Using a stakeholder co-design approach to develop interventions for quality improvement based on patient complaints

Background: While research into complaints made about hospitals is increasing, this has yet to be translated into interventions to improve quality and safety. Incorporating the views of stakeholders into learning from complaints can be an effective means of bridging the gap between research and implementation in patient safety research. Aims: The aim of the study is to assess whether a co-design approach involving stakeholders is feasible and effective for identifying interventions to address issues from patient complaints. Methods: A series of online workshops and surveys were utilized to collate the views of stakeholders including patients, healthcare providers, health system researchers, and healthcare managers on how to improve quality and safety in care. Findings of previous analyses of patient complaints were used to identify the focus of this study and guide participants. The strength and feasibility of the interventions outlined by participants was subsequently assessed. Results: Thirty-two interventions were outlined across the two workshops. These were ranked by participants using the APEASE model. Participants considered the co-design approach an appropriate and effective way to identify interventions for quality and safety improvement. Conclusions: Stakeholder co-design demonstrated excellent potential for suggesting interventions to improve patient safety based on the findings of complaints analyses

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

Background: The coronavirus disease 2019 (COVID-19) pandemic dramatically impacted the delivery of hospital care in terms of quality and safety. Objectives: To examine complaints from two time points, quarter 4 (Q4) 2019 (pre-pandemic) and Q4 2020 (second wave), and explore whether there was a difference in the frequency and/or content of complaints. Methods: A retrospective analysis of complaints from one Irish hospital was conducted using the Healthcare Complaints Analysis Tool (HCAT). Within each complaint, the content, severity, harm reported by the patient, and stage of care were categorised. The complaints were analysed using descriptive statistics and chi-square tests of independence. Results: There were 146 complaints received in Q4 2019 and 114 in Q4 2020. Complaint severity was significantly higher in Q4 2019 as compared to Q4 2020. However, there were no other significant differences. Institutional processes (e.g. staffing, resources) were the most common reason for complaints (30% in Q4 2019 and 36% in Q4 2020). The majority of complaints were concerned with care on the ward (23% in Q4 2019 and 31% in Q4 2020). Conclusions: The severity of complaints was significantly higher in Q4 2019 than in Q4 2020, which requires further exploration as the reasons for this are unclear. The lack of a difference in the frequency and content of complaints during the two time periods was unexpected. However, this may be linked to a number of factors, including public support for the healthcare system, existing system-level issues in the hospital, or indeed increased staff collaboration in the context of the COVID-19 crisis.</p

Learning from complaints about hospital care

Complaints are often seen as a negative experience in healthcare, with patients or family members writing about poor experiences of care, or things that went wrong. These things that go wrong may be small issues or major problems. Patient complaints are usually written with the aim of helping to improve healthcare for future patients. Patients may have a perspective that differs from healthcare providers. For example, providers might not know about how patients dignity was respected, whether they experienced delays, or how they were interacted with. Patients, however, know all of these things. It is known that patient insights into their care can improve healthcare. However, these insights may not be considered to the same extent as staff measures of quality and safety of care. Most assessments of quality of care in Irish healthcare services are focused on healthcare workers’ opinions, statistics about observable events (e.g., how many patients got an infection in hospital), or investigating large errors. Until recently, complaints have not been used by hospitals or the healthcare service in Ireland to make broad improvements to healthcare delivery. While these complaints receive individual responses, there is no focus on analysing these complaints together and using this data to learn about key issues in specific services and the healthcare system. This means that patients’ desire, and ability, to contribute to identifying problems and potential solutions are limited. Researchers at the London School of Economics have developed the Healthcare Complaints Analysis Tool (HCAT)1 that guides the systematic analysis of the cause and severity of complaints. The Health Research Board (HRB) and Health Service Executive (HSE) funded research project utilised the HCAT to analyse complaints received about Irish healthcare organisations. The research involved the collaboration of researchers, HSE managerial staff, healthcare workers, and quality and patient safety professionals in hospitals.An Applied Partnership Award funded by the Health Research Board and the HSE Quality Assurance and Verification Division (Grant number APA-2017-006)non-peer-reviewe

An analysis of complaints about hospital care in the Republic of Ireland

BACKGROUND: Patients and family members make complaints about their hospital care in order to express their dissatisfaction with the care received and prompt quality improvement. Increasingly, it is being understood that these complaints could serve as important data on how to improve care if analysed using a standardized tool. The use of the Healthcare Complaints Analysis Tool (HCAT) for this purpose has emerged internationally for quality and safety improvement. Previous work has identified hot spots (areas in care where harm occurs frequently) and blind spots (areas in care that are difficult for staff members to observe) from complaints analysis. This study aimed to (i) apply the HCAT to a sample of complaints about hospital care in the Republic of Ireland (RoI) to identify hot spots and blind spots in care and (ii) compare the findings of this analysis to a previously published study on hospital complaints in the UK. METHODS: A sample of complaints was taken from 16 hospitals in the RoI in Quarter 4 of 2019 (n = 641). These complaints were coded using the HCAT to classify complaints by domain, category, severity, stage of care and harm. Chi-squared tests were used to identify hot spots, and logistic regression was used to identify blind spots. The findings of this study were compared to a previously published UK study that used HCAT to identify hot spots and blind spots. RESULTS: Hot spots were identified in Irish hospital complaints while patients were receiving care on the ward, during initial examination and diagnosis, and while they were undergoing operations or procedures. This aligned with hot spots identified in the UK study. Blind spots were found for systemic problems, where patients experience multiple issues across their care. CONCLUSIONS: Hot spots and blind spots for patient harm can be identified in hospital care using the HCAT analysis. These in turn could be used to inform improvement interventions, and direct stakeholders to areas that require urgent attention. This study also highlights the promise of the HCAT for use across different healthcare systems, with similar results emerging from the RoI and the UK