NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK.
Department of Psychological and Behavioural Science, London School of Economics, London WC2A 3LJ, UK.
J R Soc Med. 2022 Oct;115(10):390-398. doi: 10.1177/01410768221098247. Epub 2022 May 31.
A range of public inquiries in the English National Health Service have indicated repeating failings in complaint handling, and patients are often left dissatisfied. The complex, bureaucratic nature of complaints systems is often cited as an obstacle to meaningful investigation and learning, but a detailed examination of how such bureaucratic rules, regulations, and infrastructure shape complaint handling, and where change is most needed, remains relatively unexplored. We sought to examine how national policies structure local practices of complaint handling, how they are understood by those responsible for enacting them, and if there are any discrepancies between policies-as-intended and their reality in local practice.
Case study involving staff interviews and documentary analysis.
A large acute and multi-site NHS Trust in England.
Clinical, managerial, complaints, and patient advocacy staff involved in complaint handling at the participating NHS Trust (=20).
Not applicable.
Findings illustrate four areas of practice where national policies and regulations can have adverse consequences within local practices, and partly function to undermine an improvement-focused approach to complaints. These include muddled routes for raising formal complaints, investigative procedures structured to scrutinize the 'validity' of complaints, futile data collection systems, and adverse incentives and workarounds resulting from bureaucratic performance targets.
This study demonstrates how national policies and regulations for complaint handling can impede, rather than promote, quality improvement in local settings. Accordingly, we propose a number of necessary reforms, including patient involvement in complaints investigations, the establishment of independent investigation bodies, and more meaningful data analysis strategies to uncover and address systemic causes behind recurring complaints.
英国国民保健署（NHS）的一系列公共调查表明，投诉处理存在反复出现的失误，患者往往对此感到不满。投诉系统的复杂、官僚性质常常被认为是进行有意义的调查和学习的障碍，但对于这些官僚规则、法规和基础设施如何塑造投诉处理，以及在哪些方面最需要变革，仍缺乏详细的研究。我们试图研究国家政策如何构建当地的投诉处理实践，负责实施这些政策的人如何理解这些政策，以及政策的初衷与其在当地实践中的实际情况之间是否存在差异。
案例研究，包括员工访谈和文件分析。
英格兰一家大型急症和多地点 NHS 信托机构。
参与 NHS 信托机构投诉处理的临床、管理、投诉和患者权益倡导工作人员（=20 人）。
无。
研究结果说明了在当地实践中，国家政策和法规可能对实践产生不利影响的四个方面，部分原因是这些政策和法规对投诉采取了以审查为重点的方法。这些方面包括：提出正式投诉的途径混乱；调查程序旨在审查投诉的“有效性”；徒劳无益的数据收集系统；以及来自官僚主义绩效目标的不利激励和权宜之计。
本研究表明，投诉处理的国家政策和法规可能会阻碍而不是促进当地环境中的质量改进。因此，我们提出了一些必要的改革措施，包括让患者参与投诉调查、建立独立的调查机构，以及更有意义的数据分析策略，以发现和解决反复出现投诉背后的系统性问题。
