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Patient-centered insights: using healthcare complaints to reveal hotspots and blindspots in quality and safety

Gillespie, Alex ORCID: 0000-0002-0162-1269 and Reader, Tom W. (2018) Patient-centered insights: using healthcare complaints to reveal hotspots and blindspots in quality and safety. The Milbank Quarterly, 96 (3). pp. 530-567. ISSN 0887-378X

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Identification Number: 10.1111/1468-0009.12338


Context: The use of healthcare 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. We used the Healthcare Complaints Analysis Tool to analyze a benchmark national dataset, conceptualize a systematic analysis, and identify the added value of complaint data. Methods: We analyzed 1110 healthcare complaints from across England. “Hotspots” were identified by mapping reported harm and near-misses onto stages of care and underlying problems. “Blindspots” 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%). Hotspots 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 three blindspots: problems arising when entering and exiting the healthcare system; systemic failures pertaining to multiple distributed and often low-level problems; and errors of omission, especially failure to acknowledge and listen to patients raising problems. Conclusions: The analysis of healthcare complaints reveals valuable and uniquely patient-centered insights on quality and safety. Hotspots of harm and near-misses provide an alternative data source on adverse events and critical incidents. Analysis of entry-exit, systemic and omission problems provide insight on blindspots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.

Item Type: Article
Official URL:
Additional Information: © 2018 The Milbank Memorial Fund
Divisions: Psychological and Behavioural Science
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Departments > Psychological and Behavioural Science
Date Deposited: 11 May 2018 11:13
Last Modified: 20 Jun 2020 00:26
Funders: London School of Economics

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