Searchable Title

Healthcare Complaints Analysis Tool: Development and Reliability Testing of a Method for Service Monitoring and Organisational Learning. Copyright: Creative Commons License.

Searchable Authors

A Gillespie
T W Lynne Reader

Reference Type

Journal Article

Authors, Section

Gillespie, A.; Reader, T. W.

Title, Section

Healthcare Complaints Analysis Tool: Development and Reliability Testing of a Method for Service Monitoring and Organisational Learning. Copyright: Creative Commons License.

Publication Year

2016

Journal Title

BMJ Quality & Safety

Volume

25

Issue

12

Pages

937-946

Availability

online

PMID

PMID: 26740496

DOI

10.1136/bmjqs-2015-004596

Abstract

Full text in Supplementary Materials file on the website. BACKGROUND: Letters of complaint written by patients and their advocates reporting poor healthcare experiences represent an under-used data source. The lack of a method for extracting reliable data from these heterogeneous letters hinders their use for monitoring and learning. To address this gap, we report on the development and reliability testing of the Healthcare Complaints Analysis Tool (HCAT). METHODS: HCAT was developed from a taxonomy of healthcare complaints reported in a previously published systematic review. It introduces the novel idea that complaints should be analysed in terms of severity. Recruiting three groups of educated lay participants (n=58, n=58, n=55), we refined the taxonomy through three iterations of discriminant content validity testing. We then supplemented this refined taxonomy with explicit coding procedures for seven problem categories (each with four levels of severity), stage of care and harm. These combined elements were further refined through iterative coding of a UK national sample of healthcare complaints (n= 25, n=80, n=137, n=839). To assess reliability and accuracy for the resultant tool, 14 educated lay participants coded a referent sample of 125 healthcare complaints. RESULTS: The seven HCAT problem categories (quality, safety, environment, institutional processes, listening, communication, and respect and patient rights) were found to be conceptually distinct. On average, raters identified 1.94 problems (SD=0.26) per complaint letter. Coders exhibited substantial reliability in identifying problems at four levels of severity; moderate and substantial reliability in identifying stages of care (except for 'discharge/transfer' that was only fairly reliable) and substantial reliability in identifying overall harm. CONCLUSIONS: HCAT is not only the first reliable tool for coding complaints, it is the first tool to measure the severity of complaints. It facilitates service monitoring and organisational learning and it enables future research examining whether healthcare complaints are a leading indicator of poor service outcomes. HCAT is freely available to download and use.

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