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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.
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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
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Wang Y, Ram S(S, Scahill S. Risk identification and prediction of complaints and misconduct against health practitioners: a scoping review. Int J Qual Health Care 2024; 36:mzad114. [PMID: 38155372 PMCID: PMC10791111 DOI: 10.1093/intqhc/mzad114] [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: 06/14/2023] [Revised: 11/17/2023] [Accepted: 12/26/2023] [Indexed: 12/30/2023] Open
Abstract
Identifying the risk and predicting complaints and misconduct against health practitioners are essential for healthcare regulators to implement early interventions and develop long-term prevention strategies to improve professional practice and enhance patient safety. This scoping review aims to map out existing literature on the risk identification and prediction of complaints and misconduct against health practitioners. This scoping review followed Arksey and O'Malley's five-stage methodological framework. A comprehensive literature search was conducted on MEDLINE, EMBASE, and CINAHL databases and finished on the same day (6 September 2021). Articles meeting the eligibility criteria were charted and descriptively analysed through a narrative analysis method. The initial search generated 5473 articles. After the identification, screening, and inclusion process, 81 eligible studies were included for data charting. Three key themes were reported: methods used for identifying risk factors and predictors of the complaints and misconduct, synthesis of identified risk factors and predictors in eligible studies, and predictive tools developed for complaints and misconduct against health practitioners. The findings reveal that risk identification and prediction of complaints and misconduct are complex issues influenced by multiple factors, exhibiting non-linear patterns and being context specific. Further efforts are needed to understand the characteristics and interactions of risk factors, develop systematic risk prediction tools, and facilitate the application in the regulatory environment.
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Affiliation(s)
- Yufeng Wang
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Sanyogita (Sanya) Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Shane Scahill
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
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Morsø L, Birkeland SF, Walløe S, Grøn PS, Rexbye H, Bogh SBB. Does systematic analysis of patient complaints and compensation cases at hospitals provide useful information to guide quality improvement? Experience from Denmark. BMJ Open Qual 2023; 12:bmjoq-2022-002101. [PMID: 36796865 PMCID: PMC9936271 DOI: 10.1136/bmjoq-2022-002101] [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: 08/18/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Patient complaints and compensation cases are analysed individually and do not allow for organisational learning. Systematic information on complaint patterns needs evidence-based measures. The Healthcare Complaints Analysis Tool (HCAT) can systematically code and analyse complaints and compensation claims, but whether this information is useful for quality improvement is underexplored. We aim to explore if and how HCAT information is perceived useful to inform healthcare quality gaps. METHODS To explore the HCAT's usefulness for quality improvement purposes, we used an iterative process. We accessed all complaints relating to a large university hospital. Trained HCAT raters systematically coded all cases, using the Danish version of HCAT. INTERVENTION The intervention had four phases: (1) coding of cases, (2) education, (3) selection of HCAT analyses for dissemination, (4) 'dashboard' development and delivery of targeted HCAT reports. To study the interventions and phases, we used quantitative and qualitative approaches. The coding patterns were descriptively displayed on department and hospital level. The educational programme was monitored using passing rates, coding reliability checks and rater feedback. Online interviews recorded dissemination feedback. We used a phenomenological approach with thematised quotations from the interviews to analyse the usefulness of the information from cases coded. RESULTS We coded 5217 complaint cases (11 056 complaint points). The average case coding time was 8.5 min (95% CI 8.2 to 8.7). All four raters passed the online test with >80% correct answers. Using rater feedback, we handled 25 cases of doubt. None affected the HCAT structure or categories. Interviews verified the usefulness of analyses after expert group dissemination. Three themes were important: 'overview of complaints', 'learning from complaints' and 'listening to the patients'. Stakeholders perceived the 'dashboard' development as highly relevant. CONCLUSION Through the development process with several adjustments, stakeholders found the systematic approach useful for quality improvement. The hospital management evaluated the approach as promising and decided to test the approach in clinical practice.
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Affiliation(s)
- Lars Morsø
- OPEN Research Unit, Odense Universitetshospital, Odense, Denmark .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Fryd Birkeland
- OPEN Research Unit, Odense Universitetshospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sisse Walløe
- OPEN Research Unit, Odense Universitetshospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Helle Rexbye
- Clinical Development, Odense University Hospital, Odense, Denmark
| | - Søren Bie Bie Bogh
- OPEN Research Unit, Odense Universitetshospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Birkeland S, Bismark M, Barry MJ, Möller S. Personality characteristics associated with satisfaction with healthcare and the wish to complain. BMC Health Serv Res 2022; 22:1305. [PMID: 36320078 PMCID: PMC9628068 DOI: 10.1186/s12913-022-08688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is increasing evidence that satisfaction with healthcare and complaint rates vary with patients' socio-demographic characteristics. Likewise, patient personality might influence the perception of health care; however, empirical research has been scarce. The aim of this study was to investigate associations between health care user personality and satisfaction with care and urge to complain. METHODS This study is a randomized survey among Danish men aged 45 to 70 years (N = 6,756; 30% response rate) with hypothetical vignettes illustrating different courses of healthcare. Assuming they received the care described in vignettes, participants rated their satisfaction and wish to complain on a five-point Likert scale. Information on personality characteristics was obtained through self-reports using the standardized Big Five Inventory-10 (BFI-10). RESULTS In multivariate analyses, we found respondents with higher scores on the agreeableness dimension expressing greater satisfaction with care (Likert difference 0.06, 95% CI 0.04 to 0.07; p < 0.001) and decreased wish to complain (-0.07, 95% CI -0.08 to -0.05; p < 0.001) while high neuroticism scores were associated with less satisfaction (-0.02, 95% CI -0.03 to -0.00, p = 0.012) and an increased wish to complain about healthcare (0.04, 95% CI 0.03 to 0.06, p < 0.001). Interaction analyses could demonstrate no statistically significant interaction between the level of patient involvement in decision making in the scenarios and the effect of personality on respondents' satisfaction and wish to complain. Generally, however, when adjusting for personality, respondents' satisfaction increased (P < 0.001) with greater patient involvement illustrated in case scenarios while the wish to complain decreased (P < 0.001). CONCLUSION Our findings suggest low agreeableness and high neuroticism scores are associated with lower patient satisfaction with healthcare and increased wish to complain. Irrespective of personality, however, the wish to complain seems responsive to changes in patient involvement, underscoring the importance of inclusive healthcare communication.
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Affiliation(s)
- Søren Birkeland
- grid.7143.10000 0004 0512 5013Department of Clinical Research, University of Southern Denmark and Open Patient Data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. Floor, 5000 Odense C, Denmark
| | - Marie Bismark
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Michael J. Barry
- grid.38142.3c000000041936754XDivision of General Internal Medicine, Massachusetts, General Hospital & Harvard Medical School, Boston, USA
| | - Sören Möller
- grid.7143.10000 0004 0512 5013Department of Clinical Research, University of Southern Denmark and Open Patient Data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. Floor, 5000 Odense C, Denmark
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Birkeland S, Bismark M, Barry MJ, Möller S. Sociodemographic characteristics associated with a higher wish to complain about health care. Public Health 2022; 210:41-47. [PMID: 35870320 DOI: 10.1016/j.puhe.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/16/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Previous research has shown that patients who are older, less educated, or have lower income are less likely to lodge complaints about health care. This variation may reflect less wish to complain or inequitable access to complaint channels or remedies. We aimed to investigate associations between sociodemographic characteristics and health users' wish to complain. STUDY DESIGN This was a randomized case vignette survey among 6756 Danish men aged 45-70 years (30% response rate). METHODS Assuming they received the care in vignettes about prostate cancer (prostate-specific antigen) testing, participants rated their wish to complain on a 5-point Likert scale. Information on sociodemographic characteristics was obtained through self-reports and municipality-level information from national registries. RESULTS Lower education was associated with an increased wish to complain (mean Likert difference 0.44 [95% CI 0.36-0.51]; P < .001). The wish to complain was higher among unemployed men (difference 0.16 [95% CI 0.04-0.28]; P < .011) and those with a chronic illness (difference 0.06 [95% CI 0.02-0.10]; P < .004). Given the same healthcare scenarios, there was no difference in wish to complain among health users who were retired, living rurally, or from lower income groups. CONCLUSIONS Health users who are less educated, lower income, elderly, or from rural or minority communities appear to be as likely, or more likely, to wish to complain about health care as others. Yet, younger, well-educated, and higher income citizens are overrepresented in actual complaint statistics. The finding suggests persisting inequalities in the suitability or accessibility of complaint processes for some groups of patients.
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Affiliation(s)
- S Birkeland
- Department of Clinical Research, University of Southern Denmark and Open Patient Data Explorative Network, Odense University Hospital. J. B. Winsløws Vej 9 a, 3. Floor, DK-5000 Odense C, Denmark.
| | - M Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - M J Barry
- Division of General Internal Medicine, Massachusetts General Hospital & Harvard Medical School, USA
| | - S Möller
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Gimbel IA, Mostert M, van Leeuwen BJ, van Leeuwen RB. From Discipline to Quality of Care: How Neurologists Can Learn from Decisions of Disciplinary Tribunals. Eur Neurol 2022; 85:202-207. [PMID: 35016179 DOI: 10.1159/000521391] [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: 08/25/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND One of the primary aims of medical disciplinary law is to improve the quality of care. However, the decisions of disciplinary tribunals are not sufficiently analysed to identify the learning elements. AIM This study aimed to investigate the frequency and nature of complaints for the specialty neurology which were upheld by the disciplinary tribunals and to learn from disciplinary law through an analysis of which factors contributed to complaints being upheld. DESIGN This is a retrospective, observational study. METHODS All upheld complaints in the field of neurology were collected for the period of January 1, 2010, to January 1, 2020. A qualitative analysis of the decisions was conducted using the usual characteristics set out by disciplinary tribunals in their annual reports. The relevant factors which potentially played a role in the complaint being upheld were identified for more detailed analysis. RESULTS In the 10-year period, a complaint was submitted to the disciplinary tribunals against 299 neurologists. Forty-four complaints were upheld (15%). The most common sanction was a warning (70%). A large majority of cases were directly related to patient care, such as decisions about the patient's diagnosis and the treatment. Recordkeeping (50%), interpretation and discussion of imaging (30%), and involvement of several consultants of one or more specialties (34%) frequently played a role in the successful complaints. CONCLUSION Medical disciplinary cases in the field of neurology are usually about diagnosis- and treatment-related aspects. Recordkeeping, interpretation of neuroimaging, and involvement of several consultants frequently play a role in a complaint being upheld. It is important that specialties evaluate disciplinary decisions on a structural and continuous basis.
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Affiliation(s)
- Inge A Gimbel
- Department of Public Health, Health Technology Assessment and Medical Humanities, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Menno Mostert
- Department of Public Health, Health Technology Assessment and Medical Humanities, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Birkeland S, Bismark M, Barry MJ, Möller S. Does greater patient involvement in healthcare decision-making affect malpractice complaints? A large case vignette survey. PLoS One 2021; 16:e0254052. [PMID: 34214136 PMCID: PMC8253406 DOI: 10.1371/journal.pone.0254052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background Although research findings consistently find poor communication about medical procedures to be a key predictor of patient complaints, compensation claims, and malpractice lawsuits (“complaints”), there is insufficient evidence to determine if greater patient involvement could actually affect the inclination to complain. Objectives We conducted an experimental case vignette survey that explores whether greater patient involvement in decision-making is likely to influence the intention to complain given different decisions and consequences. Methods Randomized, national case vignette survey with various levels of patient involvement, decisions, and outcomes in a representative Danish sample of men. We used prostate specific antigen (PSA) screening in men aged 45 to 70 years as the intervention illustrated in 30 different versions of a mock clinical encounter. Versions differed in the amount of patient involvement, the decision made (PSA test or no PSA test), and the clinical outcomes (no cancer detected, detection of treatable cancer, and detection of non-treatable cancer). We measured respondents’ inclination to complain about care in response to the scenarios on a 5-point Likert scale (from 1: very unlikely to 5: very likely). Results The response rate was 30% (6,756 of 22,288). Across all scenarios, the likelihood of complaint increased if the clinical outcome was poor (untreatable cancer). Compared with scenarios that involved shared decision-making (SDM), neutral information, or nudging in favor of screening, the urge to complain increased if the patient was excluded from decision-making or if the doctor had nudged the patient to decline screening (mean Likert differences .12 to .16, p < .001). With neutral involvement or nudging in favor of intervention, the desire to complain depended highly on the decision reached and on the patient’s course. This dependence was smaller with SDM. Conclusions Greater patient involvement in decision-making appears to be associated with less intention to complain about health care, with SDM resulting in the greatest reduction in complaint likelihood.
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Affiliation(s)
- Søren Birkeland
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marie Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Michael J. Barry
- Harvard Medical School, Boston, Massachusetts, United States of America
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Sören Möller
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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O'Dowd E, Lydon S, O'Connor P. A multi-perspective exploration of the understanding of patient complaints and their potential for patient safety improvement in general practice. Eur J Gen Pract 2021; 27:35-44. [PMID: 33904345 PMCID: PMC8081321 DOI: 10.1080/13814788.2021.1900109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Healthcare complaints are an under utilised source of information for safety improvement, particularly in general practice settings. Within general practice in Ireland, complaints management is dependent on individual practice policies, with little standardisation nationally, impeding their use for safety improvement. There is a need to understand factors that contribute to unlocking the potential of complaints for safety improvement in general practice in Ireland and internationally. Objectives To explore perceptions of healthcare complaints of general practitioners, practice nurses and managers, medico-legal professionals, and policymakers. Methods Participants were recruited using convenience sampling. Interviews were conducted from November 2019–May 2020, based on a semi-structured interview guide. Data were then transcribed and analysed using content analysis. An iterative process was applied to identify emerging themes from the interviews. Results A total of 29 participants (19 female, 10 male) were interviewed. Three themes emerged from the analysis, ‘why patients submit complaints’, ‘management of complaints’, and ‘impact of complaints’. Subthemes included ‘barriers and facilitators to complaining’, ‘practice processes’ for complaints management, and ‘impacts on staff’ of complaints, among others. Conclusion There is a lot to be learned about how individuals experience complaints, however, this study adds to existing knowledge. The findings from this study can be used to tackle challenges facing complaints management in general practice, including the barriers to complaining for patients and the negative impacts of complaints on the staff, and can also help to build on positive aspects of complaints such as the desire for systemic change among interested parties.
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Affiliation(s)
- Emily O'Dowd
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Sinead 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
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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.
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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
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Birkeland S, MorsØ L, FlØjstrup M, Mikkelsen KL, Bogh SB. Healthcare inequality in compensation claims concerning acute hospital services: a Danish register-based study. Int J Qual Health Care 2021; 33:6020174. [PMID: 33274734 DOI: 10.1093/intqhc/mzaa163] [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: 07/01/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Although citizens' equal right to acute healthcare of appropriate quality is an oft-cited goal for modern societies, healthcare disparities may persist. We aimed to investigate inequality in compensation claims and compensation payments regarding acute healthcare services. DESIGN AND SETTING We conducted a cross-sectional study of compensation claim patterns using the Danish Patient Compensation Association (DPCA) registries. PARTICIPANTS, INTERVENTIONS AND MAIN OUTCOME MEASURES We used register data on all cases managed by DPCA relating to acute hospital healthcare for adults (aged > 18 years) from 2007 to 2017. RESULTS In total, the DPCA had 5556 compensation claims for injuries caused by acute care services during the years 2007-2017. Age group of 50-64 years (odds ratio (OR) = 1.37 compared with those aged 18-49 years; P < 0.001), marriage (OR = 1.14; P < 0.001), higher income (OR = 1.55; P < 0.001) and Danish origin (OR = 1.49; P < 0.001) were statistically associated with higher odds for filing a compensation claim; men (OR = 0.83; P < 0.001) and those with many co-morbidities were much less represented (OR = 0.24; P < 0.001). Male gender (OR = 1.25; P < 0.001) and higher age (OR = 2.55 (80+ years); P < 0.001) were associated with higher odds for a compensation award. Failed diagnosis was also more often at stake in men (OR = 1.38; P < 0.001) and in patients aged 50-64 years (OR = 1.17; P < 0.001) but occurred less often in patients with multiple morbidities (OR = 0.68; P < 0.001). CONCLUSIONS Findings from our Danish material suggest some inequality in compensation claims and compensation payments regarding acute healthcare services.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Medicine (OPEN), University of Southern Denmark, J. B. Winsløws Vej 9a, 3rd floor, 5000 Odense, Denmark
| | - Lars MorsØ
- Department of Clinical Medicine (OPEN), University of Southern Denmark, J. B. Winsløws Vej 9a, 3rd floor, 5000 Odense, Denmark
| | - Marianne FlØjstrup
- Department of Emergency Medicine, Hospital of South West Jutland, Department of Regional Health Research, University of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Kim Lyngby Mikkelsen
- Danish Patient Compensation Association, Kalvebod Brygge 45, 1560 Copenhagen, Denmark
| | - Søren Bie Bogh
- Department of Clinical Medicine (OPEN), University of Southern Denmark, J. B. Winsløws Vej 9a, 3rd floor, 5000 Odense, Denmark
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Birkeland S, Linkhorst T, Haakonsson A, Barry MJ, Möller S. Representativeness of personality and involvement preferences in a web-based survey on healthcare decision-making. BMC Health Serv Res 2020; 20:851. [PMID: 32912191 PMCID: PMC7488239 DOI: 10.1186/s12913-020-05717-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Obtaining a sample that is representative of the group of interest is of utmost importance in questionnaire studies. In a survey using a state authorized web-portal for citizen communication with authorities, we wanted to investigate the view of adult men on patient involvement in health care decision-making regarding Prostate-Specific Antigen test for prostatic cancer. In this paper, we report on sample characteristics and representativeness of our sample in terms of personality and baseline involvement preferences. Methods We compared personality profiles (BFI-10) and baseline healthcare decision-making preferences (CPS) in our sample (n = 6756) to internationally available datasets. Pooled data from a) US, UK, Canada, Australia, and New Zealand (n = 1512), b) Germany, Netherlands, Switzerland, and Belgium (n = 1136), and c) Norway, Sweden, Finland, and Denmark (n = 1313) were used for BFI-10 comparisons. Regarding CPS, we compared our sample with three previous datasets relating to decision-making in cancer (n = 425, 387, and 199). Results Although statistically significant differences particularly appeared in large dataset comparisons, sample BFI-10 and CPS profiles mostly were within the range of those previously reported. Similarity was greatest in BFI-10 comparisons with group a) where no statistically significant difference could be established in factors ‘agreeableness’ and ‘neuroticism’ (p = .095 and .578, respectively). Conclusion Despite some variation, our sample displays personality and baseline preference profiles that are generally similar to those described in previous international studies. For example, this was the case with the BFI-10 ‘agreeableness’ measure (incl. trust and fault-finding items), an important factor in healthcare decision-making.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000, Odense C, Denmark.
| | - Thea Linkhorst
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000, Odense C, Denmark
| | - Anders Haakonsson
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000, Odense C, Denmark
| | - Michael John Barry
- MGH Division of General Internal Medicine & Harvard Medical School, Boston, USA
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000, Odense C, Denmark
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12
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Birkeland SF, Haakonsson AK, Pedersen SS, Rottmann N, Barry MJ, Möller S. Sociodemographic Representativeness in a Nationwide Web-Based Survey of the View of Men on Involvement in Health Care Decision-Making: Cross-Sectional Questionnaire Study. J Med Internet Res 2020; 22:e19517. [PMID: 32663149 PMCID: PMC7495257 DOI: 10.2196/19517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background Being able to generalize research findings to a broader population outside of the study sample is an important goal in surveys on the internet. We conducted a nationwide, cross-sectional, web-based survey with vignettes illustrating different levels of patient involvement to investigate men’s preferences regarding participation in health care decision-making. Following randomization into vignette variants, we distributed the survey among men aged 45 to 70 years through the state-authorized digital mailbox provided by the Danish authorities for secure communication with citizens. Objective This study aimed to investigate the sociodemographic representativeness of our sample of men obtained in a nationwide web-based survey using the digital mailbox. Methods Response rate estimates were established, and comparisons were made between responders and nonresponders in terms of age profiles (eg, average age) and municipality-level information on sociodemographic characteristics. Results Among 22,288 men invited during two waves, a total of 6756 (30.31%) participants responded to the survey. In adjusted analyses, responders’ characteristics mostly resembled those of nonresponders. Response rates, however, were significantly higher in older men (odds ratio [OR] 2.83 for responses among those aged 65-70 years compared with those aged 45-49 years, 95% CI 2.58-3.11; P<.001) and in rural areas (OR 1.10 compared with urban areas, 95% CI 1.03-1.18; P=.005). Furthermore, response rates appeared lower in areas with a higher tax base (OR 0.89 in the highest tertile, 95% CI 0.81-0.98; P=.02). Conclusions Overall, the general population of men aged 45 to 70 years was represented very well by the responders to our web-based survey. However, the imbalances identified highlight the importance of supplementing survey findings with studies of the representativeness of other characteristics of the sample like trait and preference features, so that proper statistical corrections can be made in upcoming analyses of survey responses whenever needed.
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Affiliation(s)
- Søren F Birkeland
- Open Patient Data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Anders K Haakonsson
- Open Patient Data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Nina Rottmann
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, Nyborg, Denmark
| | - Michael J Barry
- MGH Division of General Internal Medicine, Harvard Medical School, Boston, MA, United States
| | - Sören Möller
- Open Patient Data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
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13
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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.
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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
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14
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Birkeland S, Pedersen SS, Haakonsson AK, Barry MJ, Rottmann N. Men's view on participation in decisions about prostate-specific antigen (PSA) screening: patient and public involvement in development of a survey. BMC Med Inform Decis Mak 2020; 20:65. [PMID: 32252729 PMCID: PMC7132968 DOI: 10.1186/s12911-020-1077-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/24/2020] [Indexed: 01/26/2023] Open
Abstract
Background Prostate-Specific Antigen (PSA) screening for early detection of prostate cancer (PCa) may prevent some cancer deaths, but also may miss some cancers or lead to unnecessary and potentially harmful treatment. Therefore, involving patients in decision-making about PSA screening is recommended. However, we know little about the attitude of men regarding participation in decisions about PSA screening and how to assess such attitudes. The purpose of this paper is to describe patient and public participation in the development of a national, web-based case vignette survey for studying men’s view on participation in decision-making about PSA screening. Methods The project group developed a first draft plan for the survey, its vignettes and choice of measurements. This included multiple vignette variants representing various levels of patient participation in decision-making about PSA screening with different outcomes. Additionally, it included questions on respondents’ satisfaction with imagined courses of health care, their propensity to initiate a malpractice complaint, their own health care experiences, socio-demography, personality, and preferences for control regarding health care decision-making. Following feedback from a workshop with academic peers on the draft plan, a group of 30 adult men was engaged to help develop case vignette versions and questionnaire items by providing feedback on structure, comprehension, response patterns, and time required to complete the survey. Furthermore, a panel of three patients with PCa experience was assembled to assist development through a separate review-and-feedback process. Results Based on reviews of survey drafts, the large group made further suggestions about construction of the survey (e.g. clarification and modification of case vignette versions, deletion of items and adjustment of wording, instructions to guide respondents, replacement of technical terms, and optimization of sequence of survey elements). The patient panel ensured fine-tuning of vignette versions and questionnaire items and helped review the internet version of the survey. Conclusions Patient and public involvement during various phases of the survey development helped modify and refine survey structure and content. The survey exemplifies a way to measure health care users’ satisfaction with imagined courses of health care and wish to complain, taking into account their characteristics.
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Affiliation(s)
- Søren Birkeland
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3 Floor, DK-5000, Odense C, Denmark.
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.,Department of Cardiology, Odense University Hospital, J. B. Winsløwsvej 4, DK-5000, Odense C, Denmark
| | - Anders K Haakonsson
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3 Floor, DK-5000, Odense C, Denmark
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital & Harvard Medical School, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA
| | - Nina Rottmann
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care (Odense University Hospital), Winsløwparken 19, 3. sal, DK-5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. sal, DK-5000, Odense C, Denmark
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15
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van Dael J, Reader TW, Gillespie A, Neves AL, Darzi A, Mayer EK. Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights. BMJ Qual Saf 2020; 29:684-695. [PMID: 32019824 PMCID: PMC7398301 DOI: 10.1136/bmjqs-2019-009704] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022]
Abstract
Introduction A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling. Aim To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement. Method Literature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances. Results A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture. Discussion If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.
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Affiliation(s)
- Jackie van Dael
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Tom W Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Alex Gillespie
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Ana Luisa Neves
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Erik K Mayer
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
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16
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Caballero JA, Brown SP. Engagement, not personal characteristics, was associated with the seriousness of regulatory adjudication decisions about physicians: a cross-sectional study. BMC Med 2019; 17:211. [PMID: 31771585 PMCID: PMC6880351 DOI: 10.1186/s12916-019-1451-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/24/2019] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Outcomes of processes questioning a physician's ability to practise -e.g. disciplinary or regulatory- may strongly impact their career and provided care. However, it is unclear what factors relate systematically to such outcomes. METHODS In this cross-sectional study, we investigate this via multivariate, step-wise, statistical modelling of all 1049 physicians referred for regulatory adjudication at the UK medical tribunal, from June 2012 to May 2017, within a population of 310,659. In order of increasing seriousness, outcomes were: no impairment (of ability to practise), impairment, suspension (of right to practise), or erasure (its loss). This gave adjusted odds ratios (OR) for: age, race, sex, whether physicians first qualified domestically or internationally, area of practice (e.g. GP, specialist), source of initial referral, allegation type, whether physicians attended their outcome hearing, and whether they were legally represented for it. RESULTS There was no systematic association between the seriousness of outcomes and the age, race, sex, domestic/international qualification, or the area of practice of physicians (ORs p≥0.05), except for specialists who tended to receive outcomes milder than suspension or erasure. Crucially, an apparent relationship of outcomes to age (Kruskal-Wallis, p=0.009) or domestic/international qualification (χ2,p=0.014) disappeared once controlling for hearing attendance (ORs p≥0.05). Both non-attendance and lack of legal representation were consistently related to more serious outcomes (ORs [95% confidence intervals], 5.28 [3.89, 7.18] and 1.87 [1.34, 2.60], respectively, p<0.001). CONCLUSIONS All else equal, personal characteristics or first qualification place were unrelated to the seriousness of regulatory outcomes in the UK. Instead, engagement (attendance and legal representation), allegation type, and referral source were importantly associated to outcomes. All this may generalize to other countries and professions.
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Affiliation(s)
- Javier A Caballero
- General Medical Council, 350 Euston Rd, London, NW1 3JN, UK. .,University of Manchester, Faculty of Biology, Medicine and Health, Oxford Rd, Manchester, M13 9PT, UK. .,The University of Sheffield, Dept of Psychology, Western Bank, Sheffield, S10 2TN, UK.
| | - Steve P Brown
- General Medical Council, 350 Euston Rd, London, NW1 3JN, UK
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17
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Birkeland S, Bogh SB. Malpractice litigation, workload, and general practitioner retirement. Prim Health Care Res Dev 2019; 20:e23. [PMID: 32799978 PMCID: PMC6476390 DOI: 10.1017/s1463423618000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/18/2018] [Accepted: 10/04/2018] [Indexed: 11/07/2022] Open
Abstract
We investigated the association between general practitioner (GP) stress factors, including involvement in malpractice litigation or high workload levels during 2007 and ensuing retirement in a sample of Danish GPs. The case file and register information of 739 GPs were examined. Hazard ratios (HRs) were estimated for all causes of retirement from 2007 to 2016. During the study period, 34% of GPs had ceased to practice (n = 260). The HR for retirement was higher with increasing age (HR = 1.19 per year) and lower if practicing in a clinic with a greater number of GPs (HR = 0.47) but no statistically significant association was found between retirement and litigation or higher workload. Knowledge on factors influencing GPs' decision on whether to continue working is important to ensure sustainable primary care provision.
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Affiliation(s)
- Søren Birkeland
- Centre for Quality and Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Søren Bie Bogh
- Centre for Quality and Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
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18
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Lalani M, Baines R, Bryce M, Marshall M, Mead S, Barasi S, Archer J, Regan de Bere S. Patient and public involvement in medical performance processes: A systematic review. Health Expect 2018; 22:149-161. [PMID: 30548359 PMCID: PMC6433319 DOI: 10.1111/hex.12852] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/15/2018] [Accepted: 11/07/2018] [Indexed: 12/26/2022] Open
Abstract
Background Patient and public involvement (PPI) continues to develop as a central policy agenda in health care. The patient voice is seen as relevant, informative and can drive service improvement. However, critical exploration of PPI's role within monitoring and informing medical performance processes remains limited. Objective To explore and evaluate the contribution of PPI in medical performance processes to understand its extent, purpose and process. Search strategy The electronic databases PubMed, PsycINFO and Google Scholar were systematically searched for studies published between 2004 and 2018. Inclusion criteria Studies involving doctors and patients and all forms of patient input (eg, patient feedback) associated with medical performance were included. Data extraction and synthesis Using an inductive approach to analysis and synthesis, a coding framework was developed which was structured around three key themes: issues that shape PPI in medical performance processes; mechanisms for PPI; and the potential impacts of PPI on medical performance processes. Main results From 4772 studies, 48 articles (from 10 countries) met the inclusion criteria. Findings suggest that the extent of PPI in medical performance processes globally is highly variable and is primarily achieved through providing patient feedback or complaints. The emerging evidence suggests that PPI can encourage improvements in the quality of patient care, enable professional development and promote professionalism. Discussion and conclusions Developing more innovative methods of PPI beyond patient feedback and complaints may help revolutionize the practice of PPI into a collaborative partnership, facilitating the development of proactive relationships between the medical profession, patients and the public.
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Affiliation(s)
- Mirza Lalani
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rebecca Baines
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sol Mead
- General Medical Council, Registration and Revalidation Directorate, London, UK.,NHS England London and Southeast Regions, Regional Medical Directorate, London, UK
| | - Stephen Barasi
- General Medical Council, Registration and Revalidation Directorate (Wales), Wales, UK
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Samantha Regan de Bere
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
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19
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Affiliation(s)
- Jesper Lykkegaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jørgen Nexøe
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Editorial Board, Scandinavian Journal of Primary Health Care
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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20
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Jolly J, Bowie P, Price J, Mason M, Dinwoodie M. Qualitative evaluation of an educational intervention to reduce medicolegal risks for medical doctors experiencing significantly more cases than their peers in the UK and Ireland. BMJ Open 2018; 8:e020838. [PMID: 29678988 PMCID: PMC5914717 DOI: 10.1136/bmjopen-2017-020838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The Medical Protection Society (MPS) is a leading protection organisation for healthcare professionals worldwide. In the UK and Ireland, a small minority of MPS members experience significantly more medicolegal cases than their peers and are invited to participate in a risk education (RE) remediation process. To understand more about this educational intervention, we sought to explore participating doctors' views of their experiences of this process and identify self-reported performance improvements and what elements of the intervention could be improved. DESIGN Qualitative semistructured telephone interviews with a convenience sample of doctors with significantly more medicolegal cases than their peers identified by MPS. SETTING UK and Ireland MPS members. PARTICIPANTS A convenience sample of 20 general medical practitioners and hospital specialists from a total of 79 who completed the RE process (25.3% response rate), with a particular focus on the Member Risk Review programme, between November 2013 and October 2015. RESULTS 19 participants were male and 16 were based in general medical (office) practice. Three key themes were generated: personal and professional impacts and actions (eg, member has taken action to reduce clinical workload); comprehension and validity of RE interventions (eg, risks were related to wider patient management); and feedback and proposals (eg, the supportive nature of the educational interventions should be clear from the start). A number of recommendations were made by participants to improve the RE process and enhance the educational experience. CONCLUSIONS The RE process was largely valued by participants with many reporting that participation led to some positive professional behaviour changes and improvements in practice processes and personal well-being.
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Affiliation(s)
| | - Paul Bowie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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21
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Unwin E, Woolf K, Wadlow C, Potts HWW, Dacre J. Sex differences in medico-legal action against doctors: a systematic review and meta-analysis. BMC Med 2015; 13:172. [PMID: 26268807 PMCID: PMC4535538 DOI: 10.1186/s12916-015-0413-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The relationship between male sex and poor performance in doctors remains unclear, with high profile studies showing conflicting results. Nevertheless, it is an important first step towards understanding the causes of poor performance in doctors. This article aims to establish the robustness of the association between male sex and poor performance in doctors, internationally and over time. METHODS The electronic databases MEDLINE, EMBASE, and PsycINFO were searched from inception to January 2015. Backward and forward citation searching was performed. Journals that yielded the majority of the eligible articles and journals in the medical education field were electronically searched, along with the conference and poster abstracts from two of the largest international medical education conferences. Studies reporting original data, written in English or French, examining the association between sex and medico-legal action against doctors were included. Two reviewers independently extracted study characteristics and outcome data from the full texts of the studies meeting the eligibility criteria. Study quality was assessed using the Newcastle-Ottawa scale. A random effect meta-analysis model was used to summarize and assess the effect of doctors' sex on medico-legal action. Extracted outcomes included disciplinary action by a medical regulatory board, malpractice experience, referral to a medical regulatory body, complaints received by a healthcare complaints body, criminal cases, and medico-legal matter with a medical defence organisation. RESULTS Overall, 32 reports examining the association between doctors' sex and medico-legal action were included in the systematic review (n=4,054,551), of which 27 found that male doctors were more likely to have experienced medico-legal action. 19 reports were included in the meta-analysis (n=3,794,486, including 20,666 cases). Results showed male doctors had nearly two and a half times the odds of being subject to medico-legal action than female doctors. Heterogeneity was present in all meta-analyses. CONCLUSION Male doctors are more likely to have had experienced medico-legal actions compared to female doctors. This finding is robust internationally, across outcomes of varying severity, and over time.
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Affiliation(s)
- Emily Unwin
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Katherine Woolf
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Clare Wadlow
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Henry W W Potts
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
| | - Jane Dacre
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE, UK.
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