Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety

• Published in: The Milbank quarterly Vol. 96; no. 3; pp. 530 - 567
• Main Authors: GILLESPIE, ALEX, READER, TOM W.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2018; Blackwell Publishing Ltd; John Wiley and Sons Inc
• Subjects: Analysis; Benchmarks; Catastrophic failure analysis; Complaining; Complaints; Critical incidents; Data analysis; Data processing; Data quality; Discharge; England; Error analysis; Error detection and recovery; Family members; Female; Health care; health care complaints; Health care industry; Health care policy; Hospital admissions; Humans; Identification methods; Levels; Listening; Male; Mapping; Medical Errors - statistics & numerical data; Medical personnel; Medications; Near misses; Optic disk; Original Scholarship; Patient admissions; Patient assessment; patient participation; Patient Safety; Patient Satisfaction; Patient-Centered Care; Patients; Quality; Quality of care; Quality of Health Care - organization & administration; Recovery; Relatives; Reliability; risk management; Safety; Scripts; Uncertainty; Uncertainty analysis; health care complaints; risk management; patient safety; patient-centered care; patient participation
• ISSN: 0887-378X; 1468-0009
• DOI: 10.1111/1468-0009.12338

Context: The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data. Methods: We analyzed 1,110 health care complaints from across England. "Hot spots" were identified by mapping reported harm and near misses onto stages of care and underlying problems. "Blind spots" concerning difficult-to-monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission. Findings: The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty-three percent of problems entailed major or catastrophic harm, with significant regional variation (17%-31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low-level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns. Conclusions: The analysis of health care complaints reveals valuable and uniquely patient-centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry-exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.