How patient complaints can help improve our health-care system

By: Dr. Kevin Smith and Prof. Adalsteinn Brown

A new paper explores novel methods to analyze and leverage patient complaint data to help prioritize, target and guide quality improvement efforts. It also points to the importance of stronger integration of hospital and community care for better care that is organized around the patient.

Like every other domain of science, health care leaders must manage the onslaught of new evidence and insight. The number of papers published each month that describe what to do or what not to do to improve health care would overwhelm even the most diligent student, let alone busy a busy manager or policy advisor. It also takes away the chance to reflect on individual papers and what they say about how our health systems are evolving.

As Dean of Canada’s largest school of public health and health systems and CEO of Canada’s largest research hospital responsible for many patients, we too experience this time crunch and want to help by unpacking new health system research. Over the next year, we are going to pick a paper each month and use that paper as an opportunity to talk about how our health system is changing and what we can do to help or guide that transformation. We will do this as a blog and see whether we – and any readers – find it a useful exercise and we welcome your feedback.

For the first paper, we’ve chosen a publication by two faculty based at the London School of Economics on what complaints can tell us about health system performance.1 Gillespie and Reader summarized a sample of more than a 1,000 complaints from 56 randomly sampled trusts, community care organizations, and ambulance services collected between 2011 and 2012. They correlated complaint data against data on harms and near misses (the hot spots) and dug more deeply into what complaints showed around entry (admission) and exit (discharge) from the health system (the blind spots).

Their findings are important in themselves. First and foremost, they demonstrated a method to analyze complaint data in a way that it can help prioritize, target and guide quality improvement efforts. They showed that patients and caregivers have an important role in identifying and detecting quality problems. And they identified three critical blind spots, of which the most telling one is “errors of omission, especially failure to acknowledge and listen to patients raising concerns.”

But the paper also points to three important shifts in how we think about health systems. First, this is a wonderful example of a true big data approach. Gillespie and Reader have taken information and repurposed it for analysis to support quality improvement (QI). Hospitals and other health care organizations are filled with data that can be used for new and novel purposes like QI without challenging privacy rules. Think about your organization and all the data collected as part of managing care and personnel. Are you using these data to their full extent?

Second, they treat data on complaints as valuable – and true – in themselves: “health care complaints can provide an independent check on quality and safety monitoring methodologies that rely on self-report.”  This is a major shift from a decade ago when much of the discussion centred around whether patient satisfaction and experience actually measured more than the quality of food and the convenience and cost of parking. But it also raises, once again, the question of whether health care organizations use all of the information on patient experience from complaints, surveys, and simple reports of patients leaving without being seen to their full potential. And if not, what sort of organizational focus could lead to a much stronger engagement with patients and what they and their caregivers can tell us about improving care.

Finally, the paper reflects the importance of integration of care for better care. What the authors called “blind spots” become much clearer when there is no transfer in and out of an institution and no border between health and social care. The problems that happen when a patient moves from setting to setting are very much problems of moving between one organization with a specific team, way of collecting data, and set of incentives to another where the team, data and incentives change. Until we join up care around patients we will always have complaints2 (and the near misses and harms they can represent) in the blind spots of our health care system.  And until we focus on ensuring people healthy – and public health and our health care system both have a key role – we will not truly be focusing on the patient experience.  

Adalsteinn Brown is Dean and Professor at the Dalla Lana School of Public Health. Kevin Smith is President and CEO of University Health Network.

1 Alex Gillespie and Tom W. Reader. Patient-centred insights: Using health care complaints to reveal hot spots and blind spots in quality and safety. Millbank Quarterly, 2018; 96:530-567.

2 Dr. Kevin Smith is committed to examining UHN’s patient complaint data and sharing his findings in future communications.

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