Identifying quality improvement opportunities using patient complaints: Feasibility of using a complaints taxonomy in a metropolitan maternity service

Abstract

Background: The Healthcare Complaints Analysis Tool (HCAT) is a coding taxonomy developed to interrogate patient complaints for quality and safety improvement lessons. The reliability of the tool has been tested in whole-of-system and whole-of-service settings. We sought to assess whether the taxonomy is functional at the level of a single hospital department. Objectives: To demonstrate the feasibility of applying HCAT in the setting of a large maternity department with a view to using it to inform quality and safety improvement opportunities. Methods: All 200 de-identified complaints made between 1 April 2011 and 30 April 2016 to a multi-site maternity service were collated. Each complaint entry included a summary of complaint content, complaint report date, complaint closure date and an incident severity rating (ISR). HCAT was applied to the analysis of complaints using a previously validated content analysis framework. A coding flowchart was developed to aid classification. Results: The 200 complaints involved 567 issues, an average of 2.8 issues per complaint. The most common issues were rude behaviour (n ¼ 46), poor communication (n ¼ 38), complaints relating to the quality of medical care (n ¼ 36), nursing care (n ¼ 35), surgical/medical complications (n ¼ 28) and complaints relating to the attitude of staff members (n ¼ 23). Complaints in the clinical domain made up the greatest proportion of both severe (ISR 1-66.7%) and moderate (ISR 2-64.5%) incidents. Conclusions: Using a reliable taxonomy, we were able to successfully interrogate patient complaints, identifying quality improvement targets within a single maternity service. The taxonomy appears suitable for adoption and application across health jurisdictions.

Consumer compliments about nursing and midwifery care: A 12‐month retrospective analysis

“…Of all the compliments received by the health service in a 12‐month period, only 15% ( n = 422) were specific to nursing or midwifery care, and of these only 7.9% ( n = 225) were provided by healthcare consumers (i.e., patients and family or companions). Similar proportions were reported in an Australian study that examined 200 complaints and identified approximately 17.5% (35 of 200) of these related to clinical nursing care (Nowotny, Loh, Davies‐Tuck, et al, 2019). Further comparison is difficult as the authors did not identify the source of the complaints (e.g., consumers or others) or provide sufficient detail to examine nursing‐specific findings.…”

“…Similar proportions were reported in an Australian study that examined 200 complaints and identified approximately 17.5% (35 of 200) of these related to clinical nursing care (Nowotny, Loh, Davies-Tuck, et al, 2019). Further comparison is difficult as the authors did not identify the source of the complaints (e.g., consumers or others) or provide sufficient detail to examine nursing-specific findings.…”

The impact of the COVID-19 pandemic on patient complaints within one Irish teaching hospital

“…There are several strengths to this study. Firstly, the HCAT is a valid and reliable tool which has been applied successfully to many different healthcare settings [ 23 , 25 , 39 , 40 ]. The agreement between raters in this study indicated that the HCAT was a suitable tool for the analysis of complaints made about this Irish hospital.…”

“…Complaints have been analysed in both hospital [23][24][25]] and primary care [26] settings in Ireland prior to the COVID-19 pandemic. However, it is not known if, and how, the COVID-19 pandemic may have impacted complaints.…”

The golden moment after an adverse event

“…Cossler and colleagues describe an innovative use of their hospital’s malpractice data to identify risks to the safety of obstetric patients and their newborns. 5 Using these data they identified four key drivers of malpractice risk. Armed with this information, they created a regional obstetric quality network which intervened to reduce those risks.…”