Patient complaints in healthcare systems: a systematic review and coding taxonomy

Abstract

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.

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

“…However, our analysis also points to three caveats. First, while audited and based on selected evidence, many effective best practices in improving complaints management systems are driven by practical experiences and only documented in the grey literature – they are seldom reported in the academic literature [3,40]. Although methodological rigour of grey literature can be legitimately questioned, we consider these as important sources of evidence which often have high impact on policy and practice.…”

“…Studies have highlighted the effectiveness of better hospital partnership with patient advocacy organisations, as key to an effective and learning-oriented complaints system [7,55]. As one systematic review highlighted, over two-thirds of all complaints involve dissatisfaction with human interaction [3]. Therefore, any measures that involve learning from complaints for QI should draw on the participation, co-operation and initiatives of doctors, nurses and other staff [64].…”

“…Most health service QI approaches consider perspectives of: patients, public, professional and managerial [96,102]. Well-designed complaint resolution processes provide opportunities to develop appropriate strategies leading to greater patient satisfaction [3,7,64,103–107]. Improved understanding of the reasons for, and nature of, complaints can provide insights into delivery of particularly complex care, detect lapses that providers may have missed, and address these issues before they escalate into substantial problems [8,11,30,40,53].…”

“…First, is the opportunity for patients to provide feedback on their experiences (e.g. the care they receive, staff expertise and availability of supplies [3,25,26]) and to complain when their experiences do not align with their expectations. Second, is the ability of the health system to adequately analyse, respond to, and utilise patient feedback – for example in health service quality improvement (QI) [5,9,25] or improving human resource management processes (HRM) [9,18,27,28].…”

“…A recent systematic review identified a range of issues that inform patient complaints within the health sector [3]. Issues of safety and quality of care account for 33.7% of all complaints, management-related issues (processes related to admission, discharge, billing, finances, referrals) for 35.1%, and problems in staff–patient relationships (behaviour, conduct, communication) for 29.1%.…”