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Deborah Schaler - EHPR 2015 - Listening, Learning, Improving

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Staff views of patient complaint policy The document discusses a study that interviewed hospital staff about managing patient complaints. It found that clinicians see complaints as opportunities for improvement but administrative processes separate them from complaints. Staff suggested complaints be managed based on risk, responding immediately and directly to the patient. The study also found a need to aggregate patient feedback data from multiple sources and link it to service improvement efforts. Clinicians prioritized resolving complaints for individual patients and system improvement, while administrators focused on following processes. The research implications are for health services to manage complaints by risk level and link aggregated patient feedback to improvement.

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Listening, Learning, Improving Staff views of patient complaint policy Deborah Schaler, MHPol, PhD Candidate Menzies Centre for Health Policy University of Sydney
Patient feedback research project aims • Assess effectiveness of patient feedback methods (complaints, surveys, and narrative/patient stories) in driving improvement to health service safety or quality. • Identify opportunities for health services to improve their use of patient feedback. • Develop a method for health services to aggregate and analyse patient feedback data from multiple sources and link to service improvement.
Methods • Case Study – Sequential Mixed Methods design including Grounded Theory methods and situational analysis mapping • Review of peer reviewed and grey literature. Case Study: review of policy documents, patient feedback and quality improvement data; and safety & quality governance. • Semi-structured interviews/ focus groups with health service staff – 45 staff comprising clinical, administrative, and safety & quality staff. • Development of a method to aggregate patient feedback from multiple sources.
Case study: staff interviews The staff interviews were conducted following the literature review and quantitative data analysis to: •Provide qualitative data to inform and build on the early research findings……. •….. including staff comment on the effectiveness of patient complaint management processes; and to •identify opportunities to improve complaint management practice.
Staff interviews - methods • Case study site selection criteria developed and site recruited. • HREC approval to conduct semi-structured interviews; questions pilot tested prior to implementation. • Staff interviews (45) conducted: Clinical group x 36 staff including 6 clinical managers; administrative group x 9 included safety & quality staff/complaint managers, human rights (complaints) commission and Ministerial liaison/executive coordination. • Interview transcripts coded and analysed for themes.
Themes identified from staff interviews • Core theme: degree of separation. • Separation from the complaint/complainant: – Bureaucratic processes create multiple layers and ‘filtering’ between the complainant and the area the complaint is about. Impersonal responses including writing briefs & letters instead of discussing concerns directly with the patient/carer. • Separation from data: – meaningless numbers presented in data reports. No narrative or patient voice. – timeliness – reports provided too late for area to address issues.
Overview of results: staff interviews Clinicians/clinical managers clearly committed to patient safety and continual service improvement and value patient feedback, including complaints, as a service improvement tool. Bureaucratic practices hamper ability of services to link patient complaints with service improvement. Clinicians therefore turning to other methods to elicit patient feedback for service improvement e.g. patient experience trackers.
Differences across professional groups Clinicians: connect patient complaints with both individual patient experience and service improvement. -Priority: respond to the complaint (i) immediately,(ii) personally, (iii) effectively with satisfactory closure and (iv) link to improved patient experience and service improvement. -Patient/carer is central ‘driver’ in the complaint process. Administrative staff: connect complaints with individual patient experience or satisfaction; service improvement not really on radar. -Priority is to comply with administrative processes and time frames. -Minister/Executive is central ‘driver’ of the complaint process.
Opportunities to improve practice • AGREED across all professional groups: need a more personal and immediate approach to managing complaints. • Challenge: current (case study site) policy treats complaints the same way regardless of clinical/other seriousness. • Opportunity: Apply risk matrix to complaints. Level of risk determines type and timeframe for response. Complaint response to be immediate and communication to occur directly with the area the complaint was about (caveat if vulnerable patient or patient advocate required).
• Narrative is powerful and drives service improvement. • Challenges: need balance of + and - stories; complaint data reports lack narrative ‘patient voice is lost in the numbers’. • Opportunity: include narrative in patient complaint data reports; capture & report compliments better. Opportunities to improve practice
•Using patient feedback data to drive service improvement. •Challenge: data silos; no method to aggregate and analyse patient feedback from multiple sources or to link patient feedback and clinical incident data. •Opportunity: patient safety intelligence network: this research project proposes a method to aggregate patient feedback and clinical incident data by coding all data sources according to Picker Principle (quality) and ASQHCS standards (safety). Opportunities to improve practice
Research translation/policy implications Health services should: •manage complaints according to risk – clinical or other seriousness. •manage complaints immediately and directly with patient/carer. •aggregate and analyse patient feedback data and link to service improvement.
References • Ward, JK; Armitage, G. (2012). Can patients report patient safety incidents in a hospital setting? A systematic review. BMJ Qual Saf 2012;21: 685-699 • King, A; Daniels, J; Lim, J; Cochrane DD; Taylor, A; Ansermino, JM; (2010). Time to listen: a review of methods to solicit patient reports of adverse events. Qual Saf Health Care 2010;19 148-157 • Reader, TW; Gillespie, A, Roberts, J. (2014) Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014;0: 1-12 • Roberts, G; Cornwell, J; (2011) What matters to patients? Policy recommendations . Department of Health and NHS Institute for Innovation and Improvement • Coulter, A; Fitzpatrick, R; Cornwell, J; (2009) The Point of Care: Measures of patient’s experience in hospital: purpose, methods and uses. London. The King’s Fund • Goodrich, J; Cornwell, J (2008): Seeing the person in the patient. The Point of Care review paper. London. The Kings Fund www.healthissuescentre.org.au • Davies, E; Cleary, PD; (2004) Hearing the patient’s voice? Factors affecting the use of patient survey data in quality improvement. Qual Saf Health Care 2005: 14:428-432 • Davies et al Factors affecting the use of patient survey data for quality improvement in the Veteran Health Administration BMC Health Services Research 2011, 11:334 • Coulter, A; Ellins, J ; (2006) Patient-focused interventions. A review of the evidence. Picker Institute Europe • Draper et al (2001) Seeking consumer views: what use are results of hospital patient satisfaction surveys? International Journal for Quality in Health Care 2001; Volume 13, Number 6: pp.463-468 • Luxford et al (2011) Promoting patient-centred care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience International Journal for Quality in Health Care 2011; Volume 23, Number 5:pp510-515
For more information • Contact: deborah.schaler@act.gov.au

More Related Content

Deborah Schaler - EHPR 2015 - Listening, Learning, Improving

  • 1. Listening, Learning, Improving Staff views of patient complaint policy Deborah Schaler, MHPol, PhD Candidate Menzies Centre for Health Policy University of Sydney
  • 2. Patient feedback research project aims • Assess effectiveness of patient feedback methods (complaints, surveys, and narrative/patient stories) in driving improvement to health service safety or quality. • Identify opportunities for health services to improve their use of patient feedback. • Develop a method for health services to aggregate and analyse patient feedback data from multiple sources and link to service improvement.
  • 3. Methods • Case Study – Sequential Mixed Methods design including Grounded Theory methods and situational analysis mapping • Review of peer reviewed and grey literature. Case Study: review of policy documents, patient feedback and quality improvement data; and safety & quality governance. • Semi-structured interviews/ focus groups with health service staff – 45 staff comprising clinical, administrative, and safety & quality staff. • Development of a method to aggregate patient feedback from multiple sources.
  • 4. Case study: staff interviews The staff interviews were conducted following the literature review and quantitative data analysis to: •Provide qualitative data to inform and build on the early research findings……. •….. including staff comment on the effectiveness of patient complaint management processes; and to •identify opportunities to improve complaint management practice.
  • 5. Staff interviews - methods • Case study site selection criteria developed and site recruited. • HREC approval to conduct semi-structured interviews; questions pilot tested prior to implementation. • Staff interviews (45) conducted: Clinical group x 36 staff including 6 clinical managers; administrative group x 9 included safety & quality staff/complaint managers, human rights (complaints) commission and Ministerial liaison/executive coordination. • Interview transcripts coded and analysed for themes.
  • 6. Themes identified from staff interviews • Core theme: degree of separation. • Separation from the complaint/complainant: – Bureaucratic processes create multiple layers and ‘filtering’ between the complainant and the area the complaint is about. Impersonal responses including writing briefs & letters instead of discussing concerns directly with the patient/carer. • Separation from data: – meaningless numbers presented in data reports. No narrative or patient voice. – timeliness – reports provided too late for area to address issues.
  • 7. Overview of results: staff interviews Clinicians/clinical managers clearly committed to patient safety and continual service improvement and value patient feedback, including complaints, as a service improvement tool. Bureaucratic practices hamper ability of services to link patient complaints with service improvement. Clinicians therefore turning to other methods to elicit patient feedback for service improvement e.g. patient experience trackers.
  • 8. Differences across professional groups Clinicians: connect patient complaints with both individual patient experience and service improvement. -Priority: respond to the complaint (i) immediately,(ii) personally, (iii) effectively with satisfactory closure and (iv) link to improved patient experience and service improvement. -Patient/carer is central ‘driver’ in the complaint process. Administrative staff: connect complaints with individual patient experience or satisfaction; service improvement not really on radar. -Priority is to comply with administrative processes and time frames. -Minister/Executive is central ‘driver’ of the complaint process.
  • 9. Opportunities to improve practice • AGREED across all professional groups: need a more personal and immediate approach to managing complaints. • Challenge: current (case study site) policy treats complaints the same way regardless of clinical/other seriousness. • Opportunity: Apply risk matrix to complaints. Level of risk determines type and timeframe for response. Complaint response to be immediate and communication to occur directly with the area the complaint was about (caveat if vulnerable patient or patient advocate required).
  • 10. • Narrative is powerful and drives service improvement. • Challenges: need balance of + and - stories; complaint data reports lack narrative ‘patient voice is lost in the numbers’. • Opportunity: include narrative in patient complaint data reports; capture & report compliments better. Opportunities to improve practice
  • 11. •Using patient feedback data to drive service improvement. •Challenge: data silos; no method to aggregate and analyse patient feedback from multiple sources or to link patient feedback and clinical incident data. •Opportunity: patient safety intelligence network: this research project proposes a method to aggregate patient feedback and clinical incident data by coding all data sources according to Picker Principle (quality) and ASQHCS standards (safety). Opportunities to improve practice
  • 12. Research translation/policy implications Health services should: •manage complaints according to risk – clinical or other seriousness. •manage complaints immediately and directly with patient/carer. •aggregate and analyse patient feedback data and link to service improvement.
  • 13. References • Ward, JK; Armitage, G. (2012). Can patients report patient safety incidents in a hospital setting? A systematic review. BMJ Qual Saf 2012;21: 685-699 • King, A; Daniels, J; Lim, J; Cochrane DD; Taylor, A; Ansermino, JM; (2010). Time to listen: a review of methods to solicit patient reports of adverse events. Qual Saf Health Care 2010;19 148-157 • Reader, TW; Gillespie, A, Roberts, J. (2014) Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014;0: 1-12 • Roberts, G; Cornwell, J; (2011) What matters to patients? Policy recommendations . Department of Health and NHS Institute for Innovation and Improvement • Coulter, A; Fitzpatrick, R; Cornwell, J; (2009) The Point of Care: Measures of patient’s experience in hospital: purpose, methods and uses. London. The King’s Fund • Goodrich, J; Cornwell, J (2008): Seeing the person in the patient. The Point of Care review paper. London. The Kings Fund www.healthissuescentre.org.au • Davies, E; Cleary, PD; (2004) Hearing the patient’s voice? Factors affecting the use of patient survey data in quality improvement. Qual Saf Health Care 2005: 14:428-432 • Davies et al Factors affecting the use of patient survey data for quality improvement in the Veteran Health Administration BMC Health Services Research 2011, 11:334 • Coulter, A; Ellins, J ; (2006) Patient-focused interventions. A review of the evidence. Picker Institute Europe • Draper et al (2001) Seeking consumer views: what use are results of hospital patient satisfaction surveys? International Journal for Quality in Health Care 2001; Volume 13, Number 6: pp.463-468 • Luxford et al (2011) Promoting patient-centred care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience International Journal for Quality in Health Care 2011; Volume 23, Number 5:pp510-515
  • 14. For more information • Contact: deborah.schaler@act.gov.au

Editor's Notes

  1. Creswell’s Exploratory Sequential mixed methods design i.e. quantitative data collection, analysis and results followed by qualitative data collection, analysis and results leading to INTERPRETATION. Adele Clarke’s SA maps included: situational maps, social worlds/arenas maps and a position map.
  2. Creswell’s Exploratory Sequential mixed methods design i.e. quantitative data collection, analysis and results followed by qualitative data collection, analysis and results leading to INTERPRETATION. Adele Clarke’s SA maps included: situational maps, social worlds/arenas maps and a position map.
  3. Creswell’s Exploratory Sequential mixed methods design i.e. quantitative data collection, analysis and results followed by qualitative data collection, analysis and results leading to INTERPRETATION. Adele Clarke’s SA maps included: situational maps, social worlds/arenas maps and a position map.
  4. Creswell’s Exploratory Sequential mixed methods design i.e. quantitative data collection, analysis and results followed by qualitative data collection, analysis and results leading to INTERPRETATION. Adele Clarke’s SA maps included: situational maps, social worlds/arenas maps and a position map.
  5. Clinicians are committed to patient safety and quality, and value patient feedback as a service improvement tool. Challenge: different professional groups have different priorities when managing patient feedback e.g. focus on meeting time frames. Opportunity: patient feedback as a component of a patient safety intelligence network. All professional groups favour a more personal and immediate approach to managing complaints – better result; avoids escalation. Challenge: current policy is to treat negative feedback (complaints) in the same way and to the same time frame regardless of clinical/other seriousness e.g. degree of harm experienced/vulnerability of patient. Opportunity: apply a risk management approach to complaints.
  6. Narrative is very powerful and drives service improvement; value of raw data/information/patient ‘voice’ over ‘numbers’ in data reports. Challenge: need balance of negative and positive stories; lack of narrative in data reports makes it unclear what the issue was about. Opportunity: include narrative in data reports. Capture and report compliments better. Community based services could implement multi-service QI wrapped around ‘types’ of patient journeys. Challenge: Consumer feedback and survey data not fully utilised in driving service improvement. Opportunity: staff using new methods to elicit feedback e.g. Patient Experience Trackers – immediate and targeted/service specific feedback. Improve quality of data reports.
  7. Narrative is very powerful and drives service improvement; value of raw data/information/patient ‘voice’ over ‘numbers’ in data reports. Challenge: need balance of negative and positive stories; lack of narrative in data reports makes it unclear what the issue was about. Opportunity: include narrative in data reports. Capture and report compliments better. Community based services could implement multi-service QI wrapped around ‘types’ of patient journeys. Challenge: Consumer feedback and survey data not fully utilised in driving service improvement. Opportunity: staff using new methods to elicit feedback e.g. Patient Experience Trackers – immediate and targeted/service specific feedback. Improve quality of data reports.