Understanding healthcare professionals’ responses to patient complaints in secondary and tertiary care in the UK: A systematic review and behavioural analysis

Abstract

Background. The path of a complaint and patient satisfaction with complaint resolution is often dependent on healthcare professionals’ (HCPs) first response. It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs’ responses to complaints, and (2) apply behavioural science frameworks to classify these influences and provide recommendations for more effective complaints management. Methods. A systematic literature review of UK published and unpublished (“grey literature”) studies was conducted (PROSPERO registration: CRD42022301980). Five electronic databases (Scopus, Medline/Ovid, Embase, CINAHL, HMIC) were searched up to September 2021. Eligibility criteria included: studies reporting primary data, conducted in secondary and tertiary care, written in English and published between 2001–2021 (studies from primary care, mental health, forensic, paediatric, or dental care services were excluded). Extracted data included: participant quotations from qualitative studies, results from questionnaire and survey studies, case studies reported in commentaries, and descriptions and summaries of results from reports. Data were synthesised narratively using inductive thematic analysis, followed by deductive mapping to the Theoretical Domains Framework (TDF). Results. 22 articles and 3 reports meeting the inclusion criteria were included. A total of 8 actors, 22 behaviours and 24 influences on behaviour were found. Key factors influencing effective management of complaints included HCPs’ beliefs about the value of complaints, knowledge of procedures and available time and resources, and organisational culture and leadership. Defensive practices and high stress levels among HCPs were linked to lack of managerial support, role conflict and a blaming culture within the organisation. Themes mapped predominantly onto the TDF domains of social influences (categorised both as barrier and enabler), beliefs about consequences (barrier) and social/professional role and identity (barrier). Recommendations were generated using the BCW approach. Conclusions. Through the application of behavioural science, we identified a wide range of individual, social/organisational and environmental influences on complaints management in secondary and tertiary care. Our behavioural analysis informed recommendations for intervention content, with particular emphasis on reframing and building on the positive aspects of complaints as an underutilised source of feedback at an individual and organisational level.