1. Improving the analysis and use of patient complaints in the English National Health Service
- Author
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van Dael, Jackie, Mayer, Erik, and Flott, Kelsey
- Abstract
The English National Health Service (NHS) receives over 200,000 patient complaints annually. Complaints provide rich narratives of poor and unsafe care, and are often submitted with the aim of preventing harm from occurring to others. Inquiries into safety failures have demonstrated that complaints signal problems where internal systems fail. Yet, their insights remain underutilised due to their complex unstructured nature, a disregard for their informational value, and a complaints process designed for case-by-case redress. This work develops evidence-based and theory-informed approaches towards improving the analysis and use of complaints in the English NHS. Using process modelling and realist review methods, this thesis generates theory on how and under what conditions healthcare settings can achieve both case-by-case redress and system-wide analysis of complaints. Findings identify the need for a robust coding taxonomy to detect systemic problems with healthcare delivery, and support the prioritisation of deeper qualitative analysis and investigation. The inter-rater reliability of the existing NHS complaints reporting scheme 'KO41a' is tested across four NHS Trusts, and compared to the psychometrically robust and theory-informed Healthcare Complaints Analysis Tool (HCAT). Results highlight the limited discriminative value of KO41a, and indicate HCAT as a reliable alternative in most investigated settings. Drawing from social science approaches to safety, the final study conducts data linkage and narrative analysis of complaints and staff incident reports, and demonstrates the contributions of using complainants' interpretation and sense-making of adverse events to test, challenge, and complement staff representations of the causes and severity of harm. Collectively, the work in this thesis demonstrates why patient and staff perspectives need to be combined for a more holistic understanding of patient safety, and provides a pragmatic, evidence-based pathway towards integrating complaints into the historically staff-driven quality monitoring and improvement systems.
- Published
- 2021
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