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Complaints as a learning and improvement tool

The Bottom Line

  • A variety of problems can arise in the health and social services system, ranging from difficulties in getting an appointment or accessing treatment, to inadequate symptom assessment or misdiagnosis.

  • Patients have a unique perspective within the health and social service system: they can find gray areas and uncover systemic issues that arise along the continuum of care.

  • Complaints are one of the ways in which patients, families and caregivers can help improve care and services.

Have you received the wrong diagnosis? Are you unsatisfied with the treatments received? Have you been taken seriously? Have you felt infantilized? Have you been able to make an appointment with your provider?

Each year, many patients, families and caregivers who interact with the health and social systems experience dissatisfaction and adverse events. For example, in 2019 alone, the Ontario Patient Ombudsman received more than 2,400 complaints.(1) These complaints can affect all sectors, including hospital care, primary care, or home and community care.

Complaints mechanisms can play different roles. They can help to better meet the needs of patients and to listen to them. But these are also mechanisms for learning and improvement. Indeed, patients, families and caregivers have a unique point of view in the health and social systems. They are able to recognize a range of problems in the continuum of care, some of which are not identified by traditional surveillance systems.(2)

But what do we know about the nature of complaints and their effects?

What research tells us

A recent moderate-quality systematic review examined 21 articles on the nature and effects of complaints about general medical care.(3) Researchers wanted to know what motivates individuals to make complaints, but also what were the effects of complaints on patients, providers and affected systems.

Nature of complaints

Studies have found that complaints generally relate to three main types of issues:
1) clinical issues, with regard to the quality of care (for example, inadequate patient assessment or unsatisfactory treatment) or the safety of care (for example, treatment of the wrong patient, misdiagnosis or misinterpretation of the diagnosis);
2) management issues in healthcare settings (for example, cleanliness of the physical environment or a faulty telephone system) or in institutional processes (for example, long waiting lists, cancelled appointments, or out-of-pocket expenses); and
3) relationship issues, with respect to the rights of patients (for example, alleged assaults, rude behaviours, breaches of confidentiality, or discrimination) or communication (for example, the patient does not appear to be taken seriously, inadequate explanations are offered by providers, or inability to receive care in one's own language).

Motivations

The motivations have been less studied so far. Only two of the articles included in the review described patients' motivations for filing a complaint. Motivations included a desire for someone to be held accountable for a problem, to seek disciplinary action against a professional involved, or to obtain financial compensation. But beyond these personal motivations, patients also wanted to prevent the same from happening to someone else and improve the quality of care for the future.

Effects of complaints

The review reveals that complaints can have both positive and negative effects on the system as a whole, and not just on individuals. At the patient level, the effects are usually positive and lead to financial compensation, an apology or explanation, or the possibility of changing professionals.

Providers, on the other hand, often receive disciplinary action such as reprimands or fines. The effects are therefore punitive, which can therefore cause stress, anger and even depression among providers.

At the level of the system as a whole, complaints can have a positive effect, and thus become a tool for learning and improvement. They make it possible to carry out investigations, identify problems and correct them. This requires analyzing not only complaints at the individual level, but also a collective analysis of all complaints in order to learn lessons.

Make yourself heard

Not everyone may feel confident or able to make a complaint. Some people may be afraid to question the authority of providers, others may not know where to turn to, or feel helpless in the process. Remember:

Don't be afraid to rattle the cage >> You have the right to be heard, listened to, respected and to receive clear information about your health and care. You have the right to appeal if your rights are violated.

You are not alone >> Different individuals or groups can support you during the complaint process (whether it is your family, the users' or residents' committees of the establishments or an ombudsman);

Find out about the processes in place >> Different processes may be in place to file a complaint. At the local level, it is very likely that the facility that provided you care has a mechanism for making a complaint. There are also complaint mechanisms at the provincial level, whether with professional colleges, with complaints commissioners at the Ministry of Health, or perhaps a provincial ombudsman (as is the case in Ontario with the Patient Ombudsman or the Quebec Ombudsman for health and social services).(4-5)

If you are making a complaint on behalf of a patient, their consent may be required >> If you are a caregiver and you are making this complaint on behalf of someone else, the patient's (or their substitute decision-maker) may be necessary so that their personal information can be shared.

 

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Web Resource Rating: Long-term care home complaint process
 

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Author Details

References

  1. Radio-Canada. Alors que l'Ontario n'a toujours pas d'ombudsman des patients, les plaintes s'accumulent. 25 février 2020.

  2. Reader TW, Gillespie A, Roberts J. Patient complaints in healthcare systems: A systematic review and coding taxonomy, BMJ Quality and Safety, 2014, 23(8): 678-89.

  3. O'Dowd E, Lydon S, Madden C, O'Connor P. A systematic review of patient complaints about general practice. Family Practice. 2019.

  4. Patient Ombudsman of Ontario. Make a complaint. 2020. 

  5. Protecteur du citoyen. Réseau de la santé et des services sociaux. 2020.

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