1
|
Monteiro S, Acai A, Kahlke R, Chan TM, Sukhera J. Shifting paradigms: A collective and structural strategy for addressing healthcare inequity. J Eval Clin Pract 2024. [PMID: 38853452 DOI: 10.1111/jep.14013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/04/2024] [Accepted: 04/28/2024] [Indexed: 06/11/2024]
Abstract
Healthcare inequity is a persistent systemic problem, yet many solutions have historically focused on "debiasing" individuals. Individualistic strategies fit within a competency-based medical education and assessment paradigm, whereby professional values of social accountability, patient safety, and healthcare equity are linked to an individual clinician's competence. Unfortunately, efforts to realise the conceptual linkages between medical education curricula and goals to improve healthcare equity fail to address the institutional values, policies, and practices that enable structural racism. In this article, we explore alternative approaches that target collective and structural causes of health inequity. We first describe the structural basis of healthcare inequity by identifying the ways in which institutional culture, power and privilege erode patient-centred care and contribute to epistemic injustice. We then outline some reasons that stereotypes, which are a culturally supported foundation for discrimination, bias and racism in healthcare, cannot be modified effectively through individualistic strategies or education curricula. Finally, we propose a model that centres shared values for leadership by individuals and institutions with consistency in goal setting, knowledge translation, and talent development. Figure 1 summarises the key recommendations. We have provided cases to supplement this work and facilitate discussion about the model's application to practice.
Collapse
Affiliation(s)
- Sandra Monteiro
- Division of Education and Innovation, Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Ontario, Hamilton, Canada
| | - Anita Acai
- Department of Psychiatry and Behavioural Neurosciences, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Ontario, Hamilton, Canada
- St. Joseph's Education Research Centre (SERC), St. Joseph's Healthcare Hamilton, Ontario, Hamilton, Canada
| | - Renate Kahlke
- Division of Education and Innovation, Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
| | - Teresa M Chan
- Division of Emergency/Division of Education & Innovation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Office of Continuing Professional Development, McMaster University, Ontario, Hamilton, Canada
| | - Javeed Sukhera
- Hartford Hospital/Institute of Living, Hartford, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, Connecticut, New Haven, USA
| |
Collapse
|
2
|
Clausen MK, Bogh SB, Schmidt-Petersen M, Morsø L. Assessing nourishment problems at a hospital: what can we learn from them? BMJ Open Qual 2024; 13:e002745. [PMID: 38816005 PMCID: PMC11138294 DOI: 10.1136/bmjoq-2024-002745] [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: 01/03/2024] [Accepted: 05/19/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Patient safety is a high priority in the Danish health care system, including that hospital patients get the proper nutrition during their stay. A Nutrition Committee at Odense University Hospital is responsible for policy regarding nourishment at the hospital. If patients experience suboptimal treatment, i.e. improper nourishment, in the Danish health care system, they have the right to file a complaint. These complaints enable the improvement potentials based on the patients' first hand experiences. Therefore, our aim was to examine the nutrition complaint pattern and to get a deeper understanding of the context surrounding nutrition problems, allowing the extraction of learning potentials. METHODS We analysed complaints submitted to Odense University Hospital between 2018 and 2022 using the Healthcare Complaint Analysis Tool. The complaints were categorised into categories, levels of severity and overall patient harm. The complaints containing a high-severity nutrition problem were read through and thematised into aspects not defined in the Healthcare Complaint Analysis Tool. RESULTS Between 2018 and 2022, 60 complaint cases containing 89 nutrition problems were filed to Odense University Hospital. Most (58.3%) of these were filed by the patients' relatives. The nutrition problems were mostly of low severity (56.2%), while 23.6% were severe, and 20.2% were very severe. The reading of 18 very severe nutrition complaints revealed a cascade of problems triggered by the nutrition problem in six cases. Moreover, we saw that two high-severity nutrition problems led to catastrophic harm. DISCUSSION A low proportion of nutrition problems may express an underestimation regarding nourishment at the hospital. A patient's threshold may not be exceeded by suboptimal nutrition and therefore does not file a complaint. However, complaints contain important insights contributing to wider learning, given that improvements at the hospital so far are based on clinicians' reporting, overlooking the patient perspective.
Collapse
Affiliation(s)
- Mette Kring Clausen
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Søren Bie Bogh
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- OPEN Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Lars Morsø
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- OPEN Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Birkeland S, Bogh SB, Morsø L. From systematic complaint analysis to quality improvement in healthcare. BMJ Open Qual 2024; 13:e002637. [PMID: 38782487 PMCID: PMC11116851 DOI: 10.1136/bmjoq-2023-002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Søren Birkeland
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry, Region of Southern Denmark mental health services, Middelfart, Denmark
- Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Søren Bie Bogh
- Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Morsø
- Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Soares S, Ritchie H, Almodovar JL. Managing Patient Dissatisfaction and Billing Reconsideration Requests in Outpatient Clinics. J Nurs Adm 2024; 54:198-200. [PMID: 38512082 DOI: 10.1097/nna.0000000000001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Nurse leaders in many settings are responsible for clinic operations. Knowing the medical and financial stakes of each patient encounter, it is not surprising to encounter patients requesting reconsideration of bills after services are provided. This article provides recommendations on how to successfully navigate billing reconsideration requests in outpatient settings.
Collapse
Affiliation(s)
- Sharmila Soares
- Author Affiliations: Patient Services Manager (Soares-Sardinha), UNC Hospitals Neurology Clinic; Clinical Director Ambulatory Neurosciences (Ritchie), UNC Hospitals Outpatient Clinics; and Associate Professor of Neurology (Dr Almodovar), Medical Director Neurology Clinic, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | | | | |
Collapse
|
5
|
Sokol-Hessner L, Dechen T, Folcarelli P, McGaffigan P, Stevens JP, Thomas EJ, Bell S. Associations Between Organizational Communication and Patients' Experience of Prolonged Emotional Impact Following Medical Errors. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00071-0. [PMID: 38565471 DOI: 10.1016/j.jcjq.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The emotional impact of medical errors on patients may be long-lasting. Factors associated with prolonged emotional impacts are poorly understood. METHODS The authors conducted a subanalysis of a 2017 survey (response rate 36.8% [2,536/6,891]) of US adults to assess emotional impact of medical error. Patients reporting a medical error were included if the error occurred ≥ 1 year prior. Duration of emotional impact was categorized into no/short-term impact (impact lasting < 1 month), prolonged impact (> 1 month), and especially prolonged impact (> 1 year). Based on their reported experience with communication about the error, patients' experience was categorized as consistent with national disclosure guidelines, contrary to guidelines, mixed, or neither. Multinomial regression was used to examine associations between patient factors, event characteristics, and organizational communication with prolonged emotional impact (> 1 month, > 1 year). RESULTS Of all survey respondents, 17.8% (451/2,536) reported an error occurring ≥ 1 year prior. Of these, 51.2% (231/451) reported prolonged/especially prolonged emotional impact (30.8% prolonged, 20.4% especially prolonged). Factors associated with prolonged emotional impact included female gender (adjusted odds ratio 2.1 [95% confidence interval 1.5-2.9]); low socioeconomic status (SES; 1.7 [1.1-2.7]); physical impact (7.3 [4.3-12.3]); no organizational disclosure and no patient/family error reporting (1.5 [1.03-2.3]); communication contrary to guidelines (4.0 [2.1-7.5]); and mixed communication (2.2 [1.3-3.7]). The same factors were significantly associated with especially prolonged emotional impact (female, 1.7 [1.2-2.5]; low SES, 2.2 [1.3-3.6]; physical impact, 6.8 [3.8-12.5]; no disclosure/reporting, 1.9 [1.2-3.2]; communication contrary to guidelines, 4.6 [2.2-9.4]; mixed communication, 2.1 [1.1-3.9]). CONCLUSION Prolonged emotional impact affected more than half of Americans self-reporting a medical error. Organizational failure to communicate according to disclosure guidelines after patient-perceived errors may exacerbate harm, particularly for patients at risk of health care disparities.
Collapse
|
6
|
Birkeland S, Bismark M, Barry MJ, Möller S. Complaint behaviour among healthcare users: self-reported complaint experience and complaint proneness in adult men. BMJ Open Qual 2024; 13:e002581. [PMID: 38365433 PMCID: PMC10875482 DOI: 10.1136/bmjoq-2023-002581] [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: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
AIMS When patients are harmed by, or dissatisfied with, healthcare, only a minority will lodge a complaint or file a claim for compensation. This survey aimed to investigate complaint behaviour and inequalities in complaints using self-reports and hypothetical case vignettes. METHODS Cross-sectional, web-based survey among 6755 Danish men aged 45-70 years (response rate=30%). Participants reported their lifetime complaint experience and the likelihood that they would complain in response to hypothetical case vignettes. RESULTS Overall, 4.8% of participants had complained about healthcare. Predictors were younger age (OR 2.08, 95% CI 1.32 to 3.27, p=0.002 45-50 years compared with 65-70 years), chronic illness (OR 1.49, 95% CI 1.12 to 1.98, p=0.006), rural residence (OR 2.11, 95% CI 1.20 to 3.73, p=0.010 comparing least and most populated areas), high healthcare utilisation (OR 1.55, 95% CI 1.18 to 2.03, p=0.002 primary care, and OR 1.97, 95% CI 1.52 to 2.55, p=0.000 hospital care) and decreased agreeableness on the 10-item Big Five personality inventory (OR 0.91, 95% CI 0.83 to 0.99, p=0.034). Complaint experience was associated with increased wish to complain about the treatment in the hypothetical vignettes (p=0.006). CONCLUSIONS Roughly 1 in 20 men reported having complained about healthcare. Complaints were more common among men who were younger, living in rural areas, diagnosed with chronic illness and high users of healthcare services. Prior complaint experience may be associated with a higher proclivity for complaining about future healthcare. Findings suggest differences in the way healthcare users respond to care experiences, pointing to the importance of aligning expectations and providing clear information about treatment options.
Collapse
Affiliation(s)
- Søren Birkeland
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Marie Bismark
- Public Health Law, University of Melbourne, Parkville, Victoria, Australia
| | | | - Sören Möller
- Open Patient data Exploratory Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Liu SK, Bourgeois F, Dong J, Harcourt K, Lowe E, Salmi L, Thomas EJ, Riblet N, Bell SK. What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process. Diagnosis (Berl) 2024; 11:63-72. [PMID: 38114888 PMCID: PMC10875277 DOI: 10.1515/dx-2023-0075] [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: 06/21/2023] [Accepted: 10/18/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Accurate and timely diagnosis relies on close collaboration between patients/families and clinicians. Just as patients have unique insights into diagnostic breakdowns, positive patient feedback may also generate broader perspectives on what constitutes a "good" diagnostic process (DxP). METHODS We evaluated patient/family feedback on "what's going well" as part of an online pre-visit survey designed to engage patients/families in the DxP. Patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) were invited to complete the survey between December 2020 and March 2022. We adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words. RESULTS In total, 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Of all participants, 1,578 volunteered positive feedback, ranging from 1-79 words. Qualitative analysis of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). Compared to primary care, subspecialty comments showed the same overall rankings. Within Relationships, patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). Within Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %). CONCLUSIONS Patients/families valued relationships with clinicians above all else in the DxP, emphasizing the importance of supporting clinicians to nurture effective relationships and relationship-centered care in the DxP.
Collapse
Affiliation(s)
- Stephen K. Liu
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Fabienne Bourgeois
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Joe Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kendall Harcourt
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth Lowe
- Patient and Family Advisory Council, Department of Social Work, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric J. Thomas
- Department of Medicine, University of Texas McGovern Medical School, Houston, TX, USA
- Center for Healthcare Quality and Safety, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Natalie Riblet
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sigall K. Bell
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
8
|
O'Dowd E, Lydon S, Ward ME, Kane M, Geary U, Rudland C, O'Connor P. The impact of the COVID-19 pandemic on patient complaints within one Irish teaching hospital. Ir J Med Sci 2023; 192:2563-2571. [PMID: 36787028 PMCID: PMC9926407 DOI: 10.1007/s11845-023-03282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic dramatically impacted the delivery of hospital care in terms of quality and safety. OBJECTIVES To examine complaints from two time points, quarter 4 (Q4) 2019 (pre-pandemic) and Q4 2020 (second wave), and explore whether there was a difference in the frequency and/or content of complaints. METHODS A retrospective analysis of complaints from one Irish hospital was conducted using the Healthcare Complaints Analysis Tool (HCAT). Within each complaint, the content, severity, harm reported by the patient, and stage of care were categorised. The complaints were analysed using descriptive statistics and chi-square tests of independence. RESULTS There were 146 complaints received in Q4 2019 and 114 in Q4 2020. Complaint severity was significantly higher in Q4 2019 as compared to Q4 2020. However, there were no other significant differences. Institutional processes (e.g. staffing, resources) were the most common reason for complaints (30% in Q4 2019 and 36% in Q4 2020). The majority of complaints were concerned with care on the ward (23% in Q4 2019 and 31% in Q4 2020). CONCLUSIONS The severity of complaints was significantly higher in Q4 2019 than in Q4 2020, which requires further exploration as the reasons for this are unclear. The lack of a difference in the frequency and content of complaints during the two time periods was unexpected. However, this may be linked to a number of factors, including public support for the healthcare system, existing system-level issues in the hospital, or indeed increased staff collaboration in the context of the COVID-19 crisis.
Collapse
Affiliation(s)
- Emily O'Dowd
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Department of Surgical Affairs, RCSI, Dublin, Ireland.
| | - Sinéad Lydon
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Marie E Ward
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin, Ireland
- University of Dublin, Dublin, Ireland
| | - Maria Kane
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin, Ireland
| | - Una Geary
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin, Ireland
| | - Chris Rudland
- National Complaints Governance and Learning Team, Health Service Executive, Catherine Street, Limerick, Ireland
| | - Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Bell SK, Harcourt K, Dong J, DesRoches C, Hart NJ, Liu SK, Ngo L, Thomas EJ, Bourgeois FC. Patient and family contributions to improve the diagnostic process through the OurDX electronic health record tool: a mixed method analysis. BMJ Qual Saf 2023:bmjqs-2022-015793. [PMID: 37604678 PMCID: PMC10879445 DOI: 10.1136/bmjqs-2022-015793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/19/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Accurate and timely diagnosis relies on sharing perspectives among team members and avoiding information asymmetries. Patients/Families hold unique diagnostic process (DxP) information, including knowledge of diagnostic safety blindspots-information that patients/families know, but may be invisible to clinicians. To improve information sharing, we co-developed with patients/families an online tool called 'Our Diagnosis (OurDX)'. We aimed to characterise patient/family contributions in OurDX and how they differed between individuals with and without diagnostic concerns. METHOD We implemented OurDX in two academic organisations serving patients/families living with chronic conditions in three subspecialty clinics and one primary care clinic. Prior to each visit, patients/families were invited to contribute visit priorities, recent histories and potential diagnostic concerns. Responses were available in the electronic health record and could be incorporated by clinicians into visit notes. We randomly sampled OurDX reports with and without diagnostic concerns for chart review and used inductive and deductive qualitative analysis to assess patient/family contributions. RESULTS 7075 (39%) OurDX reports were submitted at 18 129 paediatric subspecialty clinic visits and 460 (65%) reports were submitted among 706 eligible adult primary care visits. Qualitative analysis of OurDX reports in the chart review sample (n=450) revealed that participants contributed DxP information across 10 categories, most commonly: clinical symptoms/medical history (82%), tests/referrals (54%) and diagnosis/next steps (51%). Participants with diagnostic concerns were more likely to contribute information on DxP risks including access barriers, recent visits for the same problem, problems with tests/referrals or care coordination and communication breakdowns, some of which may represent diagnostic blindspots. CONCLUSION Partnering with patients and families living with chronic conditions through OurDX may help clinicians gain a broader perspective of the DxP, including unique information to coproduce diagnostic safety.
Collapse
Affiliation(s)
- Sigall K Bell
- Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kendall Harcourt
- Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Joe Dong
- Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Catherine DesRoches
- Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas J Hart
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stephen K Liu
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Long Ngo
- Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric J Thomas
- Department of Internal Medicine, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas, USA
- UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
| | - Fabienne C Bourgeois
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Bell SK, Dong ZJ, Desroches CM, Hart N, Liu S, Mahon B, Ngo LH, Thomas EJ, Bourgeois F. Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool. J Am Med Inform Assoc 2023; 30:692-702. [PMID: 36692204 PMCID: PMC10018262 DOI: 10.1093/jamia/ocad003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Patients and families are key partners in diagnosis, but methods to routinely engage them in diagnostic safety are lacking. Policy mandating patient access to electronic health information presents new opportunities. We tested a new online tool ("OurDX") that was codesigned with patients and families, to determine the types and frequencies of potential safety issues identified by patients/families with chronic health conditions and whether their contributions were integrated into the visit note. METHODS Patients/families at 2 US healthcare sites were invited to contribute, through an online previsit survey: (1) visit priorities, (2) recent medical history/symptoms, and (3) potential diagnostic concerns. Two physicians reviewed patient-reported diagnostic concerns to verify and categorize diagnostic safety opportunities (DSOs). We conducted a chart review to determine whether patient contributions were integrated into the note. We used descriptive statistics to report implementation outcomes, verification of DSOs, and chart review findings. RESULTS Participants completed OurDX reports in 7075 of 18 129 (39%) eligible pediatric subspecialty visits (site 1), and 460 of 706 (65%) eligible adult primary care visits (site 2). Among patients reporting diagnostic concerns, 63% were verified as probable DSOs. In total, probable DSOs were identified by 7.5% of pediatric and adult patients/families with underlying health conditions, respectively. The most common types of DSOs were patients/families not feeling heard; problems/delays with tests or referrals; and problems/delays with explanation or next steps. In chart review, most clinician notes included all or some patient/family priorities and patient-reported histories. CONCLUSIONS OurDX can help engage patients and families living with chronic health conditions in diagnosis. Participating patients/families identified DSOs and most of their OurDX contributions were included in the visit note.
Collapse
Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhiyong J Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine M Desroches
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Hart
- Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Liu
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brianna Mahon
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric J Thomas
- Department of Medicine, UT Houston—Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
- McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Fabienne Bourgeois
- Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Han S, Xu M, Lao J, Liang Z. Collecting Patient Feedback as a Means of Monitoring Patient Experience and Hospital Service Quality - Learning from a Government-led Initiative. Patient Prefer Adherence 2023; 17:385-400. [PMID: 36819644 PMCID: PMC9936816 DOI: 10.2147/ppa.s397444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE Patient feedback plays a significant role in hospital service improvement. However, how to encourage patient feedback that can guide hospital service improvement is still being explored. By examining patient feedback data related to a tertiary hospital in China that was collected from the "12345" Government Service Convenience Hotline (GSCH), the paper discusses the learnings from GSCH in encouraging patient feedback and how quality improvement initiatives have effected the number and types of complaints made by patients and their families via GSCH. METHODS The study retrospectively collected and analyzed complaints on a Tertiary General University-affiliated hospital made via GSCH between 2016 and 2020. Patient care process-related complaints were coded using the health care complaint analysis tool (HCAT) and other complaint data were categorized based on the nature of the complaints. The autoregressive integrated moving average (ARIMA) models and mosaic plots were used to observe complaints trends and different complaint variables, respectively. The relationship between various quality improvement initiatives introduced since 2018 and patient complaints was also tested. RESULTS Close to 67% (n=2688) of calls made to the GSCH hotlines about the hospital were classified as a complaint including 60.6% vs 39.4% related to patient care process and nonpatient care process, respectively. For patient care process-related complaints, specifically against departments and personnel, 57.72% (n=961) were on clinical departments and 55.87% (n=471) were on doctors. Comparing the proportion of the complaint data in different categories in the two-year period of 2017-2018 and 2019-2020, an increase in management problems (47.73% vs 58.50%, P<0.001) and decrease in relationship problems (33.65% vs 25.69%, P=0.002) were recorded. CONCLUSION A unified, transparent, and impartial GSCH platform greatly encourages feedback from patients and families. Feedbacks provide evidence to guide health care organizations in improving the overall experience of patients and the quality of services that they provide.
Collapse
Affiliation(s)
- Sirou Han
- Hospital Administration Department, The Second Affiliated Hospital of Shandong First Medical University, Taian, People’s Republic of China
- School of Public Health, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, People’s Republic of China
| | - Min Xu
- Hospital Administration Department, The Second Affiliated Hospital of Shandong First Medical University, Taian, People’s Republic of China
- Correspondence: Min Xu, Hospital Administration Department, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Taian, Shandong Province, 271000, People’s Republic of China, Tel +86-137-9112-0603, Email
| | - Jiahui Lao
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People’s Republic of China
| | - Zhanming Liang
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Zhanming Liang, College of Public Health, Medical and Veterinary Sciences, James Cook University, JCU Townsville Campus, Douglas, Building 41, Room 217, Townsville, QLD, 4870, Australia, Tel +61-7-4781-5040, Email
| |
Collapse
|
13
|
Wang SC, Chu NF, Tang PL, Pan TC, Pan LF. Using Healthcare Complaints Analysis Tool to Evaluate Patient Complaints during the COVID-19 Pandemic at a Medical Center in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:310. [PMID: 36612630 PMCID: PMC9819617 DOI: 10.3390/ijerph20010310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this study is to evaluate patient complaints using the Healthcare Complaints Analysis Tool (HCAT) during the COVID-19 pandemic in 2021 in Taiwan. Additionally, the study examines the distribution and type of patient complaints before and during the COVID-19 pandemic to provide a better clinical procedure, hospital management and patient relationship. This study utilizes a cross-sectional design. We collected patient complaints from January 2021 to December 2021 at a medical center in Southern Taiwan. Using the Healthcare Complaints Analysis Tool (HCAT), the patient complaints are classified and coded into three major domains (clinical, management and relationship), and seven problem categories (quality, safety, environment, institutional process, respect and patient rights, listening and communication). We further compared and categorized the complaints based on whether they were COVID-19-related or not and whether it was before or during the COVID-19 pandemic to understand the differences in patient complaints. In total, we collected 584 events of patient complaints. Based on the HCAT domains, the complaints about management were the highest, at 52.9%, followed by complaints about relationship, about 37.7%. According to the types of problem, the complaints about the environment were the highest, about 32.5% (190/584), followed by communication at about 29.6% (173/584), and institutional process at about 20.4% (119/584). There were 178 COVID-19-related complaints and they were made more frequently during Q3 and Q4 (from mid-June to December) which was the pandemic period in 2021 in Taiwan. Among the COVID-19-related complaints, the most frequent were in the environment domain with 114 cases (about 65.7% of COVID-19-related complaints). The domains of patient complaints were statistically different between COVID-19-related and non-related (p < 0.001). During the COVID-19 pandemic, the proportion of COVID-19-related complaints increased 1.67 times (117/312 vs. 61/272, p < 0.001). Both prior to and during the COVID-19 pandemic, management-related complaints represented the highest domain. During the COVID-19 pandemic, the implementation of infectious disease prevention and control policies and actions may have developed some inconvenience and difficulty in seeking medical practice and process. These characteristics (complaints) are more prominent, and timely and patient-first consideration is required immediately to build up better clinical procedures, the healthcare environment and comprehensive communication. Using the HCAT can allow health centers or health practitioners to understand the needs and demands of patients through complaints, provide friendly medical and health services, avoid unequal information transmission, build trust in doctor−patient relationships and improve patients’ safety.
Collapse
Affiliation(s)
- Shu-Chuan Wang
- Department of Medical Affair Administration, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Nain-Feng Chu
- Division of Occupational Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Tzu-Cheng Pan
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Li-Fei Pan
- General Affairs Administration, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| |
Collapse
|
14
|
Giardina TD, Shahid U, Mushtaq U, Upadhyay DK, Marinez A, Singh H. Creating a Learning Health System for Improving Diagnostic Safety: Pragmatic Insights from US Health Care Organizations. J Gen Intern Med 2022; 37:3965-3972. [PMID: 35650467 PMCID: PMC9640494 DOI: 10.1007/s11606-022-07554-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify challenges and pragmatic strategies for improving diagnostic safety at an organizational level using concepts from learning health systems METHODS: We interviewed 32 safety leaders across the USA on how their organizations approach diagnostic safety. Participants were recruited through email and represented geographically diverse academic and non-academic settings. The interview included questions on culture of reporting and learning from diagnostic errors; data gathering and analysis activities; diagnostic training and educational activities; and engagement of clinical leadership, staff, patients, and families in diagnostic safety activities. We conducted an inductive content analysis of interview transcripts and two reviewers coded all data. RESULTS Of 32 participants, 12 reported having a specific program to address diagnostic errors. Multiple barriers to implement diagnostic safety activities emerged: serious concerns about psychological safety associated with diagnostic error; lack of infrastructure for measurement, monitoring, and improvement activities related to diagnosis; lack of leadership investment, which was often diverted to competing priorities related to publicly reported measures or other incentives; and lack of dedicated teams to work on diagnostic safety. Participants provided several strategies to overcome barriers including adapting trigger tools to identify safety events, engaging patients in diagnostic safety, and appointing dedicated diagnostic safety champions. CONCLUSIONS Several foundational building blocks related to learning health systems could inform organizational efforts to reduce diagnostic error. Promoting an organizational culture specific to diagnostic safety, using science and informatics to improve measurement and analysis, leadership incentives to build institutional capacity to address diagnostic errors, and patient engagement in diagnostic safety activities can enable progress.
Collapse
Affiliation(s)
- Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA.
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Umber Shahid
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Umair Mushtaq
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Divvy K Upadhyay
- Division of Quality, Safety and Patient Experience, Geisinger, Danville, PA, USA
| | - Abigail Marinez
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
15
|
Ramsey L, Lawton R, Sheard L, O’Hara J. Exploring the sociocultural contexts in which healthcare staff respond to and use online patient feedback in practice: In-depth case studies of three NHS Trusts. Digit Health 2022; 8:20552076221129085. [PMID: 36276183 PMCID: PMC9580083 DOI: 10.1177/20552076221129085] [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: 09/30/2021] [Accepted: 09/11/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Patients are increasingly reporting about their healthcare experiences online and NHS Trusts are adopting different approaches to responding. However, the sociocultural contexts underpinning these organisational approaches remain unclear. Therefore, we aimed to explore the sociocultural contexts underpinning three organisations who adopted different approaches to responding to online patient feedback. Methods Recruitment of three NHS Trusts was theoretically guided, and determined based on their different approaches to responding to online patient feedback (a nonresponding organisation, a generic responding organisation and an organisation providing transparent, conversational responses). Ethnographic methods were used during a year of fieldwork involving staff interviews, observations of practice and documentary analysis. Three in-depth case studies are presented. Findings The first organisation did not respond to or use online patient feedback as staff were busy firefighting volumes of concerns received in other ways. The second organisation adopted a generic responding style due to resource constraints, fears of public engagement and focus on resolving known issues raised via more traditional feedback sources. The final organisation provided transparent, conversational responses to patients online and described a 10-year journey enabling their desired culture to be embedded. Conclusions We identified a range of barriers facing organisations who ignore or provide generic responses to patient feedback online. We also demonstrated the sociocultural context in which online interactions between staff and patients can be embraced to inform improvement. However, this represented a slow and difficult organisational journey. Further research is needed to better establish how organisations can recognise and overcome barriers to engaging with online patient feedback, and at pace.
Collapse
Affiliation(s)
- Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,Lauren Ramsey, Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ UK.
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,School of Psychology, University of Leeds, Leeds, UK
| | | | - Jane O’Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK,School of Healthcare, University of Leeds, Leeds, UK
| |
Collapse
|
16
|
van Dael J, Reader TW, Gillespie AT, Freise L, Darzi A, Mayer EK. Do national policies for complaint handling in English hospitals support quality improvement? Lessons from a case study. J R Soc Med 2022; 115:390-398. [PMID: 35640642 PMCID: PMC9720291 DOI: 10.1177/01410768221098247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES A range of public inquiries in the English National Health Service have indicated repeating failings in complaint handling, and patients are often left dissatisfied. The complex, bureaucratic nature of complaints systems is often cited as an obstacle to meaningful investigation and learning, but a detailed examination of how such bureaucratic rules, regulations, and infrastructure shape complaint handling, and where change is most needed, remains relatively unexplored. We sought to examine how national policies structure local practices of complaint handling, how they are understood by those responsible for enacting them, and if there are any discrepancies between policies-as-intended and their reality in local practice. DESIGN Case study involving staff interviews and documentary analysis. SETTING A large acute and multi-site NHS Trust in England. PARTICIPANTS Clinical, managerial, complaints, and patient advocacy staff involved in complaint handling at the participating NHS Trust (n=20). MAIN OUTCOME MEASURES Not applicable. RESULTS Findings illustrate four areas of practice where national policies and regulations can have adverse consequences within local practices, and partly function to undermine an improvement-focused approach to complaints. These include muddled routes for raising formal complaints, investigative procedures structured to scrutinize the 'validity' of complaints, futile data collection systems, and adverse incentives and workarounds resulting from bureaucratic performance targets. CONCLUSION This study demonstrates how national policies and regulations for complaint handling can impede, rather than promote, quality improvement in local settings. Accordingly, we propose a number of necessary reforms, including patient involvement in complaints investigations, the establishment of independent investigation bodies, and more meaningful data analysis strategies to uncover and address systemic causes behind recurring complaints.
Collapse
Affiliation(s)
- J van Dael
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK
| | - T W Reader
- Department of Psychological and Behavioural Science, London School of Economics, London WC2A 3LJ, UK
| | - A T Gillespie
- Department of Psychological and Behavioural Science, London School of Economics, London WC2A 3LJ, UK.,Department of Psychology, Bjorknes University, 0456 Oslo, Norway
| | - L Freise
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK
| | - A Darzi
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK.,Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
| | - E K Mayer
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK.,Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
| |
Collapse
|
17
|
O'Dowd E, Lydon S, Lambe K, Rudland C, Hilton A, O'Connor P. Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general practice. Fam Pract 2022; 39:579-585. [PMID: 34537832 PMCID: PMC9295605 DOI: 10.1093/fampra/cmab109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Healthcare complaints are underutilized for quality improvement in general practice. Systematic analysis of complaints has identified hot spots (areas across the care pathway where issues occur frequently) and blind spots (areas across the care pathway that cannot be observed by staff) in secondary care. The Healthcare Complaints Analysis Tool (HCAT) has been adapted to the HCAT(GP). AIMS This study aimed to: (i) assess whether the HCAT(GP) can systematically analyze complaints about general practice; and (ii) identify hot spots and blind spots in general practice. METHODS GP complaints were sampled. Complaints were coded with the HCAT(GP), classified by HCAT(GP) category (e.g. Safety, Environment, Listening), stage of care (e.g. accessing care, referral/follow-up), severity (e.g. low, medium, high), and harm (e.g. none, major). Descriptive statistics were run to identify discrete issues. A chi-square test of independence identified hot spots, and logistic regression was used for blind spots. RESULTS A total of 230 complaints, encompassing 432 issues (i.e. unique problems within complaints), were categorized. Relationship issues (e.g. problems with listening, communication, and patient rights) emerged most frequently (n = 174, 40%). Hot spots were identified in the consultation and the referral/follow-up stages (χ 2(5, n = 432) = 17.931, P < 0.05). A blind spot for multiple issues was identified, with the likelihood of harm increasing with number of issues (odds ratio = 2.02, confidence interval = 1.27-3.23, P < 0.05). CONCLUSIONS Complaints are valuable data for improving general practice. This study demonstrated that the HCAT(GP) can support the systematic analysis of general practice complaints, and identify hot spots and blind spots in care.
Collapse
Affiliation(s)
- Emily O'Dowd
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Chris Rudland
- National Complaints Governance and Learning Team, Health Service Executive, Limerick, Ireland
| | - Aoife Hilton
- National Complaints Governance and Learning Team, Health Service Executive, Limerick, Ireland
| | - Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
18
|
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]
|
19
|
Crosbie C, McDougall A, Pangli H, Abu-Laban RB, Calder LA. College complaints against resident physicians in Canada: a retrospective analysis of Canadian Medical Protective Association data from 2013 to 2017. CMAJ Open 2022; 10:E35-E42. [PMID: 35042693 PMCID: PMC8920540 DOI: 10.9778/cmajo.20210026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An understanding of regulatory complaints against resident physicians is important for practice improvement. We describe regulatory college complaints against resident physicians using data from the Canadian Medical Protective Association (CMPA). METHODS We conducted a retrospective analysis of college complaint cases involving resident doctors closed by the CMPA, a mutual medicolegal defence organization for more than 100 000 physicians, representing an estimated 95% of Canadian physicians. Eligible cases were those closed between 2008 and 2017 (for time trends) or between 2013 and 2017 (for descriptive analyses). To explore the characteristics of college cases, we extracted the reason for complaint, the case outcome, whether the complaint involved a procedure, and whether the complaint stemmed from a single episode or multiple episodes of care. We also conducted a 10-year trend analysis of cases closed from 2008 to 2017, comparing cases involving resident doctors with cases involving only nonresident physicians. RESULTS Our analysis included 142 cases that involved 145 patients. Over the 10-year period, college complaints involving residents increased significantly (p = 0.003) from 5.4 per 1000 residents in 2008 to 7.9 per 1000 in 2017. While college complaints increased for both resident and nonresident physicians over the study period, the increase in complaints involving residents was significantly lower than the increase across all nonresident CMPA members (p < 0.001). For cases from the descriptive analysis (2013-2017), the top complaint was deficient patient assessment (69/142, 48.6%). Some patients (22/145, 15.2%) experienced severe outcomes. Most cases (135/142, 97.9%) did not result in severe physician sanctions. Our classification of complaints found 106 of 163 (65.0%) involved clinical problems, 95 of 163 (58.3%) relationship problems (e.g., communication) and 67 of 163 (41.1%) professionalism problems. In college decisions, 36 of 163 (22.1%) had a classification of clinical problem, 66 of 163 (40.5%) a patient-physician relationship problem and 63 of 163 (38.7%) a professionalism problem. In 63 of 163 (38.7%) college decisions, the college had no criticism. INTERPRETATION Problems with communication and professionalism feature prominently in resident college complaints, and we note the potential for mismatch between patient and health care provider perceptions of care. These results may direct medical education to areas of potential practice improvement.
Collapse
Affiliation(s)
- Charlotte Crosbie
- Department of Emergency Medicine (Crosbie, Abu-Laban), University of British Columbia, Vancouver, BC; Canadian Medical Protective Association (McDougall, Calder); Faculty of Education (McDougall), University of Ottawa, Ottawa, Ont.; Division of Plastic Surgery (Pangli), Faculty of Medicine, University of British Columbia, Vancouver, BC; Clinical Epidemiology Program (Calder), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Allan McDougall
- Department of Emergency Medicine (Crosbie, Abu-Laban), University of British Columbia, Vancouver, BC; Canadian Medical Protective Association (McDougall, Calder); Faculty of Education (McDougall), University of Ottawa, Ottawa, Ont.; Division of Plastic Surgery (Pangli), Faculty of Medicine, University of British Columbia, Vancouver, BC; Clinical Epidemiology Program (Calder), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Harpreet Pangli
- Department of Emergency Medicine (Crosbie, Abu-Laban), University of British Columbia, Vancouver, BC; Canadian Medical Protective Association (McDougall, Calder); Faculty of Education (McDougall), University of Ottawa, Ottawa, Ont.; Division of Plastic Surgery (Pangli), Faculty of Medicine, University of British Columbia, Vancouver, BC; Clinical Epidemiology Program (Calder), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Riyad B Abu-Laban
- Department of Emergency Medicine (Crosbie, Abu-Laban), University of British Columbia, Vancouver, BC; Canadian Medical Protective Association (McDougall, Calder); Faculty of Education (McDougall), University of Ottawa, Ottawa, Ont.; Division of Plastic Surgery (Pangli), Faculty of Medicine, University of British Columbia, Vancouver, BC; Clinical Epidemiology Program (Calder), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Lisa A Calder
- Department of Emergency Medicine (Crosbie, Abu-Laban), University of British Columbia, Vancouver, BC; Canadian Medical Protective Association (McDougall, Calder); Faculty of Education (McDougall), University of Ottawa, Ottawa, Ont.; Division of Plastic Surgery (Pangli), Faculty of Medicine, University of British Columbia, Vancouver, BC; Clinical Epidemiology Program (Calder), Ottawa Hospital Research Institute, Ottawa, Ont.
| |
Collapse
|
20
|
Wray J, Williams C, Oldham G. Testing the Healthcare Complaints Analysis Tool in a Specialist Pediatric Hospital to Assess Potential Utility for Organizational Learning from Complaints. J Patient Exp 2022; 9:23743735221106594. [PMID: 35734468 PMCID: PMC9208030 DOI: 10.1177/23743735221106594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The importance of improving the analysis of complaints about poor healthcare experiences is recognized but often not addressed. We explored the utility of the Healthcare Complaints Assessment Tool for analyzing written complaints in a specialist pediatric hospital receiving relatively few, but complex, complaints. The scoring framework could be applied but, in contrast to previous work, the complexity of complaints was considerably greater. Responses to the complainant were also scored and we identified instances of both higher and lower levels of severity than identified by the complainant, suggesting a novel application of the tool which will be important for institutional learning.
Collapse
Affiliation(s)
- Jo Wray
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, London, UK
| | - Claire Williams
- Patient Experience and Engagement, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Geralyn Oldham
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
21
|
Lemoine MÈ, Brisson J, Blackburn É, Payment JP, Laliberté M. La place de la bioéthique au sein du régime d’examen des plaintes dans le réseau de santé et de services sociaux québécois. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1092952ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
22
|
Epistemic Injustice in Incident Investigations: A Qualitative Study. HEALTH CARE ANALYSIS 2022; 30:254-274. [PMID: 35639265 PMCID: PMC9741561 DOI: 10.1007/s10728-022-00447-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 12/14/2022]
Abstract
Serious incident investigations-often conducted by means of Root Cause Analysis methodologies-are increasingly seen as platforms to learn from multiple perspectives and experiences: professionals, patients and their families alike. Underlying this principle of inclusiveness is the idea that healthcare staff and service users hold unique and valuable knowledge that can inform learning, as well as the notion that learning is a social process that involves people actively reflecting on shared knowledge. Despite initiatives to facilitate inclusiveness, research shows that embracing and learning from diverse perspectives is difficult. Using the concept of 'epistemic injustice', pointing at practices of someone's knowledge being unjustly disqualified or devalued, we analyze the way incident investigations are organized and executed with the aim to understand why it is difficult to embrace and learn from the multiple perspectives voiced in incident investigations. We draw from 73 semi-structured interviews with healthcare leaders, managers, healthcare professionals, incident investigators and inspectors, document analyses and ethnographic observations. Our analysis identified several structures in the incident investigation process, that can promote or hinder an actor's epistemic contribution in the process of incident investigations. Rather than repeat calls to 'involve more' and 'listen better', we encourage policy makers to be mindful of and address the structures that can cause epistemic injustice. This can improve the outcome of incident investigations and can help to do justice to the lived experiences of the involved actors in the aftermath of a serious incident.
Collapse
|
23
|
O'Dowd E, Lydon S, O'Connor P. The adaptation of the 'Healthcare Complaints Analysis Tool' for general practice. Fam Pract 2021; 38:712-717. [PMID: 34180507 DOI: 10.1093/fampra/cmab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient complaints about care in general practice are underutilized as a source of safety improvement data. OBJECTIVE This study aimed to adapt a secondary care complaints analysis tool for use in general practice contexts and assess the validity, reliability and usability of the adapted tool. METHODS The study was conducted in two phases. Phase A: The Healthcare Complaints Analysis Tool (HCAT) designed for use in secondary care was adapted for use in general practice using an iterative six-stage process. Phase B: Participants from key stakeholder groups [General practitioners (n = 5), complaints managers (n = 9), health service researchers (n = 4)]. Participants completed an online survey and analysed 20 fictionalized patient complaints using the adapted tool. Inter-rater reliability and agreement with a referent standard were analysed using Gwet's AC1 statistic. RESULTS Phase A: The HCAT was adapted to the Healthcare Complaints Analysis Tool (General Practice) [HCAT(GP)]. The HCAT(GP) tool consists of three domains (clinical, management and relationship problems), and seven categories. The HCAT(GP) had both content and face validity. Phase B: Inter-rater reliability was substantial for the HCAT(GP) categories (Gwet's AC1 = 0.65). Within-group agreement on the seven HCAT(GP) categories was substantial to perfect (AC1 0.61-0.85). Participants had substantial to perfect agreement with the referent standard across the survey with a mean AC1 of 0.899 (Range 0.76-0.97). CONCLUSIONS This study reports the adaptation of the HCAT(GP) and has established that the tool has sufficient validity, reliability and usability. This adapted tool can be applied to general practice complaints to identify areas for improvement.
Collapse
Affiliation(s)
- Emily O'Dowd
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
24
|
Kaud Y, Lydon S, O'Connor P. Measuring and monitoring patient safety in hospitals in Saudi Arabia. BMC Health Serv Res 2021; 21:1224. [PMID: 34772409 PMCID: PMC8588732 DOI: 10.1186/s12913-021-07228-z] [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: 03/31/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background There is much variability in the measurement and monitoring of patient safety across healthcare organizations. With no recognized standardized approach, this study examines how the key components outlined in Vincent et al’s Measuring and Monitoring Safety (MMS) framework can be utilized to critically appraise a healthcare safety surveillance system. The aim of this study is to use the MMS framework to evaluate the Saudi Arabian healthcare safety surveillance system for hospital care. Methods This qualitative study consisted of two distinct phases. The first phase used document analysis to review national-level guidance relevant to measuring and monitoring safety in Saudi Arabia. The second phase consisted of semi-structured interviews with key stakeholders between May and August 2020 via a video conference call and focused on exploring their knowledge of how patient safety is measured and monitored in hospitals. The MMS framework was used to support data analysis. Results Three documents were included for analysis and 21 semi-structured interviews were conducted with key stakeholders working in the Saudi Arabian healthcare system. A total of 39 unique methods of MMS were identified, with one method of MMS addressing two dimensions. Of these MMS methods: 10 (25 %) were concerned with past harm; 14 (35 %) were concerned with the reliability of safety critical processes, 3 (7.5 %) were concerned with sensitivity to operations, 2 (5 %) were concerned with anticipation and preparedness, and 11 (27.5 %) were concerned with integration and learning. Conclusions The document analysis and interviews show an extensive system of MMS is in place in Saudi Arabian hospitals. The assessment of MMS offers a useful framework to help healthcare organizations and researchers to think critically about MMS, and how the data from different methods of MMS can be integrated in individual countries or health systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07228-z.
Collapse
Affiliation(s)
- Yazeed Kaud
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, County Galway, H91 TK33, Galway, Ireland. .,Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia.
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, 1 Distillery Road, Newcastle, Co Galway, H91 TK33, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, County Galway, H91 TK33, Galway, Ireland
| |
Collapse
|
25
|
Bell SK, Bourgeois F, DesRoches CM, Dong J, Harcourt K, Liu SK, Lowe E, McGaffigan P, Ngo LH, Novack SA, Ralston JD, Salmi L, Schrandt S, Sheridan S, Sokol-Hessner L, Thomas G, Thomas EJ. Filling a gap in safety metrics: development of a patient-centred framework to identify and categorise patient-reported breakdowns related to the diagnostic process in ambulatory care. BMJ Qual Saf 2021; 31:526-540. [PMID: 34656982 DOI: 10.1136/bmjqs-2021-013672] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients and families are important contributors to the diagnostic team, but their perspectives are not reflected in current diagnostic measures. Patients/families can identify some breakdowns in the diagnostic process beyond the clinician's view. We aimed to develop a framework with patients/families to help organisations identify and categorise patient-reported diagnostic process-related breakdowns (PRDBs) to inform organisational learning. METHOD A multi-stakeholder advisory group including patients, families, clinicians, and experts in diagnostic error, patient engagement and safety, and user-centred design, co-developed a framework for PRDBs in ambulatory care. We tested the framework using standard qualitative analysis methods with two physicians and one patient coder, analysing 2165 patient-reported ambulatory errors in two large surveys representing 25 425 US respondents. We tested intercoder reliability of breakdown categorisation using the Gwet's AC1 and Cohen's kappa statistic. We considered agreement coefficients 0.61-0.8=good agreement and 0.81-1.00=excellent agreement. RESULTS The framework describes 7 patient-reported breakdown categories (with 40 subcategories), 19 patient-identified contributing factors and 11 potential patient-reported impacts. Patients identified breakdowns in each step of the diagnostic process, including missing or inaccurate main concerns and symptoms; missing/outdated test results; and communication breakdowns such as not feeling heard or misalignment between patient and provider about symptoms, events, or their significance. The frequency of PRDBs was 6.4% in one dataset and 6.9% in the other. Intercoder reliability showed good-to-excellent reliability in each dataset: AC1 0.89 (95% CI 0.89 to 0.90) to 0.96 (95% CI 0.95 to 0.97); kappa 0.64 (95% CI 0.62, to 0.66) to 0.85 (95% CI 0.83 to 0.88). CONCLUSIONS The PRDB framework, developed in partnership with patients/families, can help organisations identify and reliably categorise PRDBs, including some that are invisible to clinicians; guide interventions to engage patients and families as diagnostic partners; and inform whole organisational learning.
Collapse
Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Fabienne Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine M DesRoches
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joe Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kendall Harcourt
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen K Liu
- Department of Medicine, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Elizabeth Lowe
- Patient and Family Advisory Council, Department of Social Work, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sandy A Novack
- Patient and Family Advisory Council, Department of Social Work, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Suz Schrandt
- Society to Improve Diagnosis in Medicine, Evanston, Illinois, USA
| | - Sue Sheridan
- Society to Improve Diagnosis in Medicine, Evanston, Illinois, USA
| | - Lauge Sokol-Hessner
- Department of Medicine and Department of Health Care Quality, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Glenda Thomas
- Patient and Family Advisory Council, Department of Social Work, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Eric J Thomas
- Department of Medicine, University of Texas McGovern Medical School, Houston, Texas, USA.,Healthcare Quality and Safety, Memorial Hermann Texas Medical Center, Houston, Texas, USA
| |
Collapse
|
26
|
Jones K, Davies B, Stubbs DJ, Komashie A, Burnstein RM, Hutchinson P, Santarius T, Joannides AJ. Can compliment and complaint data inform the care of individuals with chronic subdural haematoma (cSDH)? BMJ Open Qual 2021; 10:bmjoq-2020-001246. [PMID: 34535455 PMCID: PMC8451295 DOI: 10.1136/bmjoq-2020-001246] [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: 10/22/2020] [Accepted: 05/31/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the frequency and nature of complaints and compliments reported to Patient Advice and Liaison (PALS) in individuals undergoing surgery for a chronic subdural haematoma (cSDH). DESIGN A retrospective study of PALS user interactions. SUBJECTS Individuals undergoing treatment for cSDH between 2014 and 2019. METHODS PALS referrals from patients with cSDH between 2014 and 2019 were identified. Case records were reviewed and data on the frequency, nature and factors leading up to the complaint were extracted and coded according to Healthcare Complaints Analysis Tool (HCAT). RESULTS Out of 531 patients identified, 25 (5%) had a PALS interaction, of which 15 (3%) were complaints and 10 (2%) were compliments. HCAT coding showed 8/15 (53%) of complaints were relationship problems, 6/15 (33%) a management problem and 1/15 (7%) other. Of the relationship problems, 6 (75%) were classed as problems with communication and 2 (25%) as a problem with listening. Of the compliments, 9/10 (90%) related to good clinical quality and 1/10 (10%) to staff-patient relationship. Patients were more likely to register a compliment than family members, who in turn were more likely to register a complaint (p<0.005). Complaints coded as a relationship problem had 2/8 (25%) submitted by a patient and 6/8 (75%) submitted by a relative. CONCLUSIONS Using the HCAT, routinely collected PALS data can easily be coded to quantify and provide unique perspective on tertiary care, such as communication. It is readily suited to quality improvement and audit initiatives.
Collapse
Affiliation(s)
- Katherine Jones
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Benjamin Davies
- Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Daniel J Stubbs
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Alexander Komashie
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Rowan M Burnstein
- Neurocritical Care Department and Department of Anaesthesia, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | | | | |
Collapse
|
27
|
Martin GP, Chew S, Dixon-Woods M. Why do systems for responding to concerns and complaints so often fail patients, families and healthcare staff? A qualitative study. Soc Sci Med 2021; 287:114375. [PMID: 34507217 DOI: 10.1016/j.socscimed.2021.114375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/06/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
Healthcare organisations' responses to concerns and complaints often fall short of the expectations of patients and staff who raise them, and substandard responses to concerns and complaints have been implicated in organisational failures. Informed by Habermas's systems theory, we offer new insights into the features of organisations' responses to concerns and complaints that give rise to these problems. We draw on a large qualitative dataset, comprising 88 predominantly narrative interviews with people raising and responding to concerns and complaints in six English NHS organisations. In common with past studies, many participants described frustrations with systems and processes that seemed ill-equipped to deal with concerns of the kinds they raised. Departing from existing analyses, we identify the influence of functional rationality, as conceptualised by Habermas, and embodied in procedures, pathways and scripts for response, in producing this dissatisfaction. Functionally rational processes were well equipped to deal with simple, readily categorised concerns and complaints. They were less well placed to respond adequately to concerns and complaints that were complex, cross-cutting, or irreducible to predetermined criteria for redress and resolution. Drawing on empirical examples and on Habermas's theory of communicative action, we offer suggestions for alternative and supplementary approaches to responding to concerns and complaints that might better address both the expectations of complainants and the improvement of services.
Collapse
Affiliation(s)
- Graham P Martin
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK.
| | - Sarah Chew
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, LE1 7RH, UK
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK
| |
Collapse
|
28
|
Lam BD, Bourgeois F, Dong ZJ, Bell SK. Speaking up about patient-perceived serious visit note errors: Patient and family experiences and recommendations. J Am Med Inform Assoc 2021; 28:685-694. [PMID: 33367831 DOI: 10.1093/jamia/ocaa293] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can inform quality improvements. OBJECTIVE To describe patient and family attitudes, experiences, and barriers related to speaking up about perceived serious note errors. METHODS Mixed method analysis of a 2016 electronic survey of patients and families at 2 northeast US academic medical centers. Participants had active patient portal accounts and at least 1 note available in the preceding 12 months. RESULTS 6913 adult patients (response rate 28%) and 3672 pediatric families (response rate 17%) completed the survey. In total, 8724/9392 (93%) agreed that reporting mistakes improves patient safety. Among 8648 participants who read a note, 1434 (17%) perceived ≥1 mistake. 627/1434 (44%) reported the mistake was serious and 342/627 (56%) contacted their provider. Participants who self-identified as Black or African American, Asian, "other," or "multiple" race(s) (OR 0.50; 95% CI (0.26,0.97)) or those who reported poorer health (OR 0.58; 95% CI (0.37,0.90)) were each less likely to speak up than white or healthier respondents, respectively. The most common barriers to speaking up were not knowing how to report a mistake (61%) and avoiding perception as a "troublemaker" (34%). Qualitative analysis of 476 free-text suggestions revealed practical recommendations and proposed innovations for partnering with patients and families. CONCLUSIONS About half of patients and families who perceived a serious mistake in their notes reported it. Identified barriers demonstrate modifiable issues such as establishing clear mechanisms for reporting and more challenging issues such as creating a supportive culture. Respondents offered new ideas for engaging patients and families in improving note accuracy.
Collapse
Affiliation(s)
- Barbara D Lam
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Fabienne Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Zhiyong J Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
29
|
Coren F, Brown MK, Ikeda DJ, Tietz D, Steinbock C, Baim-Lance A, Agins BD. Beyond tokenism in quality management policy and programming: moving from participation to meaningful involvement of people with HIV in New York State. Int J Qual Health Care 2021; 33:6068878. [PMID: 33415331 DOI: 10.1093/intqhc/mzab004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/07/2020] [Accepted: 01/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Consumer involvement in health-care policy and quality management (QM) programming is a key element in making health systems people-centered. Involvement of health-care consumers in these areas, however, remains underdeveloped and under-prioritized. When consumer involvement is actively realized, few mechanisms for assessing its impact have been developed. The New York State Department of Health (NYSDOH) embraces consumer involvement of people with HIV in QM as a guiding principle, informed by early HIV/AIDS advocacy and a framework of people-centered quality care. METHOD HIV consumer involvement is implemented statewide and informs all quality of care programming as a standard for QM in health-care organizations, implemented through four key several initiatives: (i) a statewide HIV Consumer Quality Advisory Committee; (ii) leadership and QM trainings for consumers; (iii) specific tools and activities to engage consumers in QM activities at state, regional and health-care facility levels and (iv) formal organizational assessments of consumer involvement in health-care facility QM programs. RESULTS We review the literature on this topic and place the methods used by the NYSDOH within a theoretical framework for consumer involvement. CONCLUSION We present a model that offers a paradigm for practical implementation of routine consumer involvement in QM programs that can be replicated in other health-care settings, both disease-specific and general, reflecting the priority of active participation of consumers in QM activities at all levels of the health system.
Collapse
Affiliation(s)
- Freda Coren
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | | | - Daniel J Ikeda
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Daniel Tietz
- New York State Department of Health, AIDS Institute, 90 Church Street, New York, NY 10007, USA
| | - Clemens Steinbock
- New York State Department of Health, AIDS Institute, 90 Church Street, New York, NY 10007, USA
| | - Abigail Baim-Lance
- Veterans Health Administration James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Bruce D Agins
- University of California, San Francisco Institute for Global Health Sciences 550 16th Street, Third Floor, San Francisco, CA 94158, USA
| |
Collapse
|
30
|
Hendrickx I, Voets T, van Dyk P, Kool RB. Using Text Mining Techniques to Identify Health Care Providers With Patient Safety Problems: Exploratory Study. J Med Internet Res 2021; 23:e19064. [PMID: 34313604 PMCID: PMC8367101 DOI: 10.2196/19064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/31/2020] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Regulatory bodies such as health care inspectorates can identify potential patient safety problems in health care providers by analyzing patient complaints. However, it is challenging to analyze the large number of complaints. Text mining techniques may help identify signals of problems with patient safety at health care providers. OBJECTIVE The aim of this study was to explore whether employing text mining techniques on patient complaint databases can help identify potential problems with patient safety at health care providers and automatically predict the severity of patient complaints. METHODS We performed an exploratory study on the complaints database of the Dutch Health and Youth Care Inspectorate with more than 22,000 written complaints. Severe complaints are defined as those cases where the inspectorate contact point experts deemed it worthy of a triage by the inspectorate, or complaints that led to direct action by the inspectorate. We investigated a range of supervised machine learning techniques to assign a severity label to complaints that can be used to prioritize which incoming complaints need the most attention. We studied several features based on the complaints' written content, including sentiment analysis, to decide which were helpful for severity prediction. Finally, we showcased how we could combine these severity predictions and automatic keyword analysis on the complaints database and listed health care providers and their organization-specific complaints to determine the average severity of complaints per organization. RESULTS A straightforward text classification approach using a bag-of-words feature representation worked best for the severity prediction of complaints. We obtained an accuracy of 87%-93% (2658-2990 of 3319 complaints) on the held-out test set and an F1 score of 45%-51% on the severe complaints. The skewed class distribution led to only reasonable recall (47%-54%) and precision (44%-49%) scores. The use of sentiment analysis for severity prediction was not helpful. By combining the predicted severity outcomes with an automatic keyword analysis, we identified several health care providers that could have patient safety problems. CONCLUSIONS Text mining techniques for analyzing complaints by civilians can support inspectorates. They can automatically predict the severity of the complaints, or they can be used for keyword analysis. This can help the inspectorate detect potential patient safety problems, or support prioritizing follow-up supervision activities by sorting complaints based on the severity per organization or per sector.
Collapse
Affiliation(s)
- Iris Hendrickx
- Centre for Language Studies, Centre for Language and Speech Technology, Faculty of Arts, Radboud University, Nijmegen, Netherlands
| | - Tim Voets
- Centre for Language Studies, Centre for Language and Speech Technology, Faculty of Arts, Radboud University, Nijmegen, Netherlands
| | - Pieter van Dyk
- Dutch Health and Youth Care Inspectorate, Utrecht, Netherlands
| | - Rudolf B Kool
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
31
|
McCreaddie M, Benwell B, Gritti A. A qualitative study of National Health Service (NHS) complaint-responses. BMC Health Serv Res 2021; 21:696. [PMID: 34266429 PMCID: PMC8283852 DOI: 10.1186/s12913-021-06733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare complaints are grievances that may be indicative of some system failures, individual failings, or a combination of both. Moreover, the experience of making a complaint, including its outcome, often falls short of patient expectations, particularly in relation to the interpersonal conduct of National Health Service (NHS) staff. Over half of unresolved (local) complaints are subsequently upheld by the ombudsman with others potentially resulting in costly litigation. Method A nuanced discourse analytical approach to analysing the language choices within complaint-responses could potentially provide greater insight into why many local complaints continue to remain unresolved. Over a period of 1 month we collated a data corpus of written complaints and their responses (n = 60) from an NHS healthcare area in Scotland, United Kingdom (UK) following anonymisation by NHS complaint handling staff. We took a qualitative approach to analysing the data drawing upon Discourse Analysis with this paper reporting on the complaint-responses only (n = 59). We had undertaken a similar review of the initial written complaints and this is reported elsewhere. In this paper we examine how, and to what extent, the complaint-responses fully addressed the complainants’ perceived grievances. Results The complaint-responses rarely acknowledged the amount of detail or ‘work’ involved in making the complaint. Complaint-responses constructed complainants’ accounts as subjective by using specific discourse strategies. Further, complaint responses used unintentionality or exceptionality to mitigate sub-standard experiences of care. We also observed the ‘fauxpology’ - a non-apology or false apology (e.g. I am sorry you feel) which imputes the cause of distress to the subjective (and possibly misguided) impressions of the complainant. The complaint-responses thereby evade blame or responsibility for the complainable action by implying that the complainants’ feelings do not align with the facts. Conclusions Complainants and complaint-responders work to different frames of reference. Complaint responders need to engage and align with complainants from the outset to ensure more appropriate complaint- responses. Complaint resolution as opposed to complaint handling could be enhanced by the approach of linguistic analysis and reference to the consumer literature’s justice-based approach to post-complaint behaviour.
Collapse
Affiliation(s)
- May McCreaddie
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Medical University of Bahrain, PO Box 15503, Adliya, Kingdom of Bahrain.
| | - Bethan Benwell
- Faculty of Arts and Humanities, University of Stirling, Dalkeith, Scotland, UK
| | | |
Collapse
|
32
|
Van Dael J, Gillespie A, Reader T, Smalley K, Papadimitriou D, Glampson B, Marshall D, Mayer E. Getting the whole story: Integrating patient complaints and staff reports of unsafe care. J Health Serv Res Policy 2021; 27:41-49. [PMID: 34233536 PMCID: PMC8772011 DOI: 10.1177/13558196211029323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective It is increasingly recognized that patient safety requires heterogeneous insights from a range of stakeholders, yet incident reporting systems in health care still primarily rely on staff perspectives. This paper examines the potential of combining insights from patient complaints and staff incident reports for a more comprehensive understanding of the causes and severity of harm. Methods Using five years of patient complaints and staff incident reporting data at a large multi-site hospital in London (in the United Kingdom), this study conducted retrospective patient-level data linkage to identify overlapping reports. Using a combination of quantitative coding and in-depth qualitative analysis, we then compared level of harm reported, identified descriptions of adjacent events missed by the other party and examined combined narratives of mutually identified events. Results Incidents where complaints and incident reports overlapped (n = 446, reported in 7.6%’ of all complaints and 0.6% of all incident reports) represented a small but critical area of investigation, with significantly higher rates of Serious Incidents and severe harm. Linked complaints described greater harm from safety incidents in 60% of cases, reported many surrounding safety events missed by staff (n = 582), and provided contesting stories of why problems occurred in 46% cases, and complementary accounts in 26% cases. Conclusions This study demonstrates the value of using patient complaints to supplement, test, and challenge staff reports, including to provide greater insight on the many potential factors that may give rise to unsafe care. Accordingly, we propose that a more holistic analysis of critical safety incidents can be achieved through combining heterogeneous data from different viewpoints, such as through the integration of patient complaints and staff incident reporting data.
Collapse
Affiliation(s)
- Jackie Van Dael
- Research Associate, NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, 4615Imperial College London, Imperial College London, UK
| | - Alex Gillespie
- Associate Professor, Department of Psychological and Behavioural Science, London School of Economics, UK
| | - Tom Reader
- Associate Professor, Department of Psychological and Behavioural Science, London School of Economics, UK
| | - Katelyn Smalley
- PhD Candidate, NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, 4615Imperial College London, Imperial College London, UK
| | - Dimitri Papadimitriou
- Deputy Research Informatics Programme Manager, Imperial College Healthcare NHS Trust, London, UK
| | - Ben Glampson
- Research Informatics Programme Manager, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel Marshall
- Complaints and Service Improvement Manager, Imperial College Healthcare NHS Trust, London, UK
| | - Erik Mayer
- Clinical Senior Lecturer, NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, 4615Imperial College London, Imperial College London, UK
| |
Collapse
|
33
|
Anderson MP, Hyrkas EK. Patient and family perceptions of an inpatient journal. Nursing 2021; 51:62-68. [PMID: 34157005 DOI: 10.1097/01.nurse.0000754044.26660.0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marguerite Peggy Anderson
- At Maine Medical Center in Portland, Me., Marguerite "Peggy" Anderson is the nursing director and Eira Kristiina Hyrkas is the director of the Center for Nursing Research and Quality Outcomes. Paul Bellfy and Paulette Gallant volunteered and contributed their time and effort to this study
| | | |
Collapse
|
34
|
Andersson I, Bååth C, Nilsson J, Eklund AJ. A scoping review-Missed nursing care in community healthcare contexts and how it is measured. Nurs Open 2021; 9:1943-1966. [PMID: 34033697 PMCID: PMC9190696 DOI: 10.1002/nop2.945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Aim To examine the extent and nature of missed nursing care in elderly care in community healthcare contexts from the perspective of healthcare staff, and to identify instruments used to measure missed nursing care and the content of these instruments. Design Scoping review. Methods Searches were conducted in the CINAHL, PubMed, Scopus and Google Scholar databases in March 2020. The selection process followed the PRISMA flow diagram. Results Sixteen research papers were found from nine countries. The instruments used in the studies were Basel Extent of Rationing of Nursing Care for nursing homes (BERNCA‐NH), modified MISSCARE survey and study‐specific instruments or items. The item content differed, as did the number of items, which was between one and 44. The studies reported values for missed nursing care, as well as described reasons for and/or the relation between missed nursing care and organization, working climate and patient outcomes.
Collapse
Affiliation(s)
- Ingrid Andersson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anna Josse Eklund
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
35
|
Busch SH, Kyanko KA. Incorrect Provider Directories Associated With Out-Of-Network Mental Health Care And Outpatient Surprise Bills. Health Aff (Millwood) 2021; 39:975-983. [PMID: 32479225 DOI: 10.1377/hlthaff.2019.01501] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mental health services are up to six times more likely than general medical services to be delivered by an out-of-network provider, in part because many psychiatrists do not accept commercial insurance. Provider directories help patients identify in-network providers, although directory information is often not accurate. We conducted a national survey of privately insured patients who received specialty mental health treatment. We found that 44 percent had used a mental health provider directory and that 53 percent of these patients had encountered directory inaccuracies. Those who encountered inaccuracies were more likely (40 percent versus 20 percent) to be treated by an out-of-network provider and four times more likely (16 percent versus 4 percent) to receive a surprise outpatient out-of-network bill (that is, they did not initially know that a provider was out of network). A federal standard for directory accuracy, stronger enforcement of existing laws with insurers liable for directory errors, and additional monitoring by regulators may be needed.
Collapse
Affiliation(s)
- Susan H Busch
- Susan H. Busch is a professor in the Department of Health Policy and Management, Yale School of Public Health, in New Haven, Connecticut
| | - Kelly A Kyanko
- Kelly A. Kyanko is an assistant professor in the Department of Population Health, New York University Langone Health, in New York City
| |
Collapse
|
36
|
Morsø L, Walløe S, Birkeland S, Mikkelsen KL, Gudex C, Bogh SB. Quantification of Complaint and Compensation Cases by Introducing a Danish Translated and Cross-Cultural Adapted Edition of the Healthcare Complaints Analysis Tool. Risk Manag Healthc Policy 2021; 14:1319-1326. [PMID: 33824609 PMCID: PMC8018441 DOI: 10.2147/rmhp.s290111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The study aimed to translate and cross-culturally adapt the English version of the HCAT to produce a Danish HCAT version and to test the Danish version’s reliability. Methods We used best-practice guidelines for linguistic translations and cultural adaptations. For cross-cultural adaptation, we conducted forward and back translation followed by expert committee review. Subsequently, two researchers assessed 140 complaint cases to test intra- and inter-rater reliability of the Danish HCAT version. We used descriptive statistics for distributions and tested for differences between English and Danish editions Intra- and inter-rater reliability used Gwet’s AC1 statistics, applying quadratic weights to assign more weight to large discrepancies. Results The back translations showed both semantic and conceptual differences, and the expert committee thus discussed the meaning of the wording in the HCAT guide and coding form to ensure that the Danish version would be conceptually similar to the English version but also culturally appropriate for Danish settings. There was discussion about how to use the coding form to graduate problem severity, and this led to some altered wording. Pilot testing revealed the need for two new categories of “hospital-acquired infection” and “involvement of patients’ relatives”. The problem categories of the HCAT-DK showed “substantial” intra- and inter-rater reliability (0.79, and 0.79 to 0.85). In addition, there was a “substantial” agreement (0.70 to 0.73) between the original HCAT and the HCAT-DK version. Conclusion The study translated and cross-culturally adapted the English HCAT version to produce a Danish HCAT version. Cultural and conceptual differences led to adjustments and to addition of two extra items in the HCAT-DK. The Danish version showed “substantial” intra- and inter-rater reliability and is considered suitable for coding complaint and compensation cases in Danish health care.
Collapse
Affiliation(s)
- Lars Morsø
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense C, DK-5000, Denmark
| | - Sisse Walløe
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense C, DK-5000, Denmark
| | - Søren Birkeland
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense C, DK-5000, Denmark
| | | | - Claire Gudex
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense C, DK-5000, Denmark
| | - Søren Bie Bogh
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense C, DK-5000, Denmark
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Bourgeois FC, Fossa A, Gerard M, Davis ME, Taylor YJ, Connor CD, Vaden T, McWilliams A, Spencer MD, Folcarelli P, Bell SK. A patient and family reporting system for perceived ambulatory note mistakes: experience at 3 U.S. healthcare centers. J Am Med Inform Assoc 2021; 26:1566-1573. [PMID: 31504576 DOI: 10.1093/jamia/ocz142] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/09/2019] [Accepted: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study sought to test a patient and family online reporting system for perceived ambulatory visit note inaccuracies. MATERIALS AND METHODS We implemented a patient and family electronic reporting system at 3 U.S. healthcare centers: a northeast urban academic adult medical center (AD), a northeast urban academic pediatric medical center (PED), and a southeast nonprofit hospital network (NET). Patients and families reported potential documentation inaccuracies after reading primary care and subspecialty visit notes. Results were characterized using descriptive statistics and coded for clinical relevance. RESULTS We received 1440 patient and family reports (780 AD, 402 PED, and 258 NET), and 27% of the reports identified a potential inaccuracy (25% AD, 35% PED, 28% NET). Among these, patients and families indicated that the potential inaccuracy was important or very important in 58% of reports (55% AD, 55% PED, 71% NET). The most common types of potential inaccuracies included description of symptoms (21%), past medical problems (21%), medications (18%), and important information that was missing (15%). Most patient- and family-reported inaccuracies resulted in a change to care or to the medical record (55% AD, 67% PED, data not available at NET). DISCUSSION About one-quarter of patients and families using an online reporting system identified potential documentation inaccuracies in visit notes and more than half were considered important by patients and clinicians, underscoring the potential role of patients and families as ambulatory safety partners. CONCLUSIONS Partnering with patients and families to obtain reports on inaccuracies in visit notes may contribute to safer care. Mechanisms to encourage greater use of patient and family reporting systems are needed.
Collapse
Affiliation(s)
- Fabienne C Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alan Fossa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Macda Gerard
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Marion E Davis
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Yhenneko J Taylor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Crystal D Connor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Tracela Vaden
- Department of Internal Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Andrew McWilliams
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA.,Department of Internal Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Melanie D Spencer
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Patricia Folcarelli
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
39
|
Alemu W, Girma E, Mulugeta T. Patient awareness and role in attaining healthcare quality: A qualitative, exploratory study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
Singh H, Bradford A, Goeschel C. Operational measurement of diagnostic safety: state of the science. ACTA ACUST UNITED AC 2020; 8:51-65. [PMID: 32706749 DOI: 10.1515/dx-2020-0045] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022]
Abstract
Reducing the incidence of diagnostic errors is increasingly a priority for government, professional, and philanthropic organizations. Several obstacles to measurement of diagnostic safety have hampered progress toward this goal. Although a coordinated national strategy to measure diagnostic safety remains an aspirational goal, recent research has yielded practical guidance for healthcare organizations to start using measurement to enhance diagnostic safety. This paper, concurrently published as an Issue Brief by the Agency for Healthcare Research and Quality, issues a "call to action" for healthcare organizations to begin measurement efforts using data sources currently available to them. Our aims are to outline the state of the science and provide practical recommendations for organizations to start identifying and learning from diagnostic errors. Whether by strategically leveraging current resources or building additional capacity for data gathering, nearly all organizations can begin their journeys to measure and reduce preventable diagnostic harm.
Collapse
Affiliation(s)
- Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, 2002 Holcombe Blvd. #152, Houston, TX, USA
| | - Andrea Bradford
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christine Goeschel
- MedStar Health Institute for Quality and Safety, MD, USA
- Department of Medicine, Georgetown University, Washington, DC, USA
| |
Collapse
|
43
|
O'Dowd E, Lydon S, Madden C, O'Connor P. A systematic review of patient complaints about general practice. Fam Pract 2020; 37:297-305. [PMID: 31742596 DOI: 10.1093/fampra/cmz082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Health care complaints are an underutilized resource for quality and safety improvement. Most research on health care complaints is focused on secondary care. However, there is also a need to consider patient safety in general practice, and complaints could inform quality and safety improvement. OBJECTIVE This review aimed to synthesize the extant research on complaints in general practice. METHODS Five electronic databases were searched: Medline, Web of Science, CINAHL, PsycINFO and Academic Search Complete. Peer-reviewed studies describing the content, impact of and motivation for complaints were included and data extracted. Framework synthesis was conducted using the Healthcare Complaints Analysis Tool (HCAT) as an organizing framework. Methodological quality was appraised using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). RESULTS The search identified 2960 records, with 21 studies meeting inclusion criteria. Methodological quality was found to be variable. The contents of complaints were classified using the HCAT, with 126 complaints (54%) classified in the Clinical domain, 55 (23%) classified as Management and 54 (23%) classified as Relationships. Motivations identified for making complaints included quality improvement for other patients and monetary compensation. Complaints had both positive and negative impacts on individuals and systems involved. CONCLUSION This review highlighted the high proportion of clinical complaints in general practice compared to secondary care, patients' motivations for making complaints and the positive and negative impacts that complaints can have on health care systems. Future research focused on the reliable coding of complaints and their use to improve quality and safety in general practice is required.
Collapse
Affiliation(s)
- Emily O'Dowd
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Caoimhe Madden
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
44
|
Gillespie A, Reader TW. Identifying and encouraging high-quality healthcare: an analysis of the content and aims of patient letters of compliment. BMJ Qual Saf 2020; 30:484-492. [PMID: 32641354 PMCID: PMC8142452 DOI: 10.1136/bmjqs-2019-010077] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 03/17/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although healthcare institutions receive many unsolicited compliment letters, these are not systematically conceptualised or analysed. We conceptualise compliment letters as simultaneously identifying and encouraging high-quality healthcare. We sought to identify the practices being complimented and the aims of writing these letters, and we test whether the aims vary when addressing front-line staff compared with senior management. METHODS A national sample of 1267 compliment letters was obtained from 54 English hospitals. Manual classification examined the practices reported as praiseworthy, the aims being pursued and who the letter was addressed to. RESULTS The practices being complimented were in the relationship (77% of letters), clinical (50%) and management (30%) domains. Across these domains, 39% of compliments focused on voluntary non-routine extra-role behaviours (eg, extra-emotional support, staying late to run an extra test). The aims of expressing gratitude were to acknowledge (80%), reward (44%) and promote (59%) the desired behaviour. Front-line staff tended to receive compliments acknowledging behaviour, while senior management received compliments asking them to reward individual staff and promoting the importance of relationship behaviours. CONCLUSIONS Compliment letters reveal that patients value extra-role behaviour in clinical, management and especially relationship domains. However, compliment letters do more than merely identify desirable healthcare practices. By acknowledging, rewarding and promoting these practices, compliment letters can potentially contribute to healthcare services through promoting desirable behaviours and giving staff social recognition.
Collapse
Affiliation(s)
- Alex Gillespie
- Department of Psychological & Behavioural Science, London School of Economics, London, UK
| | - Tom W Reader
- Department of Psychological & Behavioural Science, London School of Economics, London, UK
| |
Collapse
|
45
|
Bell SK, Delbanco T, Elmore JG, Fitzgerald PS, Fossa A, Harcourt K, Leveille SG, Payne TH, Stametz RA, Walker J, DesRoches CM. Frequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory Care Notes. JAMA Netw Open 2020; 3:e205867. [PMID: 32515797 PMCID: PMC7284300 DOI: 10.1001/jamanetworkopen.2020.5867] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/14/2020] [Indexed: 12/18/2022] Open
Abstract
Importance As health information transparency increases, patients more often seek their health data. More than 44 million patients in the US can now readily access their ambulatory visit notes online, and the practice is increasing abroad. Few studies have assessed documentation errors that patients identify in their notes and how these may inform patient engagement and safety strategies. Objective To assess the frequency and types of errors identified by patients who read open ambulatory visit notes. Design, Setting, and Participants In this survey study, a total of 136 815 patients at 3 US health care organizations with open notes, including 79 academic and community ambulatory care practices, received invitations to an online survey from June 5 to October 20, 2017. Patients who had at least 1 ambulatory note and had logged onto the portal at least once in the past 12 months were included. Data analysis was performed from July 3, 2018, to April 27, 2020. Exposures Access to ambulatory care open notes through patient portals for up to 7 years (2010-2017). Main Outcomes and Measures Proportion of patients reporting a mistake and how serious they perceived the mistake to be, factors associated with finding errors characterized by patients as serious, and categories of patient-reported errors. Results Of 136 815 patients who received survey invitations, 29 656 (21.7%) responded and 22 889 patients (mean [SD] age, 55.16 [15.96] years; 14 447 [63.1%] female; 18 301 [80.0%] white) read 1 or more notes in the past 12 months and completed error questions. Of these patients, 4830 (21.1%) reported a perceived mistake and 2043 (42.3%) reported that the mistake was serious (somewhat serious: 1563 [32.4%]; very serious: 480 [9.9%]). In multivariable analysis, female patients (relative risk [RR], 1.79; 95% CI, 1.72-1.85), more educated patients (RR, 1.38; 95% CI, 1.29-1.48), sicker patients (RR, 1.89; 95% CI, 1.84-1.94), those aged 45 to 64 years (RR, 2.23; 95% CI, 2.06-2.42), those 65 years or older (RR, 2.00; 95% CI, 1.73-2.32), and those who read more than 1 note (2-3 notes: RR, 1.82; 95% CI, 1.34-2.47; ≥4 notes: RR, 3.09; 95% CI, 2.02-4.73) were more likely to report a mistake that they found to be serious compared with their reference groups. After categorization of patient-reported very serious mistakes, those specifically mentioning the word diagnosis or describing a specific error in current or past diagnoses were most common (98 of 356 [27.5%]), followed by inaccurate medical history (85 of 356 [23.9%]), medications or allergies (50 of 356 [14.0%]), and tests, procedures, or results (30 of 356 [8.4%]). A total of 23 (6.5%) reflected notes reportedly written on the wrong patient. Of 433 very serious errors, 255 (58.9%) included at least 1 perceived error potentially associated with the diagnostic process (eg, history, physical examination, tests, referrals, and communication). Conclusions and Relevance In this study, patients who read ambulatory notes online perceived mistakes, a substantial proportion of which they found to be serious. Older and sicker patients were twice as likely to report a serious error compared with younger and healthier patients, indicating important safety and quality implications. Sharing notes with patients may help engage them to improve record accuracy and health care safety together with practitioners.
Collapse
Affiliation(s)
- Sigall K. Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Tom Delbanco
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Joann G. Elmore
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | | | - Alan Fossa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Epidemiology, University of Michigan, Ann Arbor
| | - Kendall Harcourt
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Suzanne G. Leveille
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts, Boston
| | - Thomas H. Payne
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Rebecca A. Stametz
- Steele Institute for Health Innovation, Geisinger, Danville, Pennsylvania
| | - Jan Walker
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Catherine M. DesRoches
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
46
|
Giardina TD, Royse KE, Khanna A, Haskell H, Hallisy J, Southwick F, Singh H. Health Care Provider Factors Associated with Patient-Reported Adverse Events and Harm. Jt Comm J Qual Patient Saf 2020; 46:282-290. [PMID: 32362355 DOI: 10.1016/j.jcjq.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/31/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients can provide valuable information missing from traditional sources of safety data, thus adding new insights about factors that lead to preventable harm. In this study, researchers determined associations between patient-reported contributory factors and patient-reported harms experienced after an adverse event (AE). METHODS A secondary analysis was conducted of a national sample of patient-reported AEs (surgical, medication, diagnostic, and hospital-acquired infection) gathered through an online questionnaire between January 2010 and February 2016. Generalized logit multivariable regression was used to assess the association between patient-reported contributory factors and patient-reported harms (grouped as nonphysical harm only, physical harm only, physical harm and emotional or financial harm, and all three harms) and adjusted for patient and AE characteristics. RESULTS One third of patients (32.6%) reported experiencing all three harms, 27.3% reported physical harms and one additional harm, 25.5% reported physical harms only, and 14.7% reported nonphysical harms only. Patients reporting all three harms were 2.5 times more likely to have filed a report with a responsible authority (95% confidence interval [CI] = 1.23-5.01) and 3.3 times more likely to have also experienced a surgical complication (95% CI = 1.42-7.51). Odds of reporting problems related to communication between clinician and patients/families or clinician-related behavioral issues was 13% higher in those experiencing all three harm types (95% CI = 1.07-1.19). CONCLUSION Patients' experiences are important to identify safety issues and reduce harm and should be included in patient safety measurement and improvement activities. These findings underscore the need for policy and practice changes to identify, address, and support harmed patients.
Collapse
|
47
|
Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
|
48
|
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.
Collapse
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
| |
Collapse
|
49
|
An Opportunity to Engage Obstetrics and Gynecology Patients Through Shared Visit Notes. Obstet Gynecol 2020; 134:128-137. [PMID: 31188333 DOI: 10.1097/aog.0000000000003309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess obstetrics and gynecology patients' interest in reading their ambulatory visit notes, identification of documentation errors, and perceptions of sensitive language through a quality improvement (QI) initiative. METHODS Beginning April 2016, as part of a QI project all obstetrics and gynecology patients (except family planning) were invited to read their ambulatory visit notes and provide feedback using a patient reporting tool codeveloped with patients. Two physicians with safety expertise reviewed all patient-reported errors over the first 16 months. RESULTS Among obstetrics and gynecology patients with an active portal account and an available note, 6,594 of 9,550 (69%) read at least one note. Two hundred twelve (3.2%) patients used the electronic reporting tool, submitting a total of 232 reports, in a "natural" environment with no advertisement, incentives, or clinician encouragement. In total, 94% felt they understood the notes, 95% understood the next steps in the care plan, and 92% felt the notes accurately described their visit. Of all reports, 27% of patients identified inaccuracies in the notes, including descriptions of symptoms (29%); family history (21%); medications (15%); health problems (15%); social history and physical examination, including elements that were reportedly documented but not performed (each 11%). Patients rated inaccuracies as important in 58% of reports, and, on clinician review, 75% of patient-reported mistakes had the potential to affect care. Among all reports, 7% of patients indicated bothersome words. More than half (56%) of patients included voluntary positive feedback such as appreciation for the health care provider, reassurance from notes, greater visit recall and care plan adherence, and positive effects on the patient-doctor relationship. DISCUSSION Obstetrics and gynecology patients are interested in reading notes, which can promote engagement and safety. Few patients provided feedback, but those who did identified documentation inaccuracies in about one quarter of reports; the majority were relevant to care. Greater outreach and patient encouragement are needed to further engage patients in safety.
Collapse
|
50
|
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.
Collapse
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
| |
Collapse
|