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APHA Scientific Session and Event Listing

Theresa Montini, MSW, PhD¹, Alice Noble, JD, MPH¹, and Henry Thomas Stelfox, MD, PhD². (1) American Society of Law, Medicine & Ethics, 765 Commonwealth Avenue, Suite 1634, Boston, MA 02215, 617-262-4990, tmontini@aslme.org, (2) Department of Anesthesia, Massachusetts General Hospital, Clinics 309, 55 Fruit Street, Boston, MA 02114

Objective: Patient complaints are an underutilized yet fertile source of information for understanding and improving systems of care, and for preventing medical malpractice claims. The aim of this study was to develop a standard qualitative coding scheme for patient complaints that could be adopted in a wide array of health service institutions. We developed this classification scheme: deductively, by merging the coding schemes from eight prior studies of patient complaints (Beckman et al. 1994; Hickson et al. 1994; Hickson et al. 1997; Garbutt et al. 2003; Wofford et al. 2004; Lloyd-Bostock & Mulcahy 1994; Nettleton & Harding 1994; Anderson et al. 2001); and inductively, by revising the received coding scheme in light of the codes and clarifications that emerged as we did a qualitative analysis of patient complaints from the Massachusetts General Hospital and Brigham and Women's Hospital.

Methods: Our data were 1,192 patient complaints (a 26% random sample) submitted during 2004 to the Massachusetts General Hospital (441/1,671) and Brigham and Women's Hospital (751/2,850). The patient complaints were de-identified and the texts were imported into the MAXQDA2 qualitative data analysis software, and coded inductively using the Grounded Theory method. We evaluated the resultant coding scheme for validity (inter-judge reliability) and reliability (test-retest reliability).

Results: The result was a robust, parsimonious, reliable, and valid coding scheme for patient complaints. The coding scheme and summary statistics will be presented, and the major categories will be illustrated by examples from the patient complaints analyzed.

Conclusions: Standardization of patient complaint analyses across institutions will transform patient complaints into opportunities for quality improvement and patient satisfaction. A well-developed, robust, empirically-grounded patient complaints typology can demonstrate that responding to patterns of patient complaints on a systems level is essential to quality improvement and changes in patient care. Greater insight into the typology of patient complaints will allow for the prevention of those acts or omissions that are likely to lead to patient complaints in the first instance. Aggregated complaint typologies can be compared to determine if certain medical center units are experiencing a disproportionate share of a particular type of medical complaint (Pichert et al. 1999). This optimizes the use of complaints as a quality improvement tool (Anderson et al. 2001) at the level of systems change.

Learning Objectives:

• 1. Appreciate the value of analyzing patient complaints qualitatively.
• 2. Understand the utility of a comprehensive standardized coding scheme for patient complaint analysis; and how the resultant aggregate data can be used to make comparisons across units and institutions.
• 3. Recognize that patient complaints are a valuable tool for systems change that will lead to quality improvement.

Keywords: System Involvement, Quality Improvement

Presenting author's disclosure statement:

Any relevant financial relationships? No