Identifying quality improvement opportunities using patient complaints: Feasibility of using a complaints taxonomy in a metropolitan maternity service

Abstract

Background The Healthcare Complaints Analysis Tool (HCAT) is a coding taxonomy developed to interrogate patient complaints for quality and safety improvement lessons. The reliability of the tool has been tested in whole-of-system and whole-of-service settings. We sought to assess whether the taxonomy is functional at the level of a single hospital department. Objectives To demonstrate the feasibility of applying HCAT in the setting of a large maternity department with a view to using it to inform quality and safety improvement opportunities. Methods All 200 de-identified complaints made between 1 April 2011 and 30 April 2016 to a multi-site maternity service were collated. Each complaint entry included a summary of complaint content, complaint report date, complaint closure date and an incident severity rating (ISR). HCAT was applied to the analysis of complaints using a previously validated content analysis framework. A coding flowchart was developed to aid classification. Results The 200 complaints involved 567 issues, an average of 2.8 issues per complaint. The most common issues were rude behaviour (n = 46), poor communication (n = 38), complaints relating to the quality of medical care (n = 36), nursing care (n = 35), surgical/medical complications (n = 28) and complaints relating to the attitude of staff members (n = 23). Complaints in the clinical domain made up the greatest proportion of both severe (ISR 1 – 66.7%) and moderate (ISR 2 – 64.5%) incidents. Conclusions Using a reliable taxonomy, we were able to successfully interrogate patient complaints, identifying quality improvement targets within a single maternity service. The taxonomy appears suitable for adoption and application across health jurisdictions.