Learning from complaints to the Health and Disability Commission Office: A case study into indicators of deterioration in aged residential care organisations in New Zealand.

Abstract

To identify trends in complaints received by the Health and Disability Commissioner (HDC) about aged residential care (ARC) facilities in order to learn from and implement positive changes in care. A case study of 24 deidentified publicly available HDC cases across three large New Zealand ARC organisations was completed. Cross-case analysis first involved analysis of each case individually and then compared all cases using inductive thematic analysis with the intention of drawing a single set of conclusions. The speed at which the events occurred was contributory to the complaint, with 58% of the cases being rapid in nature and with sepsis being the predominant contributing factor to rapid decline and death. Six main diagnoses were indicators of deterioration: nutrition/hydration was indicated in 22% of the cases, followed by sepsis 17%, wounds 17%, UTI/renal issues 15%, falls 15% and respiratory issues 15%. Trends in Health and Disability complaints across multiple organisations can become a powerful tool for widespread quality improvement. This review highlights that the speed of deterioration triggered many complaints, especially in cases of sepsis which is possibly overlooked as a contributing problem. Also, that nutrition/hydration was indicated in many complaints and is an important condition-indicator. Trends in complaints are not generalisable to all large organisations; however, they can be applied to individual facilities.