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Getting the whole story: integrating patient complaints and staff reports of unsafe care

Van Dael, Jackie, Gillespie, Alex ORCID: 0000-0002-0162-1269, Reader, Tom, Smalley, Katelyn, Papadimitriou, Dimitri, Glampson, Ben, Marshall, Daniel and Mayer, Erik (2022) Getting the whole story: integrating patient complaints and staff reports of unsafe care. Journal of Health Services Research and Policy, 27 (1). 41 - 49. ISSN 1355-8196

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Identification Number: 10.1177/13558196211029323


Objective: It is increasingly recognized that patient safety requires heterogeneous insights from a range of stakeholders, yet incident reporting systems in health care still primarily rely on staff perspectives. This paper examines the potential of combining insights from patient complaints and staff incident reports for a more comprehensive understanding of the causes and severity of harm. Methods: Using five years of patient complaints and staff incident reporting data at a large multi-site hospital in London (in the United Kingdom), this study conducted retrospective patient-level data linkage to identify overlapping reports. Using a combination of quantitative coding and in-depth qualitative analysis, we then compared level of harm reported, identified descriptions of adjacent events missed by the other party and examined combined narratives of mutually identified events. Results: Incidents where complaints and incident reports overlapped (n = 446, reported in 7.6%’ of all complaints and 0.6% of all incident reports) represented a small but critical area of investigation, with significantly higher rates of Serious Incidents and severe harm. Linked complaints described greater harm from safety incidents in 60% of cases, reported many surrounding safety events missed by staff (n = 582), and provided contesting stories of why problems occurred in 46% cases, and complementary accounts in 26% cases. Conclusions: This study demonstrates the value of using patient complaints to supplement, test, and challenge staff reports, including to provide greater insight on the many potential factors that may give rise to unsafe care. Accordingly, we propose that a more holistic analysis of critical safety incidents can be achieved through combining heterogeneous data from different viewpoints, such as through the integration of patient complaints and staff incident reporting data.

Item Type: Article
Official URL:
Additional Information: © 2021 The Authors
Divisions: Psychological and Behavioural Science
Subjects: R Medicine > RA Public aspects of medicine > RA1001 Forensic Medicine. Medical jurisprudence. Legal medicine
Date Deposited: 27 Jan 2022 18:06
Last Modified: 31 Jan 2022 09:45

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