Healthcare complaints in general medical practice predominantly related to quality and safety

O’Dowd E, Lydon S, Madden C, O’Connor P. A systematic review of patient complaints about general practice Family Practice. 2020; 37(3): 297-305.

Review question

•      What is the nature of healthcare complaints in general medical practice?

Background

•      Healthcare complaints are formal expressions of dissatisfaction regarding any action or care by a healthcare provider that is perceived to be suboptimal and to have an adverse impact on patients and their families.

•      Healthcare complaints are recognized as an underutilized resource for quality and safety improvement. There is value in analyzing complaints at the system level by collecting the information from all complaints and using the insights to make improvements.

•      The aim of this systematic review is to synthesize the current research on healthcare complaints and medico-legal claims in general practice.

How the review was done

•      Review authors conducted a detailed search of five research databases for suitable articles to include in the review.

•      Key terms used in the literature search included patient satisfaction, safety, complaints, malpractice, and primary care.

•      In addition to the database searches, authors scanned the reference lists of relevant literature reviews for additional articles suitable for inclusion.

•      A total of 2,960 articles were retrieved from the initial search, of which 21 were included in this review.

•      This study was funded by the National University of Ireland, Galway, Hardiman PhD scholarship program. Review authors declare no conflicts of interest. 

What the researchers found

•      Among the complaints included in the review, 54.6% were clinical in nature (focusing on the quality and safety of clinical care), 23.4% were concerning management (focusing on the clinical environment and institutional processes), and 23% were related to relationships (focusing on communication and respect).

•      Examples of clinical complaints included inadequate patient assessment, failure to supervise or monitor care, unsatisfactory treatment, wrong patient or body part being treated, misdiagnoses, and problems with health records.

•      Examples of management-related complaints included those concerning the telephone system, poor administration, inadequate disposal of drugs, length of wait time, and cancelled appointments.

•      Examples of relationship-type complaints included alleged assault, discrimination, inadequate examination, inadequate explanation, and not taking the patient seriously.

•      Motivations for patient complaints included a desire for someone to be held responsible, economic compensation, and professional discipline for the practitioner involved.

Conclusion

•      Findings from this review highlighted the high proportion of quality- and safety-related complaints in general practice, patients’ motivations to improve the health system, and the various positive and negative impacts that complaints can have on individuals and systems involved.

•      Review authors recommend for future research to be focused on the reliable coding of complaints and their use to improve quality and safety in general practice.