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Learning from complaints in healthcare: a realist review of academic literature, policy evidence, and frontline insights

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Title: Learning from complaints in healthcare: a realist review of academic literature, policy evidence, and frontline insights
Authors: Van Dael, J
Reader, T
Gillespie, A
Neves, A
Darzi, A
Mayer, E
Item Type: Journal Article
Abstract: Introduction A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling. Aim To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement. Method Literature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances. Results A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture. Discussion If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.
Issue Date: 17-Jul-2020
Date of Acceptance: 26-Dec-2019
URI: http://hdl.handle.net/10044/1/76594
DOI: 10.1136/bmjqs-2019-009704
ISSN: 2044-5415
Publisher: BMJ Publishing Group
Start Page: 684
End Page: 695
Journal / Book Title: BMJ Quality and Safety
Volume: 29
Copyright Statement: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
National Institute for Health Research
The Health Foundation
National Institute of Health Research
National Institute for Health Research
Funder's Grant Number: RDB04
RDB18 79650
NF SI 061710038
Keywords: adverse events, epidemiology and detection
health policy
patient safety
patient-centred care
1103 Clinical Sciences
1117 Public Health and Health Services
1302 Curriculum and Pedagogy
Health Policy & Services
Publication Status: Published
Online Publication Date: 2020-02-04
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
Institute of Global Health Innovation