The organisational response to patient complaints: a case study in Taiwan

Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis

BACKGROUND

Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation.

OBJECTIVES

1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences.

SEARCH METHODS

We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care.

SELECTION CRITERIA

We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services.

DATA COLLECTION AND ANALYSIS

Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles.

MAIN RESULTS

We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability.

AUTHORS' CONCLUSIONS

Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Patient involvement in Danish health care

PURPOSE

The purpose of this paper is to investigate different types of patient involvement in Denmark, and to discuss the potential implications of pursuing several strategies for patient involvement simultaneously.

DESIGN/METHODOLOGY/APPROACH

The paper presents a preliminary framework for analysis of patient involvement in health care. This framework is used to analyze key governance features of patient involvement in Denmark based on previous research papers and reports describing patient involvement in Danish health care.

FINDINGS

Patient involvement is important in Denmark at the rhetorical level, and many policies and initiatives have been introduced. All three governance forms (voice, choice and co-production) are used. However, there are important barriers and limitations in translating the rhetoric into practice, and potential synergy and negative synergy effects can be identified when pursuing the strategies at the same time.

RESEARCH LIMITATIONS/IMPLICATIONS

Because of the chosen research approach, the research results may lack generalizability. Therefore, researchers are encouraged to test the proposed framework further.

PRACTICAL IMPLICATIONS

The paper includes implications for the development of patient involvement in health care.

ORIGINALITY/VALUE

This paper fulfills a need to study different types of patient involvement and to develop a theoretical framework for characterizing and analyzing such involvement strategies.

Patients do not always complain when they are dissatisfied: implications for service quality and patient safety

OBJECTIVE

This study aimed to explore the actions taken by patients who had been admitted to an acute care Queensland hospital and experienced dissatisfaction with service delivery. It is proposed that before complaints can be used as part of a strategy to inform health service improvement and ultimately ensure patient safety, an understanding of the effectiveness of the complaints handling process from the patient's perspective must be gained.

METHODS

In-depth qualitative interviews using a phenomenological exploration were undertaken. The theoretical framework supporting the thematic analysis of the interview data was drawn from Lazarus's cognitive emotive model of coping. Analysis of the research data, aided by Leximancer software, revealed a series of relational themes that supported the interpretative data analysis process undertaken.

FINDINGS

In 16 interviews, the study outcomes identified that 15 of the participants did not voice their complaint at the time of the event, but after the event, they stated they wished that they had reacted differently and complained at the actual point in time that they were dissatisfied. The themes that emerged that reflected potential lost opportunities included issues with ineffective communication, being treated with disrespect, inconsistent standards of care, perceptions of negligence, and lack of information about how to make a complaint.

CONCLUSIONS

Our findings suggest that health-care professionals should take a more active role in identifying and responding to patients who are experiencing dissatisfaction but are not actively complaining. This level of vigilance and responsiveness will ensure opportunities to improve health service delivery, and patient safety are not lost.

Analysis of complaints lodged by patients attending a university hospital: a 4-year analysis

OBJECTIVE

Health practitioners often regard complaints concerning the quality of patient care in a negative light. However, complaints by patients and their relatives are an important source of information when considering ways in which to improve care. In the present study, we evaluated the complaints of patients and their relatives with regard to our hospital, such that we could take adequate remedial measures.

METHOD

Records of all patient complaints made between June 2008 and June 2012 were retrieved from the archives of the Quality Improvement Unit. The socio-demographic profiles of complainants, and their reasons for complaining, were analyzed using the SPSS statistical package.

RESULTS

The results revealed that 453 complaints, relating to medical care, the attitude of staff, waiting times, and financial issues, were made against our hospital over 4 years. Of the complainants, 68.9% (n = 312) were male, and 31.1% (n = 141) were female. The majority (16.3% and 20.4%, respectively) of the complaints were due to medical care and staff attitude problems. The unit about which most patients complained was hospital administration (22.1%), and one hundred fifty-three (33.8%) complaints were about physicians. Complaint frequency was 0.22 per 1.000 visits.

CONCLUSION

Complaints may be potentially useful quality assurance tools, and can identify system flaws. The primary causes of complaints were medical care, attitude of the staff, and waiting time, and many of these issues may be remedied.

A research of service outcomes in Taiwan: the role of patients' quality perceptions and wait time

Wait time is a continuing issue in healthcare services. U.S. studies reveal wait time is inversely related to healthcare service outcome as well as patient behavior and attitudes. However, Taiwan, despite being an important center for global healthcare services, has not been the subject of much research attention regarding wait time and its impact on patient perceptions and behavior. In the authors' exploratory study, patients in Taiwan completed a self-report questionnaire on how wait time and service quality characteristics relate to service outcome. Results indicate the influence of healthcare service quality and wait time on service outcome. Contributions, limitations, and research and managerial implications are discussed.

Patients' rights to complain in Finnish psychiatric care: an overview

Cuts in resources for Finnish psychiatric care may jeopardize the realization of patients' rights in mental health settings. The right to complain is a basic right of all patients in Finland, and is especially important to patients treated involuntarily and also to those who have experienced coercive treatment methods during their hospitalizations. In Finland, a patient's right to complain is guaranteed by law, both in legislation and in national quality recommendations. The complaint process in Finland is very complex, and there are several ways to make a complaint that are not always familiar to patients with severe illnesses. Psychiatric patients may have cognitive impairments that make the formulation of a complaint difficult. Despite help from the patient ombudsman, unbalanced power structures in psychiatric hospitals, insufficient information and long evaluation of appeals makes the complaint process very demanding for psychiatric patients.

A 22 month study of patient complaints at a National Health Service hospital

Patient complaints are an important source of information for service improvements. We audited patient complaints made about medical care in a National Health Service District general hospital over a 22 month period. Complaints were about medical care, nursing care, attitudes of staff, poor communication, clinical delay (9%) and hospital environment. The complaints department closed 66% complaints within 20 days. The majority of the complaints were directly related to clinical care, poor communication, attitudes of staff and nursing care. However, 99% of patients were satisfied with an explanation and an apology indicating that almost all have been due to a lack of good communication than due to real deficiencies in the clinical care. The hospital management has investigated the majority of cases within 20 days and has made several policy changes after the investigations.