Jessica J Liu 1 , Leahora Rotteau 2 , Chaim M Bell 3,2 , Kaveh G Shojania 3,2 Show Affiliations »
Abstract
BACKGROUND AND OBJECTIVES: Recent years have seen increasing calls for more proactive use of patient complaints to develop effective system-wide changes, analogous to the intended functions of incident reporting and root cause analysis (RCA) to improve patient safety. Given recent questions regarding the impact of RCAs on patient safety, we sought to explore the degree to which current patient complaints processes generate solutions to recurring quality problems. DESIGN/SETTING: Qualitative analysis of semistructured interviews with 21 patient relations personnel (PRP), nursing and physician leaders at three teaching hospitals (Toronto, Canada). RESULTS: Challenges to using the patient complaints process to drive hospital-wide improvement included: (1) Complaints often reflect recalcitrant system-wide issues (eg, wait times) or well-known problems which require intensive efforts to address (eg, poor communication). (2) The use of weak change strategies (eg, one-off educational sessions). (3) The handling of complaints by unit managers so they never reach the patient relations office. PRP identified giving patients a voice as their primary goal. Yet their daily work, which they described as 'putting out fires', focused primarily on placating patients in order to resolve complaints as quickly as possible, which may in effect suppress the patient voice. CONCLUSIONS: Using patient complaints to drive improvement faces many of the challenges affecting incident reporting and RCA. The emphasis on 'putting out fires' may further detract from efforts to improve care for future patients. Systemically incorporating patients' voices in clinical operations, as with co-design and other forms of authentic patient engagement, may hold greater promise for meaningful improvements in the patient experience than do RCA-like analyses of patient complaints. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
BACKGROUND AND OBJECTIVES: Recent years have seen increasing calls for more proactive use of patient complaints to develop effective system-wide changes, analogous to the intended functions of incident reporting and root cause analysis (RCA) to improve patient safety. Given recent questions regarding the impact of RCAs on patient safety, we sought to explore the degree to which current patient complaints processes generate solutions to recurring quality problems. DESIGN/SETTING: Qualitative analysis of semistructured interviews with 21 patient relations personnel (PRP), nursing and physician leaders at three teaching hospitals (Toronto, Canada). RESULTS: Challenges to using the patient complaints process to drive hospital-wide improvement included: (1) Complaints often reflect recalcitrant system-wide issues (eg, wait times) or well-known problems which require intensive efforts to address (eg, poor communication). (2) The use of weak change strategies (eg, one-off educational sessions). (3) The handling of complaints by unit managers so they never reach the patient relations office. PRP identified giving patients a voice as their primary goal. Yet their daily work, which they described as 'putting out fires', focused primarily on placating patients in order to resolve complaints as quickly as possible, which may in effect suppress the patient voice. CONCLUSIONS: Using patient complaints to drive improvement faces many of the challenges affecting incident reporting and RCA. The emphasis on 'putting out fires' may further detract from efforts to improve care for future patients . Systemically incorporating patients ' voices in clinical operations, as with co-design and other forms of authentic patient engagement, may hold greater promise for meaningful improvements in the patient experience than do RCA-like analyses of patient complaints. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Entities: Chemical
Species
Keywords:
patient satisfaction; qualitative research; quality improvement
Mesh： See more »
Year: 2019
PMID： 31123172 DOI： 10.1136/bmjqs-2018-008801
Source DB: PubMed Journal: BMJ Qual Saf ISSN： 2044-5415 Impact factor: 7.035