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Should the public have access to written patient complaints and is it time to re-badge “patient complaints”?

30 Sep

by Rahul Alam, Research Associate in General Practice theme

Rahul Alam blog picture_Sept 14

Affording patients the opportunity to “complain” regarding the care they receive is now seen and recognised as an essential part of improving patient safety. The Francis report described the short comings in patient safety when patient complaints are not heeded [1]. “Provide every patient with a pen and paper by their bedside to provide comments and concerns” was one recommendation for improving patient safety in another recent government review [2].

Recognising these concerns, the NHS has embraced and pro-actively encouraged the collection of complaints, which have soared from 148,200 written complaints in 2010-2011 to 174,872 in 2013-2014. Over 60,500 were reported from primary care and they contribute to a staggering 3,300 written complaints a week within the NHS in England and Wales alone! [3]

Given the wide-ranging healthcare services that are available and the varying levels of patient interactions, it is likely that complaints vary in their properties and dimensions. Currently, patient complaints are not easily accessible to the public, so there is no easy mechanism for identifying and acting on complaints raised by patients. Concerns have been raised around patient consent and confidentiality which means that only some senior NHS staff can access and act on these complaints. However, should anonymised patient complaint data be made available to the public? Benefits could be considerable. For example, second-hand experiences could empower patients to act, if and when they experience similar events themselves. Healthcare organisations can learn from each other, foresee potential problems from previous complaints and adopt examples of good practice. And finally, the research community, with input from patients and the public can explore salient issues in an attempt to improve patient safety and minimise harm.

Issues around confidentiality and consent could be mitigated if “complaints” are used as an opportunity to tap in to patient’s feelings, experiences and knowledge and used to drive patient-driven improvements. The complaint could be seen as an opportunity not only to say “what went wrong” but also to emphasize and ask “what can be done” to prevent future episodes of failure.

When health, well-being and patient safety is at stake, the patient complaints can be used to make improvements from the perspective of the patient. Complaints from patients and their families can often be emotionally charged but at the same time, patients and their families are probably best positioned to answer these key questions around improvement. Asking patients for a “suggestion for improvement” is likely to funnel patient emotions and discontent. This may lead to patients producing material that can be useful to improve care and patient safety at the same time as addressing their concerns and reassuring patients that preventative efforts are being made. We need to think of mechanisms of how we can harness these views for improvement.

Given the increasing numbers of patient complaints, it seems prudent to capture as many patient suggestions as possible. I would argue that a complaint coupled with a “suggestion to improve” is better than a complaint alone. There may be occasions when a “suggestion to improve” is not possible or some may argue that they do not wish to provide a “suggestion to improve”. My counter argument would simply be that we all have a shared responsibility to contribute to the system’s well -being, just as the system has a responsibility for our own well-being.

  1. Francis, R., The Mid Staffordshire NHS Foundation Trust. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. ID 2535334 01/13, ISBN: 9780102981476. London: The Stationery Office, Crown copyright. 2013.
  2. Clwyd, A. and T. Hart, A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. Final Report. Crown copyright 2901299. 2013.
  3. HSCIC, Workforce and Facilities Team, Health and Social Care Information Centre. Data on Written Complaints in the NHS 2013-14. 2014.

Image courtesy of Stuart Miles at