Patient Saf 2021; 17:e883-e889. [PMID: 29547475 DOI: 10.1097/pts.0000000000000481] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to develop a valid and reliable taxonomy of coworker reports of alleged unprofessional behavior by physicians and advanced practice professionals and determine the prevalence of reports describing particular types of unprofessional conduct. METHODS We conducted qualitative content analysis of coworker reports of alleged unprofessional behavior by physicians and advanced practice professionals to create a standardized taxonomy. We conducted a focus group of experts in medical professionalism to assess the taxonomy's face validity. We randomly selected 120 reports (20%) of the 590 total reports submitted through the medical center's safety event reporting system between June 2015 and September 2016 to measure interrater reliability of taxonomy codes and estimate the prevalence of reports describing particular types of conduct. RESULTS The initial taxonomy contained 22 codes organized into the following four domains: competent medical care, clear and respectful communication, integrity, and responsibility. All 10 experts agreed that the four domains reflected essential elements of medical professionalism. Interrater reliabilities for all codes and domains had a κ value greater than the 0.60 threshold for good reliability. Most reports (60%, 95% confidence interval = 51%-69%) described disrespectful or offensive communication. Nine codes had a prevalence of less than 1% and were folded into their respective domains resulting in a final taxonomy composed of 13 codes. CONCLUSIONS The final taxonomy represents a useful tool with demonstrated validity and reliability, opening the door for reliable analysis and systems to promote accountability and behavior change. Given the safety implications of unprofessional behavior, understanding the typology of coworker observations of unprofessional behavior may inform organization strategies to address this threat to patient safety.
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Affiliation(s)
- William Martinez
- From the Division of General Internal Medicine and Public Health
| | | | | | - Casey H Braddy
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amy J Brown
- Center for Patient and Professional Advocacy
| | | | | | | | - Lynn E Webb
- Center for Patient and Professional Advocacy
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14
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Johnsson A, Boman Å, Wagman P, Pennbrant S. Manoeuvring between interplay and context- an ethnographic study of social interaction in encounters between registered nurses, older patients and their relatives. BMC Nurs 2021; 20:232. [PMID: 34789256 PMCID: PMC8600746 DOI: 10.1186/s12912-021-00754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Social interactions between registered nurses, older patients and their relatives are essential and play a central role in developing a successful care relationship in healthcare encounters. How nurses interact with patients affects the patient’s well-being. Limited time and demands for efficiency influence the encounter and complaints from patients and relatives often concern social interactions. Therefore, the aim of this study was to explore the social interaction in encounters between registered nurses, older patients and their relatives at a department of medicine for older people. Methods The study has an ethnographic approach including participatory observations (n = 21) and informal field conversations (n = 63), followed by a thematic analysis with an abductive approach reflecting Goffman’s interactional perspective. Result The result revealed a pattern where the participants manoeuvred between interplay and context. By manoeuvring, they defined roles but also created a common social situation. Nurses led the conversation; patients followed and described their health problems, while relatives captured the moment to receive and provide information. Finally, nurses summarised the encounter using ritual language, patients expressed gratitude through verbal and non-verbal expressions, while relatives verbally confirmed the agreements. Conclusion The social interaction between registered nurses, older patients and relatives was shaped by a pattern where the participants manoeuvred between interplay and context. When all participants assume responsibility for the social interaction, they become active and listen to each other. The approach adopted by nurses is crucial, thus training in communication and social interaction skills are important. When the asymmetry due to imbalance, is reduced, less misunderstanding and a satisfactory care relationship can be achieved.
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Affiliation(s)
- Anette Johnsson
- Department of Health Sciences, University West, Gustava Melins Gata 2, SE-461 86, Trollhättan, Sweden.
| | - Åse Boman
- Department of Health Sciences, University West, Gustava Melins Gata 2, SE-461 86, Trollhättan, Sweden
| | - Petra Wagman
- Department of Rehabilitation, Jönköping University, Jönköping, Sweden
| | - Sandra Pennbrant
- Department of Health Sciences, University West, Gustava Melins Gata 2, SE-461 86, Trollhättan, Sweden
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15
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Geng J, Chen X, Shi J, Bao H, Chen Q, Yu H. Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach. BMC Public Health 2021; 21:1886. [PMID: 34663271 PMCID: PMC8524814 DOI: 10.1186/s12889-021-11947-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China's public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap. METHODS We established a hypothetical model that comprised patients' awareness of insurance policies, the fulfillment of patients' expectations of insurance benefits, patients' perceived value of health insurance coverage, patients' satisfaction with health insurance programs, patients' complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases. RESULTS The SEM model, with good fit indices, showed that patients' awareness of health insurance policies, insurance program's fulfillment of expectations, and patients' perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients' expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients' perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis. CONCLUSIONS Our findings highlight the importance of incorporating patients' perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients' expectations.
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Affiliation(s)
- Jinsong Geng
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.
| | - Xiaowei Chen
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.,Library and Reference Department, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Haini Bao
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Qian Chen
- Department of Ophthalmology, The Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
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16
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Browne J, Bullock A, Poletti C, Cserző D. Recent research into healthcare professions regulation: a rapid evidence assessment. BMC Health Serv Res 2021; 21:934. [PMID: 34493260 PMCID: PMC8425088 DOI: 10.1186/s12913-021-06946-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Over the last decade, regulators have taken significant steps towards tackling perceptions that regulatory systems are burdensome. There has been much international research activity in the regulation of health and care professionals. This article reports a review of studies on health professions regulation between January 2011 and March 2020. Its chief object was to provide robust and up-to-date evidence to assist regulators in policy development and implementation. The main objectives of this study were to: 1. Identify and retrieve research in the field of health and care professions regulation in English since 2011; 2. Evaluate the published research, exploring its utility to regulators and practitioners, and drawing out any key messages; 3. Draw conclusions concerning the scope and limitations of the research literature and identify areas for further research. METHODS We undertook a rapid evidence assessment (REA) of the international literature on health and care professions regulation, including reviewing ten UK regulators' websites to identify issues of concern and strategic priorities. We retrieved 3833 references, using a four-stage screening process to select the 81 most relevant. RESULTS Results are reported within six key themes: harm prevention and patient safety; fitness to practise; quality assurance of education and training; registration including maintenance of registers; guidelines and standards and relations with regulatory bodies. CONCLUSIONS Regulation of professionals in health and care is comparatively undeveloped as a field of academic study. Consequently, the published evidence is diffuse and small-scale. Most work presents relatively weak data of low relevance to regulators, mainly reporting or describing the current position. Few studies are able to show the impact of regulation or demonstrate a causal link between regulation and its effects. To inform their research and policy agendas health and social care regulators need to commission, interpret and apply the scholarly literature more effectively; academics need to engage with regulators to ensure that their research provides high-quality evidence with practical relevance to the regulators' agendas. Further study is needed to explore how effective academic collaborations between regulators and researchers may be created and sustained.
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Affiliation(s)
- Julie Browne
- Cardiff University, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), 10/12 Museum Place, Cardiff, CF10 3BG, UK. .,Cardiff University, Cardiff University School of Medicine, Centre for Medical Education, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Alison Bullock
- Cardiff University, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), 10/12 Museum Place, Cardiff, CF10 3BG, UK
| | - Chiara Poletti
- Cardiff University, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), 10/12 Museum Place, Cardiff, CF10 3BG, UK
| | - Dorottya Cserző
- Cardiff University, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), 10/12 Museum Place, Cardiff, CF10 3BG, UK
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17
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An Analysis of Formal Patient Complaints and Malpractice Events Involving Hand and Upper Extremity Surgeons. J Am Acad Orthop Surg 2021; 29:659-665. [PMID: 33999868 DOI: 10.5435/jaaos-d-21-00073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/05/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Our purpose was to define and categorize patient complaints within a hand surgery practice over a 10-year period. In addition, we aimed to define surgeon and patient factors associated with formal complaints. METHODS All patients who filed a complaint with our institution's patient advocacy service against six hand surgeons in an academic practice over a 10-year period were recorded and categorized using the Patient Complaint Analysis System. A control group consisting of all patients seen by the surgeons during the study period was created. Demographic differences between the complaint and control groups were analyzed, as were complaint rates between surgeons. We obtained the number of malpractice events involving each of the surgeons. RESULTS During the 10-year study period, 73 of 36,010 unique patients seen (0.20%) filed a complaint. Care and treatment category comprised the highest percentage of complaint designations (30%), followed by access and availability (23%). Forty-three patients (59%) who filed complaints were treated surgically. Patients with a complaint had a significantly higher percentage of mental, behavioral, or neurodevelopmental disorders compared with controls (55% versus 42%, P = 0.03). The complaint rate (total complaints/total new patients seen) ranged between 0.09% and 0.29% for the six surgeons, and these results were not statistically significant. DISCUSSION Within an academic hand and upper extremity surgery practice, the rate of patient complaints is 0.20% or approximately one complaint for every 500 new patients seen. Most patient complaints are categorized within the care and treatment domain. Underlying mental health conditions are associated with more frequent complaints. Communication issues appear to represent a modifiable area that hand surgeons can improve to help mitigate potential complaints. Understanding both the frequency and types of patient complaints may allow hand surgeons to recognize areas for improvement and avoid potential exposure to malpractice litigation. LEVEL OF EVIDENCE Prognostic level III (case-control).
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18
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Patient complaints in general practice seen through the lens of professionalism: a retrospective observational study. BJGP Open 2021; 5:BJGPO.2020.0168. [PMID: 33589467 PMCID: PMC8278513 DOI: 10.3399/bjgpo.2020.0168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/13/2020] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Professionalism is a key competence for physicians. Patient complaints provide a unique insight into patient expectations regarding professionalism. Research exploring the exact nature of patient complaints in general practice, especially focused on professionalism, is limited. AIM To characterise patient complaints in primary care and to explore in more detail which issues with professionalism exist. DESIGN & SETTING A retrospective observational study in which all unsolicited patient complaints to a representative out-of-hours general practice (OOH GP) service provider in The Netherlands were analysed over a 10-year period (2009-2019). METHOD Complaints were coded for general characteristics and thematically categorised using the CanMEDS Physician Competency Framework (CanMEDS) as sensitising concepts. Complaints categorised as professionalism were subdivided using open coding. RESULTS Out of 746 996 patient consultations (telephone, face-to-face, and home visits) 484 (0.065%) resulted in eligible complaint letters. The majority consisted of two or more complaints, resulting in 833 different complaints. Most complaints concerned GPs (80%); a minority (19%) assistants. Thirty-five per cent concerned perceived professionalism lapses of physicians. A rich diversity in the wording of professionalism lapses was found, where ' not being taken seriously ' was mentioned most often. Forty-five per cent related to medical expertise, such as missed diagnoses or unsuccessful clinical treatment. Nineteen per cent related to management problems, especially waiting times and access to care. Communication issues were only explicitly mentioned in 1% of the complaints. CONCLUSION Most unsolicited patient complaints were related to clinical problems. A third, however, concerned professionalism issues. Not being taken seriously was the most frequent mentioned theme within the professionalism category.
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19
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Elias RM, Fischer KM, Siddiqui MA, Coons T, Meyerhofer CA, Pretzman HJ, Greig HE, Stevens SK, Burton MC. A Taxonomic Review of Patient Complaints in Adult Hospital Medicine. J Patient Exp 2021; 8:23743735211007351. [PMID: 34179414 PMCID: PMC8205411 DOI: 10.1177/23743735211007351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Previous studies show that patient complaints can identify gaps in quality of care, but it is difficult to identify trends without categorization. We conducted a review of complaints relating to admissions on hospital internal medicine (HIM) services over a 26-month period. Data were collected on person characteristics and key features of the complaint. The complaints were also categorized into a previously published taxonomy. Seventy-six unsolicited complaints were identified, (3.5 per 1000 hospital admissions). Complaints were more likely on resident services. The mean duration between encounter and complaint was 18 days, and it took an average of 12 days to resolve the complaint. Most patients (59%) had a complaint in the Relationship domain. Thirty-nine percent of complaints mentioned a specific clinician. When a clinician was mentioned, complaints regarding communication and humaneness predominated (68%). The results indicate that the efforts to reduce patient complaints in HIM should focus on the Relationships domain.
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Affiliation(s)
- Richard M Elias
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen M Fischer
- Health Sciences Research Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Mustaqeem A Siddiqui
- Division of Hematology, Department of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA.,Office of Patient Experience, Mayo Clinic, Rochester, MN, USA
| | - Trevor Coons
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Holly J Pretzman
- Informatics and Quality Management Services, Mayo Clinic, Rochester, MN, USA
| | - Hope E Greig
- Office of Patient Experience, Mayo Clinic, Rochester, MN, USA
| | | | - M Caroline Burton
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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20
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Ryynänen S, Vasari P. Restoring the Performance of a Health Care Organization Following the First Wave of COVID-19 by Using Patient Complaint Data. J Patient Exp 2021; 8:2374373521996267. [PMID: 34179369 PMCID: PMC8205405 DOI: 10.1177/2374373521996267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sanna Ryynänen
- Helsinki University Hospital, Finland and University of Lapland, Helsinki, Finland
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21
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Giardina TD, Korukonda S, Shahid U, Vaghani V, Upadhyay DK, Burke GF, Singh H. Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation. BMJ Qual Saf 2021; 30:996-1001. [PMID: 33597282 PMCID: PMC8552507 DOI: 10.1136/bmjqs-2020-011593] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 12/29/2022]
Abstract
Background Patient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement. Objective To systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement. Methods We reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring. Results In cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing. Conclusions Analysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.
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Affiliation(s)
- Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Saritha Korukonda
- Investigator Initiated Research Operations, Geisinger, Danville, PA, USA
| | - Umber Shahid
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Viralkumar Vaghani
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Divvy K Upadhyay
- Division of Quality, Safety and Patient Experience, Geisinger, Danville, PA, USA
| | - Greg F Burke
- Division of Quality, Safety and Patient Experience, Geisinger, Danville, PA, USA
- Division of General Internal Medicine, Geisinger, Danville, PA, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, Texas, USA
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22
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Birkeland S, Brabrand M, Mikkelsen KL, Bie Bogh S. Changes in compensation claim contents following reorganization of emergency hospital care. Int J Qual Health Care 2020; 32:685-693. [PMID: 33031503 DOI: 10.1093/intqhc/mzaa131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To study the effects of the reorganization on patient compensation claim contents relating to health care quality and patient safety. DESIGN AND SETTINGS Danish emergency care has developed considerably over the past decades, including a major reorganization to improve health care quality and patient safety through ensuring easier access to specialist treatment. Analysis of compensation claim patterns is used to evaluate the effects of such health care system changes. PARTICIPANTS, INTERVENTIONS AND MAIN OUTCOME MEASURES A sample of 1613 compensation claims to the Danish Patient Assurance organization was reviewed using a standardized taxonomy (the Healthcare Complaints Analysis Tool [HCAT]). Using trend analysis, we compared the proportions of claims categorized under HCAT domains, problem categories and sub-categories before and after the reorganization, with particular emphasis on the 'Clinical problems' domain covering health care quality and patient safety issues. RESULTS We observed a baseline increase in claims relating to clinical problems (P < 0.01), but this increase was less pronounced following the reorganization. This appeared to be driven mainly by a decrease in claims about clinician skills (P = 0.03) and health care neglects (P = 0.01). However, claims about diagnostic errors and patient outcomes showed a tendency (insignificant) to increase. CONCLUSIONS Emergency care reorganization apparently has been followed by a shift in claim contents towards fewer claims about health care neglect and staff competencies, although claims about other matters may have become more common. Present analyses of compensation claim trends should be supplemented by effect studies using traditional outcome measures such as mortality and readmission rates.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Medicine, (OPEN) University of Southern Denmark, J. B. Winsløws Vej 9a, 3rd floor, DK-5000 Odense C, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, University of Southern Denmark, Kløvervænget 25-25C, DK-5000 Odense C, Denmark
| | - Kim Lyngby Mikkelsen
- The Danish Patient Compensation Association, Kalvebod Brygge 45, DK-1560 Copenhagen V, Denmark
| | - Søren Bie Bogh
- Department of Clinical Medicine, (OPEN) University of Southern Denmark, J. B. Winsløws Vej 9a, 3rd floor, DK-5000 Odense C, Denmark
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23
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Roerig M, Farmer J, Ghoneim A, Gomaa N, Dempster L, Evans K, La W, Quiñonez C. Developing a coding taxonomy to analyze dental regulatory complaints. BMC Health Serv Res 2020; 20:1083. [PMID: 33239029 PMCID: PMC7691083 DOI: 10.1186/s12913-020-05943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background As part of their mandate to protect the public, dental regulatory authorities (DRA) in Canada are responsible for investigating complaints made by members of the public. To gain an understanding of the nature of and trends in complaints made to the Royal College of Dental Surgeons of Ontario (RCDSO), Canada’s largest DRA, a coding taxonomy was developed for systematic analysis of complaints. Methods The taxonomy was developed through a two-pronged approach. First, the research team searched for existing complaints frameworks and integrated data from a variety of sources to ensure applicability to the dental context in terms of the generated items/complaint codes in the taxonomy. Second, an anonymized sample of complaint letters made by the public to the RCDSO (n = 174) were used to refine the taxonomy. This sample was further used to assess the feasibility of use in a larger content analysis of complaints. Inter-coder reliability was also assessed using a separate sample of letters (n = 110). Results The resulting taxonomy comprised three domains (Clinical Care and Treatment, Management and Access, and Relationships and Conduct), with seven categories, 23 sub-categories, and over 100 complaint codes. Pilot testing for the feasibility and applicability of the taxonomy’s use for a systematic analysis of complaints proved successful. Conclusions The resulting coding taxonomy allows for reliable documentation and interpretation of complaints made to a DRA in Canada and potentially other jurisdictions, such that the nature of and trends in complaints can be identified, monitored and used in quality assurance and improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05943-7.
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Affiliation(s)
- Monika Roerig
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Julie Farmer
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada.
| | - Abdulrahman Ghoneim
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Noha Gomaa
- Oral Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Laura Dempster
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Krystal Evans
- Royal College of Dental Surgeons of Ontario, Toronto, Canada
| | - Wanda La
- Royal College of Dental Surgeons of Ontario, Toronto, Canada
| | - Carlos Quiñonez
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
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24
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Zare M, Afifi S, Karimzadeh I, Salehi-Marzijarani M, Zarei L, Ghazipour G, Mirjalili M, Lankarani KB, Sabzghabaee AM, Ahmadizar F, Peymani P. A Population-Based Study on Patients Complaining Regarding Community Pharmacies Services. J Res Pharm Pract 2020; 9:88-93. [PMID: 33102382 PMCID: PMC7547744 DOI: 10.4103/jrpp.jrpp_19_82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/05/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: Patients’ complain regarding pharmaceutical services at community pharmacies is a fundamental issue as it can directly affect people's service utilization. For the first time in Iran, this survey aimed to investigate the experience of people regarding declare a complaint against the pharmacy sectors as a community-based study. Methods: In this cross-sectional study, over 100 samples based on postal codes were randomly selected from the city of Shiraz in 2017–2018. The data collection instrument was designed in two parts (demographic and social profile which record the complaint experiences against pharmacists, pharmacy services, etc.). The data were analyzed by SPSS. Findings: All 1035 eligible participants had a mean age of 45.54 ± 15.82 years (ranged from 14 to 91). Nearly 70% of the participants were female. Around 81.8% had a family physician coverage, whereas 7.4% of them had no medical insurance coverage. The frequency of complaints from the pharmacies was 35.6%. Nearly 55% of the complaints were related to governmental pharmacies. Homemakers were 1.36 times more likely to have experienced complaints in comparison with their employed female counterparts. Health status had an inverse association with complaints. Those participants who had received prescription medication were about two times more likely to have filed a complaint in comparison with those who received medication without a prescription. In addition, females aged 40–59 and above 60 and unemployed participants were more satisfied with respect to complaint follow-up process. Conclusion: Low level of satisfaction with respect to the complaint process is a concerning issue; hence, strategies are warranted to improve the quality of services provided in the pharmacies.
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Affiliation(s)
- Marziyeh Zare
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saba Afifi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Leila Zarei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamreza Ghazipour
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahtabalsadat Mirjalili
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran B Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammad Sabzghabaee
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Payam Peymani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Clinical Pharmacology and Toxicology, University Hospital Zurich-University of Zurich, Switzerland
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25
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Taylor DR, Bouttell J, Campbell JN, Lightbody CJ. A case-controlled study of relatives’ complaints concerning patients who died in hospital: The role of treatment escalation/limitation planning. Int J Qual Health Care 2020; 32:212-218. [DOI: 10.1093/intqhc/mzaa008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/23/2019] [Accepted: 02/05/2020] [Indexed: 12/11/2022] Open
Abstract
Abstract
Objectives
To independently assess quality of care among patients who died in hospital and whose next-of-kin submitted a letter of complaint and make comparisons with matched controls. To identify whether use of a treatment escalation limitation plan (TELP) during the terminal illness was a relevant background factor.
Design
The study was an investigator-blinded retrospective case-note review of 42 complaints cases and 72 controls matched for age, sex, ward location and time of death.
Setting
The acute medical and surgical wards of three District General Hospitals administered by NHS Lanarkshire, Scotland.
Participants
None.
Intervention
None.
Outcome measures
Quality of care: clinical ‘problems’, non-beneficial interventions (NBIs) and harms were evaluated using the Structured Judgment Review Method. Complaints were categorized using the Healthcare Complaints Analysis Tool.
Results
The event frequencies and rate ratios for clinical ‘problems’, NBIs and harms were consistently higher in complaint cases compared to controls. The difference was only significant for NBIs (P = 0.05). TELPs were used less frequently in complaint cases compared to controls (23.8 versus 47.2%, P = 0.013). The relationship between TELP use and the three key clinical outcomes was nonsignificant.
Conclusions
Care delivered to patients at end-of-life whose next-of-kin submitted a complaint was poorer overall than among control patients when assessed independently by blinded reviewers. Regular use of a TELP in acute clinical settings has the potential to influence complaints relating to end-of-life care, but this requires further prospective study.
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Affiliation(s)
- D Robin Taylor
- University Hospital Wishaw, 50 Netherton Street, Wishaw, ML2 0DP, UK
- Usher Institute of Population Health Sciences, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Janet Bouttell
- Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK
| | | | - Calvin J Lightbody
- University Hospital Hairmyres, 218 Eaglesham Rd, East Kilbride, G75 8RG, UK
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An Analysis of Complaints in Two Large Tertiary University Teaching Hospital ENT Departments: A Two-Year Retrospective Review. Int J Otolaryngol 2020; 2020:1484687. [PMID: 32280347 PMCID: PMC7142350 DOI: 10.1155/2020/1484687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/11/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction. Complaints relating to patient care are known to correlate with surgical complication rates and malpractice lawsuits. In a continually evolving health service and on-going financial pressures, identifying current complaint themes could drive future improvements in healthcare delivery.
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van Dael J, Reader TW, Gillespie A, Neves AL, Darzi A, Mayer EK. Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights. BMJ Qual Saf 2020; 29:684-695. [PMID: 32019824 PMCID: PMC7398301 DOI: 10.1136/bmjqs-2019-009704] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022]
Abstract
Introduction A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling. Aim To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement. Method Literature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances. Results A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture. Discussion If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.
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Affiliation(s)
- Jackie van Dael
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Tom W Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Alex Gillespie
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Ana Luisa Neves
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Erik K Mayer
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
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Labrague LJ, De Los Santos JAA, Tsaras K, Galabay JR, Falguera CC, Rosales RA, Firmo CN. The association of nurse caring behaviours on missed nursing care, adverse patient events and perceived quality of care: A cross-sectional study. J Nurs Manag 2019; 28:2257-2265. [PMID: 31660656 DOI: 10.1111/jonm.12894] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/21/2019] [Accepted: 10/26/2019] [Indexed: 01/17/2023]
Abstract
AIM This study evaluated the role of nurse caring in predicting missed nursing care, adverse patient events and the quality of nursing care. BACKGROUND Missed nursing care is an issue essential in health care, as it is associated with adverse patient events. While studies have previously examined factors that result in missed nursing care activities and adverse events, the role of nurse caring itself in this context has not yet been explored. METHODS A cross-sectional research design was adopted, employing a convenience sample of 549 registered nurses from six hospitals in the Philippines identified between October 2018 and January 2019. Four self-report scales were used in this study as follows: the caring behaviour inventory, the missed nursing care scale, the adverse patient events scale and a single-item scale to measure the quality of nursing care. RESULTS Comforting or talking with patients and changing patients' positioning in bed were the most frequently missed care tasks, while patient/family complaints and patient/family verbal abuse were the most frequently reported adverse events. Nurse caring strongly predicted the quality of care, missed nursing care and patient adverse events. CONCLUSION Fostering caring behaviours among nurses has a profound effect on nurses' decision to omit or provide nursing care as well as on reducing adverse events and promoting quality nursing care. IMPLICATIONS FOR NURSING MANAGEMENT The adoption of strategies to improve caring behaviours among nurses is critically important to prevent or reduce the occurrence of errors and adverse events.
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Affiliation(s)
| | | | - Konstantinos Tsaras
- Nursing Department, Technological Educational Institute of Thessaly, Larissa, Greece
| | - Jolo R Galabay
- College of Nursing and Midwifery, Isabela State University, Ilagan Campus, Philippines
| | - Charlie C Falguera
- School of Health Sciences, University of the Philippines Manila, Manila, Philippines
| | - Rheajane A Rosales
- College of Nursing, Samar State University, Catbalogan City, Philippines
| | - Carmen N Firmo
- School of Health Sciences, University of the Philippines Manila, Manila, Philippines
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29
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Bogh SB, Kerring JH, Jakobsen KP, Hilsøe CH, Mikkelsen K, Birkeland SF. Healthcare Complaints Analysis Tool: reliability testing on a sample of Danish patient compensation claims. BMJ Open 2019; 9:e033638. [PMID: 31772109 PMCID: PMC6887041 DOI: 10.1136/bmjopen-2019-033638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The study aim was to test the intra-assessor and interassessor reliability of the Healthcare Complaints Analysis Tool (HCAT) for categorising the information in the claim letters in a sample of Danish patient compensation claims. DESIGN, SETTING AND PARTICIPANTS We used a random sample of 140 compensation cases completed by the Danish Patient Compensation Association that were filed in the field of acute medicine at Danish hospitals from 2007 to 2018. Four assessors were trained in using the HCAT manual before assessing the claim letters independently. MAIN OUTCOME MEASURES Intra-assessor and interassessor reliability was tested at domain, problem category and subcategory levels of the HCAT. We also investigated the reliability of ratings on the level of harm and of the descriptive details contained in the claim letters. RESULTS The HCAT was reliable for identifying problem categories, with reliability scores ranging from 0.55 to 0.99. Reliability was lower when coding the 'severity' of the problem. Interassessor reliability was generally lower than intra-assessor reliability. The categories of 'quality' and 'safety' were the least reliable of the seven HCAT problem categories. Reliability at the subcategory level was generally satisfactory, with only a few subcategories having poor reliability. Reliability was at least moderate when coding the stage of care, the complainant and the staff group involved. However, the coding of 'level of harm' was found to be unreliable (intrareliability 0.06; inter-reliability 0.29). CONCLUSION Overall, HCAT was found to be a reliable tool for categorising problem types in patient compensation claims.
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Affiliation(s)
| | | | | | | | - Kim Mikkelsen
- Patient Injury Prevention and Learning, Patient Insurance Association, Copenhagen, Denmark
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30
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Johnsson A, Wagman P, Boman Å, Pennbrant S. Striving to establish a care relationship-Mission possible or impossible?-Triad encounters between patients, relatives and nurses. Health Expect 2019; 22:1304-1313. [PMID: 31588667 PMCID: PMC6882259 DOI: 10.1111/hex.12971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 11/27/2022] Open
Abstract
Background When patients, relatives and nurses meet, they form a triad that can ensure a good care relationship. However, hospital environments are often stressful and limited time can negatively affect the care relationship, thus decreasing patient satisfaction. Objective To explain the care relationship in triad encounters between patients, relatives and nurses at a department of medicine for older people. Design A qualitative explorative study with an ethnographic approach guided by a sociocultural perspective. Method Participatory observations and informal field conversations with patients, relatives and nurses were carried out from October 2015‐September 2016 and analysed together with field notes using ethnographic analysis. Result The result identifies a process where patients, relatives and nurses use different strategies for navigating before, during and after a triad encounter. The process is based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view. Conclusion The result indicates that nurses, who are aware of the process and understand how to navigate between the different perspectives in triad encounters, can acknowledge both the patient's and relatives’ stories, thus facilitating their ability to understand the information provided, ensure a quality care relationship and strengthen the patient's position in the health‐care setting, therefore making the mission to establish a care relationship possible.
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Affiliation(s)
- Anette Johnsson
- Department of Health Sciences, University West, Trollhättan, Sweden.,School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Petra Wagman
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Åse Boman
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Sandra Pennbrant
- Department of Health Sciences, University West, Trollhättan, Sweden
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31
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Nowotny BM, Loh E, Davies-Tuck M, Hodges R, Wallace EM. Identifying quality improvement opportunities using patient complaints: Feasibility of using a complaints taxonomy in a metropolitan maternity service. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519869447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Benjamin M Nowotny
- Department of Obstetrics and Gynaecology, The Ritchie Centre, School of Clinical Sciences, Monash University, Clayton, Australia
- Victorian Department of Health and Human Services, Safer Care Victoria, Melbourne, Australia
| | - Erwin Loh
- St Vincent’s Health Australia, East Melbourne, Victoria, Australia
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Miranda Davies-Tuck
- Department of Obstetrics and Gynaecology, The Ritchie Centre, School of Clinical Sciences, Monash University, Clayton, Australia
- Victorian Department of Health and Human Services, Safer Care Victoria, Melbourne, Australia
| | - Ryan Hodges
- Department of Obstetrics and Gynaecology, The Ritchie Centre, School of Clinical Sciences, Monash University, Clayton, Australia
- Monash Health, Clayton, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, School of Clinical Sciences, Monash University, Clayton, Australia
- Victorian Department of Health and Human Services, Safer Care Victoria, Melbourne, Australia
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32
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Koskenniemi J, Leino‐Kilpi H, Puukka P, Suhonen R. Respect and its associated factors as perceived by older patients. J Clin Nurs 2019; 28:3848-3857. [DOI: 10.1111/jocn.15013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/09/2019] [Accepted: 06/30/2019] [Indexed: 02/03/2023]
Affiliation(s)
| | - Helena Leino‐Kilpi
- Department of Nursing Science, Turku University Hospital University of Turku Turku Finland
| | - Pauli Puukka
- National Institute for Health and Welfare Turku Finland
| | - Riitta Suhonen
- Department of Nursing Science, Turku University Hospital and City of Turku, Welfare Division University of Turku Turku Finland
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33
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Liu J, Hou S, Evans R, Xia C, Xia W, Ma J. What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness. J Med Internet Res 2019; 21:e14634. [PMID: 31392961 PMCID: PMC6702801 DOI: 10.2196/14634] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. Objective The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. Methods First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. Results In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed. Conclusions Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries.
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Affiliation(s)
- Jing Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengchao Hou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Library, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Richard Evans
- College of Engineering, Design and Physical Sciences, Brunel University London, London, United Kingdom
| | - Chenxi Xia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weidong Xia
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
| | - Jingdong Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Nowotny BM, Basnayake S, Lorenz K, Hall J, Ruddock S, Fennessy G, Cox E, Hodges R, Loh E, Wallace EM. Using medico-legal claims for quality improvement in maternity care: application and revision of an NHSLA coding taxonomy. BJOG 2019; 126:1437-1444. [PMID: 31131503 DOI: 10.1111/1471-0528.15823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To validate the NHSLA maternity claims taxonomy at the level of a single maternity service and assess its ability to direct quality improvement. DESIGN Qualitative descriptive study. SETTING Medico-legal claims between 1 January 2000 and 31 December 2016 from a maternity service in metropolitan Melbourne, Australia. POPULATION All obstetric claims and incident notifications occurring within the date range were included for analysis. METHODS De-identified claims and notifications data were derived from the files of the insurer of Victorian public health services. Data included claim date, incident date and summary, and claim cost. All reported issues were coded using the NHSLA taxonomy and the lead issue identified. MAIN OUTCOME MEASURES Rate of claims and notifications, relative frequency of issues, a revised taxonomy. RESULTS A combined total of 265 claims and incidents were reported during the 6 years. Of these 59 were excluded, leaving 198 medico-legal events for analysis (1.66 events/1000 births). The costs for all claims was $46.7 million. The most common claim issues were related to management of labour (n = 63, $17.7 million), cardiotocographic interpretation (n = 43, $24.4 million), and stillbirth (n = 35, $656,750). The original NHSLA classification was not sufficiently detailed to inform care improvement programmes. A revised taxonomy and coding flowchart is presented. CONCLUSIONS Systematic analysis of obstetric medico-legal claims data can potentially be used to inform quality and safety improvement. TWEETABLE ABSTRACT New taxonomy to target health improvement from maternity claims based on NHSLA Ten Years of Maternity Claims.
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Affiliation(s)
- B M Nowotny
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Vic., Australia
| | | | - K Lorenz
- Victorian Bar, Melbourne, Vic., Australia
| | - J Hall
- Maryborough District Health Service, Maryborough, Vic., Australia
| | - S Ruddock
- Monash Health, Clayton, Vic., Australia
| | - G Fennessy
- Victorian Managed Insurance Authority, Melbourne, Vic., Australia
| | - E Cox
- Victorian Managed Insurance Authority, Melbourne, Vic., Australia
| | - R Hodges
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Monash Health, Clayton, Vic., Australia
| | - E Loh
- St Vincent's Health Australia, East Melbourne, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Vic., Australia
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35
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Jack K, Ridley C, Turner S. Effective communication with older people. Nurs Older People 2019; 31:e1126. [PMID: 31468756 DOI: 10.7748/nop.2019.e1126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/09/2022]
Abstract
Effective communication with older people is an important aspect of nursing practice. Ineffective communication can lead to older people feeling inadequate, disempowered and helpless. Nurses have a duty to ensure that older people think they are being listened to and that their concerns are being validated in a non-judgemental way. Central to effective communication is the ability of nurses to be self-aware, and monitor their thoughts and feelings about, for example, negative stereotypes associated with the ageing process. Effective communication can sometimes be difficult to achieve due to the effects of ageing, but nurses can overcome some barriers through thoughtful interventions. It is important to treat older people as individuals, and to monitor and adapt communication accordingly. By doing so, nurses can ensure older people feel empowered, respected and able to maintain their independence.
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Affiliation(s)
- Kirsten Jack
- Manchester Metropolitan University, Manchester, England
| | | | - Samuel Turner
- Manchester Metropolitan University, Manchester, England
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36
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A Retrospective Review of Physician-related Patient Complaints from a Tertiary Pediatric Hospital. Pediatr Qual Saf 2019; 4:e136. [PMID: 30937416 PMCID: PMC6426489 DOI: 10.1097/pq9.0000000000000136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background Trends in patient concerns can identify systematic problems in health care delivery that may not be detected when addressing individual concerns. It can be difficult identifying trends without using a standardized taxonomy. The study objectives were to describe patient complaints from a tertiary care pediatric hospital and categorize them using a standardized complaint taxonomy. Methods Physician-based patient complaints were compiled from April 2011 to May 2014 from a tertiary pediatric hospital. These complaints were coded independently by 2 reviewers using the Reader taxonomy, a published standardized taxonomy. Complaints were placed into 3 domains: clinical, management, and relationships then organized into categories. Inter-rater reliability for domain classification between the 2 reviewers was calculated using Cohen's unweighted κ. Results Eighty-seven patient complaints were identified, representing approximately 1 per 10,000 physician-patient encounters. Half (48/87) were related to care in the emergency department. When adjusted for volume, pediatric hospital medicine had the highest number of complaints, with 12.1 per 10,000 encounters. The majority of patient complaints, 66% (57/87), were of the clinical domain (κ = 0.61). Sixty percent (52/87) were in the relationship domain (κ = 0.68), and 16% (14/87) were in the management domain (κ = 0.65). Conclusions We found a low overall complaint rate. Our results indicate that interventions to improve patient experience should initially be targeted at emergency and hospital medicine on the clinical and relationship domains. The inter-rater reliability of the Reader taxonomy was moderate with implications for processing patient complaints at a hospital level.
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Nowotny BM, Loh E, Lorenz K, Wallace EM. Sharing the pain: lessons from missed opportunities for healthcare improvement from patient complaints and litigation in the Australian health system. AUST HEALTH REV 2019; 43:382-391. [DOI: 10.1071/ah17266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/04/2018] [Indexed: 11/23/2022]
Abstract
Learning from medical errors to prevent their recurrence is an important component of any healthcare system’s quality and safety improvement functions. Traditionally, this been achieved principally from review of adverse clinical outcomes. The opportunity to learn systematically and in a system manner from patient complaints and litigation has been less well harnessed. Herein we describe the pathways and processes for both patient complaints and medicolegal claims in Victoria, and Australia more broadly, and assess the potential for these to be used for system improvement. We conclude that both patient complaints and medicolegal claims could afford the potential to additionally inform and direct safety and quality improvement. At present neither patient complaints nor medicolegal claims are used systematically to improve patient safety. We identify how this may be done, particularly through sharing findings across agencies. What is known about the topic? Patient complaints and medicolegal claims are accepted parts of the healthcare industry. However, using these in a shared and collated manner as part of an improvement agenda has not been widely considered or proposed. What does the paper add? This paper provides a summary of the patient complaint and medicolegal landscape in public hospital system in Australia broadly, and Victoria more specifically, identifying the agencies involved and the opportunities for sharing learnings. The paper draws on existing literature and experiences from both Australia and elsewhere to propose a framework whereby complaints and claims data could be shared systematically and strategically to reduce future harm and improve patient care. What are the implications for practitioners? We offer an approach for practitioners, healthcare managers and policy makers in all Australian jurisdictions to design and implement a statewide capacity to share patient complaints and medicolegal claims as an additional component of system quality and safety.
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Gillespie A, Reader TW. Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety. Milbank Q 2018; 96:530-567. [PMID: 30203606 PMCID: PMC6131356 DOI: 10.1111/1468-0009.12338] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Policy Points: Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low-level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient-centered insights that localize issues and shed light on difficult-to-monitor problems. CONTEXT The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data. METHODS We analyzed 1,110 health care complaints from across England. "Hot spots" were identified by mapping reported harm and near misses onto stages of care and underlying problems. "Blind spots" concerning difficult-to-monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission. FINDINGS The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty-three percent of problems entailed major or catastrophic harm, with significant regional variation (17%-31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low-level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns. CONCLUSIONS The analysis of health care complaints reveals valuable and uniquely patient-centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry-exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.
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Bryce AR, Rossi TA, Tansey C, Murphy RA, Murphy LA, Nakamura RK. Effect of client complaints on small animal veterinary internists. J Small Anim Pract 2018; 60:167-172. [PMID: 30284723 DOI: 10.1111/jsap.12936] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate the effect of client complaints on small animal veterinary internists' welfare, job satisfaction and medical practices. MATERIALS AND METHODS Cross-sectional anonymous survey study. Between February 1 and March 31, 2017, a web-based questionnaire was made available through the American College Veterinary Internal Medicine sub-specialty Small Animal Internal Medicine E-mail List Serve. RESULTS A total of 92 completed surveys were available for review. Fifty-nine (64∙1%) respondents received a client complaint during the previous 6 months with cost of care the most common reason (53∙3%). Eighty-nine (96∙7%) respondents worry about client complaints being made against them with 33 (35∙8%) stating they worry "most of the time" or "all of the time." Thirty-two (34∙8%) reported being verbally assaulted by a client in the previous 6 months and 27 (29∙4%) reported being threatened with litigation during the previous 6 months. Sixty-six (71∙7%) have reported changing the way they practice medicine to avoid a client complaint and 40 (43∙5%) have considered changing their career because of complaints made against them. CLINICAL RELEVANCE Client complaints are a frequent problem among small animal veterinary internists that have detrimental effects on job satisfaction, psychological distress and medical practices.
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Affiliation(s)
- A R Bryce
- Department of Internal Medicine, Southern California Veterinary Specialty Hospital, Irvine, California 92614, USA
| | - T A Rossi
- Department of Internal Medicine, Southern California Veterinary Specialty Hospital, Irvine, California 92614, USA
| | - C Tansey
- Department of Oncology, Inland Valley Veterinary Specialists and Emergency Center, Upland, California 91786, USA
| | - R A Murphy
- Department of Psychiatry, Beamount Hospital, Dublin 9, Ireland
| | - L A Murphy
- Department of Critical Care, Veterinary Specialty Center of Delaware, New Castle, Delaware 19720, USA
| | - R K Nakamura
- Department of Cardiology, IDEXX Laboratories, Westbrook, Maine 04092, USA
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Johnsson A, Boman Å, Wagman P, Pennbrant S. Voices used by nurses when communicating with patients and relatives in a department of medicine for older people-An ethnographic study. J Clin Nurs 2018; 27:e1640-e1650. [PMID: 29493834 DOI: 10.1111/jocn.14316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden. BACKGROUND Communication is an essential tool for nurses when working with older patients and their relatives, but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome. DESIGN An ethnographic design informed by the sociocultural perspective was applied. METHODS Forty participatory observations were conducted and analysed during the period October 2015-September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken, and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semistructured follow-up interviews were conducted with five nurses. RESULTS In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualised, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices, this indicates a shift in the orientation or situation. CONCLUSION The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved. RELEVANCE TO CLINICAL PRACTICE Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes.
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Affiliation(s)
- Anette Johnsson
- Department of Health Sciences, University West, Trollhättan, Sweden.,Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Åse Boman
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Petra Wagman
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Sandra Pennbrant
- Department of Health Sciences, University West, Trollhättan, Sweden
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Patient Complaints in Image-Guided Interventions: Evaluation of Multifactorial Issues Using a Coding Taxonomy. AJR Am J Roentgenol 2018; 210:1288-1291. [PMID: 29547056 DOI: 10.2214/ajr.17.19104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to classify complaints from patients undergoing image-guided interventions using a coding taxonomy and to test whether single-coded complaints were resolved satisfactorily compared with multifactorial (multiple codes) complaints. MATERIALS AND METHODS In this retrospective study, patients' complaint narratives between April 1999 and December 2012 were reviewed and categorized according to a three-level taxonomy into domains and codes. Resolutions were categorized as satisfactory or unsatisfactory to the patient and were classified as follows: clarification, apology, manager notification, change of provider, reimbursement, and quality review. Complaints were classified as single coded (only one code identified in the patients' description) and multifactorial (multiple codes identified). Statistical analysis was performed with the Fisher test, with the significance level set at 0.05. A run chart with the distribution of complaints by domains (relationships, management, and clinical) by year was performed. RESULTS A total of 146 codes were extracted from 71 narratives (2.06 codes/complaint) and were classified into the following domains: clinical (52%; n = 76), management (24%; n = 35), and relationships (24%; n = 35). The most common codes included quality of care, safety, and communication breakdown issues. A run chart found a decline in absolute numbers of complaints over the years in the domains studied. The frequency of satisfactory resolution was 86% for multifactorial versus 81% for single-coded complaints with no statistically significant differences observed (p = 0.72). Over 50% of complaints were resolved by providing clarification to patients (n = 36). CONCLUSION There were no statistically significant differences between multifactorial and single-coded complaints. Clinical codes and communication breakdown were the most common reasons for patient-reported complaint, with most complaints successfully resolved with clarification.
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Mattarozzi K, Sfrisi F, Caniglia F, De Palma A, Martoni M. What patients' complaints and praise tell the health practitioner: implications for health care quality. A qualitative research study. Int J Qual Health Care 2017; 29:83-89. [PMID: 27920247 DOI: 10.1093/intqhc/mzw139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 11/16/2016] [Indexed: 12/26/2022] Open
Abstract
Objective In order to identify which health care aspects play a role in patient satisfaction and quality of health care, the present study analyses a large number of instances of complaint and praise. Design and setting One thousand two hundred and thirty-five instances of complaint and one thousand five hundred thirty-six of praise submitted from patients or other souces (i.e. a patient's family member or a legal representative) to a northern-Italian hospital were analysed. Main outcome measures We adopted Reader and colleagues' (2014) patients' complaint taxonomy, in conjunction with a detailed content analysis of relationship and communication of information aspects. Results The most frequent causes of complaint concerned care system management (68.1%), particularly the time taken to access treatment, and relationship aspects (52.8%). The importance of relationship aspects was confirmed by the expression of gratitude through praise (89%). The most critical factor of the relationship domain was effective communication of information to the patient (39.3%). Frequently patients complained of: (i) having received information that was inconsistent with the truth, (ii) having had difficulty in obtaining information, and (iii) untimely communication of information. Clinical aspects did not seem to be the main factors that triggered a complaint (36,8%), and, when indicated, they were almost always associated with relationship issues. Conclusions This study indicates that not only complaints, but also instances of praise, are a potentially important source of information regarding health care aspects that play a role in patient satisfaction and quality of care. Our findings underline the relevance of relationship aspects in determining patients' satisfaction with the care received. In particular, health practitioners should focus their attention on how information is understood, translated and applied by patients.
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Affiliation(s)
- Katia Mattarozzi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V.le Berti Pichat, 5, 40127Bologna, Italy
| | - Fiamma Sfrisi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V.le Berti Pichat, 5, 40127Bologna, Italy
| | - Filippo Caniglia
- "Ufficio Relazioni con il Pubblico e con le Associazioni di Volontariato", Sant'Orsola Malpighi Hospital, Via Albertoni 15, 40138Bologna, Italy
| | - Alessandra De Palma
- "Medicina Legale e Gestione Integrata del Rischio", Local Health Trust, Sant'Orsola Malpighi Hospital, Via Massarenti 9, 40138Bologna, Italy
| | - Monica Martoni
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V.le Berti Pichat, 5, 40127Bologna, Italy
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Hutchinson M, Jackson D, Wilson S. Technical rationality and the decentring of patients and care delivery: A critique of 'unavoidable' in the context of patient harm. Nurs Inq 2017; 25:e12225. [PMID: 28980365 DOI: 10.1111/nin.12225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 11/30/2022]
Abstract
In recent decades, debate on the quality and safety of healthcare has been dominated by a measure and manage administrative rationality. More recently, this rationality has been overlaid by ideas from human factors, ergonomics and systems engineering. Little critical attention has been given in the nursing literature to how risk of harm is understood and actioned, or how patients can be subjectified and marginalised through these discourses. The problem of assuring safety for particular patient groups, and the dominance of technical forms of rationality, has seen the word 'unavoidable' used in connection with intractable forms of patient harm. Employing pressure injury policy as an exemplar, and critically reviewing notions of risk and unavoidable harm, we problematise the concept of unavoidable patient harm, highlighting how this dominant safety rationality risks perverse and taken-for-granted assumptions about patients, care processes and the nature of risk and harm. In this orthodoxy, those who specify or measure risk are positioned as having more insight into the nature of risk, compared to those who simply experience risk. Driven almost exclusively as a technical and administrative pursuit, the patient safety agenda risks decentring the focus from patients and patient care.
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Affiliation(s)
- Marie Hutchinson
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Debra Jackson
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford, UK.,Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, UK.,Nursing Research, Oxford University Hospitals NHS Trust, Oxford, UK.,University of Technology, Sydney, NSW, Australia
| | - Stacey Wilson
- College of Health, Massey University, Palmerston North, New Zealand
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Evaluation of Patient and Family Outpatient Complaints as a Strategy to Prioritize Efforts to Improve Cancer Care Delivery. Jt Comm J Qual Patient Saf 2017; 43:498-507. [DOI: 10.1016/j.jcjq.2017.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/14/2017] [Accepted: 04/19/2017] [Indexed: 11/21/2022]
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Smith-Merry J, Walton M, Healy J, Hobbs C. Responses by hospital complaints managers to recommendations for systemic reforms by health complaints commissions. AUST HEALTH REV 2016; 41:527-532. [PMID: 27764646 DOI: 10.1071/ah16138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/30/2016] [Indexed: 11/23/2022]
Abstract
Objective This paper explores how hospital complaints managers react to recommendations for systemic quality reforms by health complaints commissions in response to complaints by patients in Queensland and New South Wales. Methods Semi-structured qualitative interviews were conducted with complaints managers in 17 hospitals. Interview transcripts were then thematically analysed and data on responses to health complaint commissions was organised in relation to Valerie Braithwaite's typology of motivational postures. Results Respondents supported involvement by an independent authority where patients had serious complaints about the services they received in hospital, but wanted more negotiation with commissions on service improvement recommendations. Conclusions Hospital complaints managers mostly responded as virtuous or rational actors to the symbolic power of complaints commissions. This may be context dependent because Australian health commissions operate within a pro-reform context as a result of recent publicity around health system failures. What is known about the topic? Little is known about regulatory relationships between complaints commissions and hospitals. There has been no Australian research considering how complaints managers respond to commission recommendations for quality improvements and reforms to hospital services. What does the paper add? The paper uses a novel theoretical framework based on regulatory theory to understand and describe the reactions of complaints managers to commission recommendations. What are the implications for practitioners? Commissions should seek commentary from complaints managers through open dialogue before making final recommendations. This will ease the progress of reforms and make recommendations more acceptable and 'genuine' in the specific context of the hospital.
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Affiliation(s)
- Jennifer Smith-Merry
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
| | - Merrilyn Walton
- School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building, NSW 2006, Australia.
| | - Judith Healy
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, ACT 0200, Australia. Email
| | - Coletta Hobbs
- School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building, NSW 2006, Australia.
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