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Correspondence to Dr Perla J Marang-van de Mheen, Medical Decision Making, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands; [email protected]
Patients can voice their concerns in letters of complaint, written to the hospital or a regulatory body. By doing so, patients may want to express disappointment with some aspect of care and/or may want to urge and help the hospital to improve the care delivered to patients in the future.1–4 Healthcare providers and managers are committed, and ethically obliged, to continuously improve healthcare, as well as to listen and act on their patients’ concerns. Still, patient complaints are hardly used for quality improvement (QI),5 6 which seems a missed opportunity to learn from the patient’s perspective. Using patient complaints (ie, the content of formal complaint letters received by hospitals) as an actual tool for improvement is, however, hampered by various problems related to this source of information. This article will discuss these problems, which might explain why patient complaints often remain so absent from systematic efforts to improve healthcare.
Complaints are handled in isolation
The first barriers to using complaints for systematic improvement are introduced by the ways in which complaints are handled in hospitals.
Physical separation
Complaints handling is traditionally located near hospital lawyers, patient advocates or guest services, rather than the later-developed quality and safety departments. It may also be difficult to reference complaints data for QI purposes as complaints are often archived in binders, sorted on patient or physician names, rather than in accessible digital databases. This separation of complaints from QI practices precludes this information from being used, for example, to gain insights into patient-centredness or continuity of care.6
Case-by-case handling
Moreover, while most hospitals have installed systems to learn from adverse events and incidents, systems to learn from complaints are lacking.7 The ability to learn from complaints is particularly limited by the one-by-one approach to complaints. On receiving a complaint, most hospitals notify the involved providers, who (help to) write a response.8–10 While important for restoring the provider–patient relationship, this approach also treats complaints as isolated issues between individual providers and patients. One negative effect of this is that providers could be given the feeling that they are individually responsible for the whole...