London School of Economics.
Milbank Q. 2018 Sep;96(3):530-567. doi: 10.1111/1468-0009.12338.
Policy Points: Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low-level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient-centered insights that localize issues and shed light on difficult-to-monitor problems.
The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data.
We analyzed 1,110 health care complaints from across England. "Hot spots" were identified by mapping reported harm and near misses onto stages of care and underlying problems. "Blind spots" concerning difficult-to-monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission.
The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty-three percent of problems entailed major or catastrophic harm, with significant regional variation (17%-31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low-level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns.
The analysis of health care complaints reveals valuable and uniquely patient-centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry-exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.
政策要点：医疗投诉中包含有关质量和安全的有价值数据；然而，目前尚没有可靠的分析方法来挖掘其潜力。我们展示了一种分析医疗投诉的方法，该方法可提供有关热点（发生伤害和险兆事件的地方）和盲点（入院前、出院后、系统性和低水平问题以及遗漏错误）的可靠见解。系统分析医疗投诉可以通过提供以患者为中心的见解来改善质量和安全，这些见解可定位问题并揭示难以监测的问题。
由于缺乏可靠的分析工具以及对可获得的见解存在不确定性，利用医疗投诉来改善质量和安全的做法受到限制。我们开发的医疗保健投诉分析工具用于分析基准国家数据集，概念化系统分析，并确定投诉数据的附加值。
我们分析了来自英格兰各地的 1110 例医疗投诉。通过将报告的伤害和险兆事件映射到护理阶段和潜在问题，确定“热点”。通过检查准入和出院问题、系统性问题以及遗漏错误，分析难以监测的护理方面的“盲点”。
该工具的可靠性为中等至良好。每份投诉有 1.87 个问题（32%为临床问题，32%为关系问题，34%为管理问题）。23%的问题涉及重大或灾难性伤害，且区域差异显著（17%-31%）。严重伤害的热点包括检查期间的安全问题、病房内的质量问题以及入院和出院期间的机构问题。险兆事件发生在护理的各个阶段，患者和家属经常参与错误检测和恢复。投诉揭示了 3 个盲点：（1）进出医疗保健系统时出现的问题；（2）涉及多个分布广泛且往往是低水平问题的系统性故障；（3）遗漏错误，尤其是未能承认和倾听患者提出的担忧。
对医疗投诉的分析揭示了有关质量和安全的宝贵且独特的以患者为中心的见解。伤害和险兆事件热点为不良事件和关键事件提供了替代数据来源。对准入-出院、系统性和遗漏错误问题的分析可提供有关盲点的见解，这些盲点否则可能难以监测。基准数据和分析脚本可作为补充文件下载。
