BackgroundPatient complaints have been identified as a valuable resource for monitoring and improving patient safety. This article critically reviews the literature on patient complaints, and synthesises the research findings to develop a coding taxonomy for analysing patient complaints.MethodsThe PubMed, Science Direct and Medline databases were systematically investigated to identify patient complaint research studies. Publications were included if they reported primary quantitative data on the content of patient-initiated complaints. Data were extracted and synthesised on (1) basic study characteristics; (2) methodological details; and (3) the issues patients complained about.Results59 studies, reporting 88 069 patient complaints, were included. Patient complaint coding methodologies varied considerably (eg, in attributing single or multiple causes to complaints). In total, 113 551 issues were found to underlie the patient complaints. These were analysed using 205 different analytical codes which when combined represented 29 subcategories of complaint issue. The most common issues complained about were ‘treatment’ (15.6%) and ‘communication’ (13.7%). To develop a patient complaint coding taxonomy, the subcategories were thematically grouped into seven categories, and then three conceptually distinct domains. The first domain related to complaints on the safety and quality of clinical care (representing 33.7% of complaint issues), the second to the management of healthcare organisations (35.1%) and the third to problems in healthcare staff–patient relationships (29.1%).ConclusionsRigorous analyses of patient complaints will help to identify problems in patient safety. To achieve this, it is necessary to standardise how patient complaints are analysed and interpreted. Through synthesising data from 59 patient complaint studies, we propose a coding taxonomy for supporting future research and practice in the analysis of patient complaint data.

Social representations research has tended to focus upon the representations that groups have in relation to some object. The present article elaborates the concept of social representations by pointing to the existence of "alternative representations" as sub-components within social representations. Alternative representations are the ideas and images the group has about how other groups represent the given object. Alternative representations are thus representations of other people's representations. The present article uses data from Moscovici's (1976Moscovici's ( /2008 analysis of the diffusion of psychoanalysis to examine how people engage with alternative representations. It is demonstrated that there can be more or less dialogical relations with alternative representations. The analysis concludes by considering seven "semiotic barriers" which work to neutralise the dialogical potential of alternative representations, thus on the one hand enabling groups to talk about the views of others, while, on the other hand, remaining unchallenged by those views.

The relationship between assistive technology for cognition (ATC) and cognitive function was examined using a systematic review. A literature search identified 89 publications reporting 91 studies of an ATC intervention in a clinical population. The WHO International Classification of Functioning, Disability and Health (ICF) was used to categorize the cognitive domains being assisted and the tasks being performed. Results show that ATC have been used to effectively support cognitive functions relating to attention, calculation, emotion, experience of self, higher level cognitive functions (planning and time management) and memory. The review makes three contributions: (1) It reviews existing ATC in terms of cognitive function, thus providing a framework for ATC prescription on the basis of a profile of cognitive deficits, (2) it introduces a new classification of ATC based on cognitive function, and (3) it identifies areas for future ATC research and development. (JINS, 2012, 18, 1-19)

Acknowledgement: Alex Gillespie would like to acknowledge the support of an

BackgroundPatient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error.MethodThe Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect.ResultsPatient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients.ConclusionA social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and health policy to reduce patient neglect.

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The analysis of health care complaints reveals valuable and uniquely patient-centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry-exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.

This paper introduces the idea of symbolic resources as the use of cultural elements to mediate the representational work occasioned by ruptures or discontinuities in the smooth experience of ordinary life, moments when the 'taken-for-granted' meanings cease to be taken for granted. In particular we are concerned with the use of symbolic resources in moments of developmental transitions, that is, the mobilization of symbolic elements ranging from shared bodies of knowledge or argumentative strategies to movies, magazines or art pieces. The paper begins with a brief theoretical sketch of these ideas, and then presents three case studies, each of which involves the use of a different type of symbolic resource within a particular age group. In the first, children are observed in interaction with a peer about a conservation problem. In the second, adolescents are observed negotiating the meaning of their art productions with their peers, teachers and parents. The third example looks at Western tourists searching for spirituality, adventure and freedom in Ladakh as an alternative to the materialism of modernity. In each case the analysis of the symbolic resources employed indicates the significance of the gaze of the other in the construction of meanings, and of the various constraints operating within specific situations. The analysis also reveals different modes of use of symbolic resources, linked to changing forms of reflectivity.