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.

In high-risk industries such as aviation, the skills not related directly to technical expertise, but crucial for maintaining safety (e.g. teamwork), have been categorized as non-technical skills. Recently, research in anaesthesia has identified and developed a taxonomy of the non-technical skills requisite for safety in the operating theatre. Although many of the principles related to performance and safety within anaesthesia are relevant to the intensive care unit (ICU), relatively little research has been done to identify the non-technical skills required for safe practice within the ICU. This review focused upon critical incident studies in the ICU, in order to examine whether the contributory factors identified as underlying the critical incidents, were associated with the skill categories (e.g. task management, teamwork, situation awareness and decision making) outlined in the Anaesthetists' Non-technical Skills (ANTS) taxonomy. We found that a large proportion of the contributory factors underlying critical incidents could be attributed to a non-technical skill category outlined in the ANTS taxonomy. This is informative both for future critical incident reporting, and also as an indication that the ANTS taxonomy may provide a good starting point for the development of a non-technical skills taxonomy for intensive care. However, the ICU presents a range of unique challenges to practitioners working within it. It is therefore necessary to conduct further non-technical skills research, using human factors techniques such as root-cause analyses, observation of behaviour, attitudinal surveys, studies of cognition, and structured interviews to develop a better understanding of the non-technical skills important for safety within the ICU. Examples of such research highlight the utility of these techniques.

Objective: There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an ICU team performance framework. 'team decision making'. A prototype framework explaining team performance in the ICU was developed using these categories. The purpose of the framework is to consolidate the existing ICU teamwork literature, and to guide the development and testing of interventions for improving teamwork. Data Conclusions:Effective teamwork is shown as crucial for providing optimal patient care in the ICU. In particular, team leadership appears vital for guiding the way in which ICU team members interact and coordinate with others. Key words: ICU; Teamwork; Team performance framework; Training interventions; Patient safety; LeadershipPublished as: Reader, T., Flin, R., Mearns, K., & Cuthbertson, B. (2009). Developing a team performance framework for the Intensive Care Unit. Critical Care Medicine, 35, 1789-1793 3 Teamwork refers to the way in which team members function and coordinate to produce 'synchronised' output (1). Patient safety research has demonstrated that poor teamwork is a causal factor underlying critical incidents in the intensive care unit (ICU) (2). Due to this, a growing amount of research has been conducted within the ICU in order to identify the specific components of teamwork that influence patient outcomes (3,4). The main purpose of this research is to guide the design of training materials and workplace interventions to improve teamwork. However, at present the findings from studies investigating ICU teamwork are disparate and lack synthesis, therefore the extent to which they can influence practice, training and future research is limited. This review takes an industrial psychology perspective to summarise the ICU teamwork literature, and develops a conceptual team performance framework tailored for intensive care medicine. Team performance frameworksPsychology researchers in high-risk industries (e.g. aviation, military, nuclear power) have found effective teamwork as crucial for maintaining safety within these domains (5,6). In order to better understand the relationship between teamwork and performance in these settings, team performance frameworks (or models) have been developed. These show team outputs (e.g. team effectiveness, performance, errors) to be influenced by group 'processes' related to team communication, leadership, coordination and decision-making (7-11). Furthermore, group processes are influenced by a range of 'inputs' (e.g. group structures, member characteristics, work tasks) (12)(13)(14). The purposes of team performance frameworks are three-fold. Firstly, they systematise the mechanisms that predict team performance, thus facilitating the Published as: Reader, T., Flin, R., Mearns, K., & Cuthbertson, B. (2009) MethodThe identification of ICU teamwork ...