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Do national policies for complaint handling in English hospitals support quality improvement? Lessons from a case study

Van Dael, J, Reader, Tom W., Gillespie, Alex ORCID: 0000-0002-0162-1269, Freise, Lisa, Darzi, Ara and Mayer, Erik K. (2022) Do national policies for complaint handling in English hospitals support quality improvement? Lessons from a case study. Journal of the Royal Society of Medicine, 115 (10). 390 - 398. ISSN 0141-0768

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Identification Number: 10.1177/01410768221098247


Objectives: A range of public inquiries in the English National Health Service have indicated repeating failings in complaint handling, and patients are often left dissatisfied. The complex, bureaucratic nature of complaints systems is often cited as an obstacle to meaningful investigation and learning, but a detailed examination of how such bureaucratic rules, regulations, and infrastructure shape complaint handling, and where change is most needed, remains relatively unexplored. We sought to examine how national policies structure local practices of complaint handling, how they are understood by those responsible for enacting them, and if there are any discrepancies between policies-as-intended and their reality in local practice. Design: Case study involving staff interviews and documentary analysis. Setting: A large acute and multi-site NHS Trust in England. Participants: Clinical, managerial, complaints, and patient advocacy staff involved in complaint handling at the participating NHS Trust (n=20). Main outcome measures: Not applicable. Results: Findings illustrate four areas of practice where national policies and regulations can have adverse consequences within local practices, and partly function to undermine an improvement-focused approach to complaints. These include muddled routes for raising formal complaints, investigative procedures structured to scrutinize the ‘validity’ of complaints, futile data collection systems, and adverse incentives and workarounds resulting from bureaucratic performance targets. Conclusion: This study demonstrates how national policies and regulations for complaint handling can impede, rather than promote, quality improvement in local settings. Accordingly, we propose a number of necessary reforms, including patient involvement in complaints investigations, the establishment of independent investigation bodies, and more meaningful data analysis strategies to uncover and address systemic causes behind recurring complaints.

Item Type: Article
Official URL:
Additional Information: © 2022 The Authors
Divisions: Psychological and Behavioural Science
Subjects: R Medicine > RA Public aspects of medicine
Date Deposited: 21 Apr 2022 12:09
Last Modified: 29 Feb 2024 01:36

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