Continuous Quality Improvement Research Articles

Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement.

Despite an epidemic of End-Stage Kidney Disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: 1.) Design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment2.) Provide transplant suitability assessments for all patients of the service3.) Describe what temporary contraindications to kidney transplantation should be the focus of health service improvements4.) Explore participant experiences with the suitability assessment process and:5.) Use our findings to inform pre-and post-transplant model of care development within Kimberley Renal Services. Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis, semi-structured interview with thematic analysis. Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and non-medical contraindications, 5/46 had medical contraindications only, and 24/46 had non-medical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46) and high body mass index (BMI) (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation. In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people we achieved substantial catch-up in suitability assessments, and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.

An Exploration of Continuous Quality Improvement Approaches within the Texas Quality Rating and Improvement System

ABSTRACT This study explored the use of continuous quality improvement (CQI) approaches in the Texas quality rating and improvement system (QRIS), Texas Rising Star. CQI approaches can assist child programs with engaging in quality improvement support and lift the quality of early learning programs to serve young children. We applied an implementation science-based fidelity monitoring framework as we analyzed secondary data from 1,789 child care programs using an online platform, survey data from mentors (n = 97), directors (n = 562), and teachers (n = 211), focus group transcripts (12 focus groups with 48 participants), and data from CQI plans (n = 173). Research Findings: Key findings from the study showed variability in how CQI was implemented across early learning programs, but generally showed (1) opportunities to differentiate delivery of CQI plans with lower star rated programs, (2) promising levels of engagement and participation within the CQI approach, and (3) positive director and teacher perceptions of the CQI approach. Practice or Policy: Study findings suggest that CQI approaches within QRIS may be a useful way to provide differentiated quality improvement support to early learning programs.

Exploring the voice of patients: Mapping their experience following care in an integrated health area

Measuring patient-reported experience measures (PREMs) is essential for the continuous improvement of quality. This study aims to assess the quality perceived by patients in the key care processes of an integrated health area measuring PREM elements, with the goal of identifying opportunities for improvement. The research was conducted in the first half of 2023 within a Spanish integrated health area, analysing five key healthcare processes: Primary Care, Emergency Services, Hospitalisation, Consultations, and Surgery. To assess perceived quality, PREM elements such as accessibility, information, and professionalism were measured using the Net Promoter Score (NPS). The Lot Quality Assurance Sampling (LQAS) method was employed to identify specific areas for improvement by detecting rejected lots and optimising sample sizes. Although the perceived quality was generally high, with good or excellent NPS scores, significant variability was observed between processes. A total of 104 rejected lots (21%) were identified across the processes evaluated. The highest number of rejections occurred in and Emergency Services (67%), with notable issues in accessibility and information. The study underscores the need for targeted interventions in accessibility and information to enhance the patient experience, particularly in Primary Care and Emergency Services. The measurement of PREM elements using NPS, in conjunction with the LQAS method, proves to be an effective tool for identifying and prioritising areas for improvement, especially when applied on a regular basis.

Quantification of building performance to evaluate novel design methods

A framework is proposed to characterize in a holistic and quantitative manner the performance of buildings. This framework aims at using continuous performance assessment, from the design conception through the life of a building. The quantitative assessment will allow designers to move away from thinking of buildings a prototype that provides no feedback loop to designers towards analysing buildings as living laboratories that inform novel design approaches. To understand the value of the framework and any factors limiting its application a biomimicry approach was used as an example. Biomimicry principles capitalize on evolution to deliver continuous quality improvement and therefore these principles were found to be consistent with modern design objectives. A series of high-profile buildings were analysed based on publicly available data. Six buildings were shortlisted for a more in-dept analysis, nevertheless it became evident that for all these buildings there was insufficient data analysis, against the design objectives, to enable a holistic assessment of performance. To illustrate the weaknesses in the data set, the best documented building, the Council House Building (CH2) in Melbourne, Australia was analysed and areas where data was missing were established.

Implementation of RedCap data systems in Kenyan psychiatric rehabilitation: a community case study

Data collection systems are vital in implementation of interventions within patient care as they allow us to better understand and improve the care given. This is equally true in the field of psychiatric rehabilitation, which has been steadily growing in the medical world for the past 20 years. It has recently been a focus of psychiatric medicine in Kenya with the Kenya Mental Health Action Plan 2021-2025 calling for improvement of care in the field. With psychiatric rehabilitation growing in low- and middle-income countries in recent years studies have come out showing the effects of newly employed programs and stressing the need for data collection practices that can be used to encourage best practices in local communities. This paper describes the implementation of data systems for the Moi Teaching and Referral Hospital Nawiri Skills and Recovery Centre (Nawiri) in Eldoret, Kenya. The goals of the data systems were 1) To collect and organize information for continuous quality improvement of services at Nawiri, 2) To collect information for reporting to MTRH leadership, Ministry of Health as well as private funders, 3) To provide data to assess outcomes of people who receive services at Nawiri to create evidence for effective interventions to help create policy to make psychiatric rehabilitation more available to people living with Severe mental illness in Kenya. Lessons learned from data systems implementation included insights into ease of data collection, adaptability of data instruments to fit facility needs, and ability to reproduce RedCap data collection in other settings.

Characterization of trends in preoperative hemoglobin A1c testing prior to metabolic and bariatric surgery: a retrospective, observational study

BackgroundIrrespective of baseline diabetes status, preoperative hemoglobin A1c (A1C) influences perioperative care in patients undergoing metabolic and bariatric surgery (MBS). Accordingly, the American Society of Metabolic and Bariatric Surgery (ASMBS) endorses that patients undergoing MBS should receive a preoperative A1C test. We aimed to assess the proportion of MBS patients who received a preoperative A1C test and determine whether baseline diabetes status influences receipt of a test.MethodsWe queried the 2017 to 2022 MBSAQIP database for patients undergoing open, laparoscopic, or robotic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy. Using descriptive methods, we compared the clinical and demographic characteristics of patients who received a preoperative A1C test with patients who did not. We performed logistic regression analysis using diabetes status as a predictor variable and receipt of a test as the outcome, covarying for sociodemographic and clinical factors.ResultsWe identified 996,217 patients who underwent RYGB or sleeve gastrectomy between 2017 to 2022. The average age of the cohort was 43.8 years (SD = 11.9) and 81.0% were female. Overall, 45.7% received a preoperative A1C test. The proportion who was tested increased over the six-year study period, from 35.5% in 2017 to 56.0% in 2022. Compared to those who were not tested, patients who were tested were more likely to have several cardiopulmonary comorbidities, including COPD (1.4% vs 1.2%, p < 0.001), PE (1.4% vs 1.2%, p < 0.001), sleep apnea (39.3 vs. 36.4%, p < 0.001), HTN (47.1% vs 44.0%, p < 0.001), and MI (1.2% vs. 1.0%, p < 0.001), though the differences in proportions were small and may not be clinically significant. Compared to patients who did not have diabetes or had diabetes controlled by diet alone, patients with non-insulin dependent diabetes had 77% increased odds of receiving a A1C test (adjusted OR (aOR) 1.77, p < 0.001); insulin dependent patients had 113% increased odds (aOR 2.13, p < 0.001).ConclusionDespite society recommendations endorsing measurement of preoperative A1C prior to MBS, less than half of patients undergoing MBS between 2017 and 2022 received a preoperative A1C test. Additionally, there were differential patterns in testing based on diabetes status. Preoperative glycemic evaluation is an area for continued quality improvement.

Exploring the conceptual history of validity in nursing diagnoses: A Koselleckian perspective.

This purpose of this article was to use the method of conceptual history to analyze the evolution of the concept of "validity" in nursing diagnoses and to identify key transformations, theoretical influences, and implications for contemporary clinical judgment and decision-making. Five stages derivate from the approach proposed by Reinhart Koselleck, including: identify the concept and its relevance, historical contextualization, contextual use, semantic changes over time, and synthesis and interpretation. The concept of "validity" in nursing diagnoses is essential for accurate diagnostics, interdisciplinary communication, and evidence-based decision-making, though its interpretation varies due to differing philosophical perspectives and methodological challenges. Historically, "validity" in nursing evolved from empirical methods to theory-driven approaches incorporating psychometric and clinical frameworks. Validation processes have adapted, integrating scientific rigor, ethical considerations, and practical utility, while also reflecting societal, technological, and cultural shifts. Today, the focus is on balancing methodological diversity and evidence-based practice, with a need for continuous quality improvement, interdisciplinary collaboration, cultural sensitivity, and patient involvement. The concept of "validity" in nursing diagnoses has evolved from early empirical methods to its current focus on evidence-based practices, interdisciplinary integration, and cultural sensitivity, emphasizing the need for accurate, technologically informed diagnostics to enhance patient care and guide clinical decision-making. Nursing must integrate diverse perspectives, cultural sensitivity, and technology into its diagnoses, and professionals should be trained in both scientific and ethical aspects to improve patient outcomes.

A Framework for Implementing Community-Based Dental Education.

Community-based dental education (CBDE) is essential for equipping dental students with the practical skills required for independent practice while simultaneously addressing the oral health needs of the community through real-world experiential learning. The success of CBDE initiatives rely on effective collaboration across stakeholders, including educational institutions, community organisations, and students, to address both faculty educational goals and community oral health needs. This paper introduces a practical toolbox to support CBDE program implementation. Developed from an extensive literature review, analysis of relevant case studies, and insights from the authors' experiences, the toolbox provides structured, evidence-based guidance on planning, administration, and ongoing evaluation for CBDE programs. Key components include strategies for fostering robust partnerships with community organisations, designing program components that maximise student engagement, and implementing continuous quality improvement practices. The toolbox emphasises creating an adaptable framework that ensures CBDE programs remain responsive to the evolving needs of both students and the communities they serve and sustain long-term collaborations.

EMYWAY Workplace-Based Entrustable Professional Activities Assessments in Otolaryngology Residency Training: A Nationwide Experience.

To present workplace-based entrustable professional activities (EPAs) assessment data from the first 2 years of the EMYWAY platform in otolaryngology residency training in Taiwan. Two-year cross-sectional study. Otolaryngology training programs. In 2020, the Taiwan Society of Otorhinolaryngology-Head and Neck Surgery (TSO-HNS) developed a workplace-based assessment (WBA) framework with 11 EPAs, integrating milestones to evaluate resident competency. In 2021, TSO-HNS piloted the EMYWAY platform for WBAs, which includes an EPA-based assessment workflow, coaching feedback, and a dashboard displaying residents' entrustment-supervision levels. Data are analyzed annually for accreditation and curriculum enhancement. This study reports on the pilot year and the first full-scale year of implementation. Eleven programs participated in the pilot year. Subsequently, 362 faculty members and 274 resident physicians from 34 programs nationwide engaged with EMYWAY. In the full-scale year from August 2022 to July 2023, 9805 responses were recorded, primarily from surgical theaters (45.9%; 4502/9805) and third-year residents (23.8%; 2331/9805). The most frequently evaluated EPAs were "head and neck" (17.5%; 1716/9805), "sinonasal" (13.5%; 1324/9805), and "ear" (12.2%; 1193/9805), with task complexity increasing with resident seniority (P < .0001). A positive correlation was found between residents' self-assessments and faculty members' ratings (r = 0.531; P < .001). Over 98.2% of residents and 88.4% of faculty members provided substantial feedback (>10 words). Analysis of WBAs reported by training programs identified faculty development targets and teaching-intensive tasks. EMYWAY effectively documents workplace learning and tracks resident competency progression. Continuous improvement of WBA quality is essential for advancing the competency-based medical education ecosystem.

Bridging Growth and Investment: The Interaction of FDI, Institutions and Financial Development in China

Over the last 30 years, China has experienced outstanding economic growth along with significant transformation in its financial system and institutional environment. It has also emerged as the primary destination for substantial foreign direct investment (FDI). Therefore, numerous studies have focused on the roles of FDI, financial development and institutional quality in stimulating the Chinese economy. However, existing literature primarily addresses the direct linear impact on economic growth, neglecting potential non-linear relationships and the roles of institutions and financial development in moderating the FDI–growth nexus. This study employs unit root and Johansen’s cointegration tests to examine the roles of FDI, institutional quality and financial development in explaining economic growth in China from 1985 to 2020. Our results show that FDI, institutions, financial development and growth are cointegrated, with non-linear effects of institutional quality and financial development on growth. Furthermore, the impact of FDI on growth decreases when financial development is high (0.627%–0.517%), but increases with improved institutional quality (0.921%–1.158%). Hence, continuous improvements in institutional quality and the financial system do not uniformly affect economic growth, but significantly influence the contribution of FDI to economic growth in China.

Construction of a Comprehensive Evaluation System for Classroom Teaching Quality in Undergraduate Vocational Education

Undergraduate vocational education is developing rapidly, and classroom teaching quality has become the key to measuring education quality. This study constructs a comprehensive evaluation system for the quality of classroom teaching in undergraduate vocational education. The system is based on students, supervisors, teaching units and peers, and evaluates from multiple dimensions such as teacher quality, teaching content, teaching methods, learning outcomes and overall satisfaction with teaching. At the same time, this study has applied and verified the comprehensive evaluation system in practice. The research results show that the constructed comprehensive evaluation system for the quality of classroom teaching in undergraduate vocational education can effectively identify problems and propose targeted improvement measures based on them, thereby promoting the continuous improvement of classroom teaching quality.

Nursing home staff’s experiences with the implementation of an automated blister packaging system for solid, orally ingestible drugs: a qualitative study in Northern Italy

ObjectivesTo explore nursing home (NH) staff’s experiences implementing an automated blister packaging system for solid, orally ingestible drugs.DesignThis was a descriptive qualitative study. Semistructured interviews were used for data collection,...

Current status and influencing factors of nutrition management in patients with digestive tract cancer from the integrated perspective of medical care staff, patients, and family caregivers: a qualitative study.

The research aimed to collect experience and viewpoints related to the nutrition management of patients with digestive tract cancers from medical care staff, patients, and family caregivers and provide reasonable and effective references for the mode of nutrition management of these patients. Using a phenomenological qualitative research method, six physicians, six nurses, three nutritionists, six patients, and six family caregivers from a tertiary A cancer hospital in Jiangsu Province were chosen by purposive sampling methods from February to June 2023. Data was collected through semi-structured in-depth interviews and analyzed by the content analysis method. Data analysis revealed two major themes, each with four subcategories: current status of clinical nutrition management tract cancers which consisted of "lack of whole-process nutrition management model," "inadequate role of nutrition management professionals," "lack of a mechanism for continuous improvement of nutrition management quality," and "lack of nutrition science popularization and training system" and influencing factors of clinical nutrition management that contained "patient-related factors," "family-related factors," "medical staff-related factors," and "hospital environment and policy-related factors." Nutritional management of digestive cancer patients is currently inadequate and should be viewed through an integrated perspective. Improvements should be made at four angles: patient, family, healthcare provider, and hospital environment by establishing a multidisciplinary nutritional management team.

Advancing District Nursing Care Through a Learning Healthcare System: A Viewpoint on Key Requirements.

The increasing complexity of healthcare needs driven by an ageing population places pressure on district nursing care. Many vulnerable older adults prefer to remain at home, requiring care coordinated with general practitioners and other professionals. This demand for integrated care is further challenged by a shortage of nursing professionals and the lack of standardised approaches to measure care quality. This article identifies the key requirements for implementing a learning healthcare system in district nursing care, using patient outcome data to foster continuous improvement and create a more adaptive, evidence-based, and patient-centred approach. This paper synthesises findings from multiple studies conducted as part of a PhD thesis, utilising a multi-method approach. These methods include examining patient outcomes in district nursing care and evaluating necessary cultural, organisational, and financial changes. Four key requirements were identified: (1) standardising patient outcome measures; (2) fostering a data-driven culture and strengthening professional autonomy; (3) enhancing organisational support and integrated care; and (4) adopting financing models that incentivise continuous learning and quality improvement. Implementing a learning healthcare system with patient outcome data in district nursing care requires a transformative shift. Standardising outcome measures, investing in information systems, and promoting continuous learning are crucial. Aligning financial incentives with patient outcomes, strengthening professional autonomy, and enhancing organisational support can make district nursing more responsive and capable of meeting complex needs. The described requirements are essential for advancing district nursing care through a more adaptive, evidence-based, and patient-centred approach.

Advancements in the application of precision nursing model on hemodialysis for diabetic nephropathy: A review.

This study explores the application and advancements of precision nursing model (PNM) in hemodialysis for diabetic nephropathy patients. Diabetic nephropathy is a severe complication of diabetes, frequently leading to end-stage renal disease and necessitating long-term hemodialysis. The PNM aims to enhance treatment outcomes and patient quality of life through individualized care plans, multidisciplinary collaboration, and continuous quality improvement. Research indicates that this model significantly improves clinical indicators and patient satisfaction, demonstrating broad applicability. This paper provides a detailed overview of the definition, theoretical foundation, implementation strategies, and specific interventions of the PNM, and evaluates its effectiveness in hemodialysis. Additionally, it addresses the challenges faced in implementation and suggests future research directions. Emphasis is placed on the need for long-term studies, technological innovations, and cost-effectiveness analyses to further integrate precision nursing into clinical practice.

Practical strategies to improve MRI operations and workflow in pediatric radiology.

Magnetic resonance imaging (MRI) is an essential tool in pediatric imaging. It offers detailed, high-contrast images without ionizing radiation, making it particularly suitable for children. Creating an efficient MRI service is challenging given the balancing priorities of image quality and scan time and the overlying logistical challenges, including MRI safety protocols, the need for sedation in certain patient populations, and flexibility to accommodate patients at different phases of care. This paper reviews practical strategies to improve MRI operations and workflows in pediatric radiology, emphasizing protocol standardization and customization, scheduling optimization, and identification of key performance indicators (KPIs). Operational data through dashboards and reports enable continuous quality assessment and improvement, while specialized staff training ensures high imaging and patient safety standards. The strategies outlined in this paper highlight the importance of a comprehensive, patient-centered approach to MRI operations. By prioritizing efficiency, quality, and patient care, radiology departments can improve diagnostic outcomes and patient experience.

Efficacy of quality improvement interventions on antibiotic prescription practices for ventilator-associated pneumonia at a tertiary care centre: a prospective pre–post interventional study

BackgroundVentilator-associated pneumonia (VAP) is a prevalent nosocomial infection in the intensive care unit (ICU), significantly increasing patient morbidity, mortality, and healthcare costs. Effective management is essential, particularly in the context...

Parental Perspectives on Pediatric Surgical Recovery: Narrative Analysis of Free-Text Comments From a Postoperative Survey.

Qualitative experience data can inform health care providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable information to guide health care quality improvement; positive feedback can confirm the efficacy of current practices and systems, while negative comments can identify areas for improvement. This study aimed to understand families' perspectives regarding their children's surgical recovery using qualitative patient experience data (free-text comments) from a prospective cohort study conducted within a larger study developing a postoperative-outcome risk stratification model. Participants were parents or guardians of children aged 0-18 years who underwent surgery at a pediatric tertiary care facility; children undergoing either outpatient or inpatient procedures were eligible to be enrolled. Participants with English as a second language were offered translational services during the consent process and were included if any family member could translate the surveys into their preferred language. Participants were ineligible if they and their families could not understand English or the child had a neurodevelopmental disability. Perioperative data were collected from families using web-based surveys, including 1 preoperative survey and follow-up surveys sent on postoperative days 1, 2, 3, 7, 15, 30, and 90. Surveys were completed until the family indicated the child was fully recovered or until postoperative day 90 was reached. Follow-up surveys included opportunities to leave free-text comments on the child's surgical experience. In total, 91% (453/500) of enrolled families completed at least 1 postoperative survey; 53% (242/453) provided at least 1 free-text comment and were included in the presented analysis, based on a total of 485 comments. The patient's age distribution was bimodal (modes at 2-3 and 14-15 years), with 66% (160/242) being male. Patients underwent orthopedic (60/242, 25%), urological (39/242, 16%), general (36/242,15%), otolaryngological (31/242, 13%), ophthalmological (32/242, 13%), dental (27/242, 11%), and plastic (17/242, 7%) surgeries. Largely positive comments (398/485, 82%) were made on the recovery and clinical care experience. A key theme for improvement included "communication," with subthemes highlighting parental concerns regarding the "preoperative discussions," "clarity of discharge instructions," and "continuity of care." Other themes included "length of stay" and "recovery experience." Feedback also suggested survey design amendments for future iterations of this instrument. Collecting parental recovery feedback is feasible and valued by families. Findings underscored the significance of enhancing communication strategies between health care providers and parents to align expectations and support proactive family-centered care. Our postoperative surveys allowed families to provide actionable suggestions for improving their experience, which may not have been considered during their hospital encounter. Our longitudinal survey protocol may be expanded to support continuous quality improvement initiatives involving near-real-time patient feedback to improve the health care experience of patients and families.

ESR Essentials: gadolinium-wise MRI-practice recommendations by the European Society for Magnetic Resonance in Medicine and Biology.

The Gadolinium Research and Education Committee (GREC) is a working group of the European Society for Magnetic Resonance in Medicine and Biology (ESMRMB), established in 2016. The aim of the committee is to monitor scientific evidence for a continuous quality and safety improvement of enhanced MRI using gadolinium-based contrast agents (GBCAs), and also assess potential alternatives. The scope of the present article is to describe the level of evidence concerning safety beyond the single patient (access to community and environmental impact), justification and optimization of the use of GBCAs beyond dosage (appropriateness and influence on clinical decision making), dose reduction with the use of AI (benefits and pitfalls), the advent of next-generation GBCAs (based on currently available data). CLINICAL RELEVANCE: GBCAs are extensively used in MRI and influence clinical decision-making. Their use to enhance the contrast-to-noise ratio is guided by recommendations from subspecialty societies. These guidelines advocate for GBCA use as an additional tool when necessary, ensuring they are administered at the lowest reasonable dose. KEY POINTS: The choice of GBCAs used in radiology should be based on MRI cost-effectiveness, MRI access to the patient community, and impact on the environment, (evidence level: low). GBCA optimization includes reducing GBCA volume burden and increasing appropriateness by including post-contrast enhancement in MRI protocols, depending on clinical indications, (evidence level: moderate). Next-generation GBCAs show higher kinetic stability and higher T1 relaxivity when compared with standard macrocyclic GBCAs allowing comparable diagnostic accuracy at lower doses, (evidence level: moderate).

Five-year analysis of hospital complaints at a Japanese tertiary teaching hospital.

Patient complaint taxonomies strongly support the use of healthcare complaints as a powerful tool to improve the quality and safety of patient care. Hospitals use complaint data at the organizational level to address quality variation across service lines and departments. We applied a validated typology method to identify where the complaints occured and gained deeper insights about how they can be more effectively utilized to drive and implement continuous quality and service improvement activities within a tertiary hospital. We included all complaints and opinions from patients and their families over a 5-year period at a large tertiary teaching hospital in Japan. Two analysts categorized the opinions into complaints and gratitude expressions, with complaints classified using Reader etal.'s taxonomy. We performed statistical tabulations and determined the number of complaints across hospital sectors using the chi-squared test, residual analysis, and Cramer's V tests to check for significant correlations between the variables. A total of 6607 complaints and comments were received. Of these, 5401 related to the Clinical, Administrative, and Human Relations domains, respectively (11.1%, 56.1%, and 32.8%). At the domain level, the most common complaints are related to the Relationships domain in both the Medical and Nursing departments. However, a detailed analysis of the category levels demonstrated that the Medicine department received the most complaints in the Communication and Patient Rights category, whereas in the Nursing department, the Humanness/Caring and Patient Rights categories were the most common sources for complaints. The Administrative department complaints were mostly related to the Management domain, with the largest number of complaints related to the Institutional Issues category. We used a validated taxonomy to identify and address trends in patient complaints and identified the key hospital departments that required remedial improvement actions. All hospital departments received direct and targeted feedback on how to effectively improve the quality, safety and services of their clinical service lines.