Patient perception, preference and participationDissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center
Introduction
Hospital managers consider the satisfaction of patients and their relatives to be of ever-increasing importance. Different contextual factors have contributed to this development. For one, the growth of patient-centered care has changed clinical practice [1], [2], [3], [4], [5], [6], [7].
A second factor is the development of a model of shared decision making (SDM) between the physician and patient; as stated by Ashraf et al. “in the shared-decision-making model, physicians engage patients in interactive discussions to develop a treatment plan based on patient preferences and values” [8]. This contributes to the redistribution of their mutual expectations [9], [10], [11] and their respective roles and the responsibility each has within the treatment framework [12], [13], [14]. SMD appears to be a significant factor in relation to treatment adherence, health status and level of satisfaction [15], [16]. Glass et al., for example, reported that “SDM was positively associated with satisfaction with decision (SWD) and was strongest for three areas of SDM: patients being helped in a health care consultation with understanding information, with treatment preference elicitation, and with weighing options thoroughly” [17].
Finally, there is a third contextual factor: the development of a form of judicialization of care. A study conducted in the United States, which included more than 40,000 physicians, indicated that each practitioner devoted approximately 50.7 months over a career lasting an average of 40 years, to one or more cases involving litigation [18], [19], [20], [21], [22]. In addition to the constraint of illness and treatment, the patient also has to go through an equally grueling legal procedure: according to Friele [23], fewer than a third of patients who file for malpractice feel that they obtained justice.
Owing to the negative effects of legal procedures, hospital managers prefer to shift any patient–physician conflicts away from legal confrontation toward conciliation.
Lausanne University Hospital (CHUV), Switzerland, has 1463 beds and provides specialized medical and nursing care (45,000 yearly admissions). On April 1, 2012, the CHUV established an office where patients can voice their concerns: Espace Patients & Proches (EPP). Three professionals trained in mediation are available at EPP on a daily basis to meet any patients of this hospital, their relatives and friends who have encountered difficulties with health care. EPP's goals are the following:
- •
To offer a space in which patients, their relatives, and friends can talk about their dissatisfaction with medical services.
- •
To closely examine the experience of the health-care process.
- •
To propose projects to hospital management with the aim of improving the quality of care.
This study aimed to analyze the complaints so as to better understand the reasons that motivated them and their underlying expectations. This investigation set out to obtain data more qualitatively and quantitatively robust than those derived from classic satisfaction surveys (conducted either by mail or face to face) within the framework of quality-evaluation programs; the limitations of such an approach have been demonstrated in several studies [24], [25], [26], [27], [28]. The material in question consists of first-hand data relating to the subjective experience of hospital. These accounts were obtained and recorded by EPP staff. In some cases, the accounts were the result of several hours of discussion. These records thus represent a valuable source for understanding the subjective experience of patients, their relatives, and friends undergoing problematic or distressing medical care.
Some studies have focused on the suggestions made by hospital's users toward improving the quality of care. However, to our knowledge, none has been devoted to the systematic analysis of the narratives of such individuals about their hospital experiences. Jangland et al. examined complaints of patients and their relatives about medical encounters and communication addressed to a nationwide organization [29], whereas our study focused on information on all topics collected in a low-threshold complaints center located in the hospital, which aims to restore the relationship between health care professionals and patients, their relatives, and friends.
Section snippets
Methods
EPP mediators are charged with rigorously documenting each visit based on a series of indicators and providing a detailed account of the situation. “Situation” here refers to a synthesis of the problems encountered during the treatment process and their perception of the difficulties they faced. The EPP's mission is to record the circumstances as perceived by those individuals—not to investigate matters in the manner of a legal office. The average account is 400 words. It contains either one
Results
In total, 372 different types of complaints and 28 main analytic themes were identified. Five clustered themes emerged from the analysis of the interconnections among the core themes (Table 1).
The analytic themes included the different types of complaints identified in the 253 accounts. For example, the theme “Access to information for patients, relatives, and friends” included the following five types of complaints that were found in at least five accounts: Difficulty in accessing medical
Discussion
The main reason for patients, their relatives, and friends going to the EPP was related to the quality of the “Interpersonal relationship” with health-care professionals. Such complaints were markedly more frequent than those concerning technical aspects of care. For example, complaints pertaining to the attitude of health-care professionals appeared approximately four times more often than those regarding medical errors. Complainants thus seem to be more tolerant of what they generally
References (41)
- et al.
The evolving concept of patient-centeredness in patient–physician communication research
Soc Sci Med
(2013) - et al.
Patient involvement in the decision-making process improves satisfaction and quality of life in postmastectomy breast reconstruction
J Surg Res
(2013) - et al.
Verbal analysis of doctor–patient communication
Soc Sci Med
(1991) - et al.
Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)
Soc Sci Med
(1997) - et al.
Doctor–patient communication: a review of the literature
Soc Sci Med
(1995) - et al.
Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey
Patient Educ Couns
(2012) - et al.
Patients’ and relatives’ complaints about encounters and communication in health care: evidence for quality improvement
Patient Educ Couns
(2009) Through the patient eyes: understanding and promoting patient-centered care
NEJM
(1994)- et al.
The doctor, the patient and his sickness
Revue Française Soc
(1961) The lost art of healing: practicing compassion in medicine
(1996)
Patient satisfaction and the new consumer
Hospitals Health Netw/AHA
Getting health reform right
Instances of alienation: portrait of the torn patient
Rev Med Suisse
Missed expectations? Physicians’ views of patients participation in medical decision-making
Med Care
Hierarchy researchers and forms of research
Actes Recherche Sci Soc
Four models of the physician–patient relationship
J Amer Med Assoc
Physician–patient relations: no more models
Am J Bioethics
Psychother Psychosom
On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim
Health Aff (Millwood)
Association of depression and suicidal ideation with unreasonable patient demands and complaints among Japanese physicians: a national cross-sectional survey
Int J Behav Med
Cited by (48)
Communication Skills in Patient-Doctor Interactions: Learning from Patient Complaints
2018, Health Professions EducationCitation Excerpt :Prior research on patient complaints focused on documenting the frequency of complaints, complainant demographics, and categorizing broadly the nature of these complaints into categories such as billing, treatment, diagnosis, efficiency, operational systems, poor attitudes, and communication.14–17 Specific communication skills such as poor attitudes and insufficient information provided were highlighted as part of some studies’ sub-group analysis.14,18–20 However, these general themes do not elucidate the types of communication errors that led to patient dissatisfaction and eventual complaints.
Health care providers’ perceptions of family caregivers’ involvement in consultations within a geriatric hospital setting
2018, Geriatric NursingCitation Excerpt :Staff were also concerned about increasing complaints and litigation. A survey by Schaad et al.17 found that communication issues between FCs and HPs were the the main triggers for FCs' formal complaints, rather than technical or medical issues. Doctors identified their main challenge as dealing with competing responsibilities, such as involving FCs while maintaining patient autonomy and confidentiality.
A new kid on the block? The spiritual practitioner in the modern hospital
2021, Palliative and Supportive CareCollusion in palliative care: An exploratory study with the Collusion Classification Grid
2019, Palliative and Supportive Care