The study explores the management of patient complaints at a private hospital in Taiwan (i.e. the Case Hospital). The case study aims to identify factors which influence the response of the hospital to patient complaints and whether it incorporates information derived from patient complaints in its quality improvement efforts. The study was conducted in two stages. The first stage was a cross-institutional comparison of quality management systems between a hospital in Britain and a hospital in Taiwan. The study explored how these hospitals managed patient complaints and whether they took such feedback into account in reviewing priority of services. The second stage included a detailed case study of the hospital in Taiwan (the Case Hospital), exploring the hospital???s responses to patient complaints, along with the factors which may have influenced these responses. The study was designed to triangulate data through the use of a multi-method approach to derive converging or diverging empirical evidence from a variety of data sources. Data were obtained through interviews with hospital senior managers, a senior social worker, government officials, and managers of non-government organisations. A questionnaire survey was administered to managers, and the Critical Incident Technique (CIT), along with observation, was applied, as well as analysis of documents. Principally, this study adopts the techniques of thematic analysis (Lincoln and Guba, 1985a) with an interpretivist approach to analyse the empirical data. The results of the study indicate that although the Case Hospital appeared to be concerned about patients??? complaints, it did not respond in a systematic way to the messages received. Hospital managers appeared to merely attempt to pacify complainants while ignoring the underlying causes of their complaints. It was evident that there were no protocols in place as to how staff should handle complaints, and as a result, the hospital was failing to use the information about systemic problems provided by patient complaints to make any sustainable quality improvement. In other words, whilst the Case Hospital was attempting to resolve patient complaints on a case-by-case basis (doing things right for the patient, or in the terms of Argyris (1990), using ???single-loop??? learning), it was not reviewing or acting on these complaints as a collective group to identify systemic problems and deficiencies (doing right things, i.e. ???double-loop??? learning). The study found that the organisational response to complaints was influenced by features of the complaints and institutional attributes. Features of complaints affected the response pathways to complaints, such as patients??? status, the severity of complaints, and the nature of complaints. In terms of systemic features, the organisational response to complaints was influenced by the interaction between managerial factors (e.g. organisational structure and organisational culture), operational factors (e.g. documentation and communication), and technical factors (e.g. complaints handling techniques and information systems). The values of the top hospital management have been recognised as a powerful influence on these factors. Generally, results show that although the Case Hospital tends to take action to address individual complainants, there was no evidence of sustainable quality improvement within the organisation as a result of complaints data. The study recommends that if the hospital intends to use patient complaints to improve quality of clinical care, a ???double-loop??? learning strategy should be adopted within the organisation. This study also argues that governments need to take more responsibility and demand more accountability from hospitals, in terms of complaints handling. The individual hospital would thus be able to respond to patient complaints in a systemic way. Hospitals need to be more accountable when using patient complaints to drive quality improvement in the future.

The study explores the management of patient complaints at a private hospital in Taiwan (i.e. the Case Hospital). The case study aims to identify factors which influence the response of the hospital to patient complaints and whether it incorporates information derived from patient complaints in its quality improvement efforts. The study was conducted in two stages. The first stage was a cross-institutional comparison of quality management systems between a hospital in Britain and a hospital in Taiwan. The study explored how these hospitals managed patient complaints and whether they took such feedback into account in reviewing priority of services. The second stage included a detailed case study of the hospital in Taiwan (the Case Hospital), exploring the hospital???s responses to patient complaints, along with the factors which may have influenced these responses. The study was designed to triangulate data through the use of a multi-method approach to derive converging or diverging empirical evidence from a variety of data sources. Data were obtained through interviews with hospital senior managers, a senior social worker, government officials, and managers of non-government organisations. A questionnaire survey was administered to managers, and the Critical Incident Technique (CIT), along with observation, was applied, as well as analysis of documents. Principally, this study adopts the techniques of thematic analysis (Lincoln and Guba, 1985a) with an interpretivist approach to analyse the empirical data. The results of the study indicate that although the Case Hospital appeared to be concerned about patients??? complaints, it did not respond in a systematic way to the messages received. Hospital managers appeared to merely attempt to pacify complainants while ignoring the underlying causes of their complaints. It was evident that there were no protocols in place as to how staff should handle complaints, and as a result, the hospital was failing to use the information about systemic problems provided by patient complaints to make any sustainable quality improvement. In other words, whilst the Case Hospital was attempting to resolve patient complaints on a case-by-case basis (doing things right for the patient, or in the terms of Argyris (1990), using ???single-loop??? learning), it was not reviewing or acting on these complaints as a collective group to identify systemic problems and deficiencies (doing right things, i.e. ???double-loop??? learning). The study found that the organisational response to complaints was influenced by features of the complaints and institutional attributes. Features of complaints affected the response pathways to complaints, such as patients??? status, the severity of complaints, and the nature of complaints. In terms of systemic features, the organisational response to complaints was influenced by the interaction between managerial factors (e.g. organisational structure and organisational culture), operational factors (e.g. documentation and communication), and technical factors (e.g. complaints handling techniques and information systems). The values of the top hospital management have been recognised as a powerful influence on these factors. Generally, results show that although the Case Hospital tends to take action to address individual complainants, there was no evidence of sustainable quality improvement within the organisation as a result of complaints data. The study recommends that if the hospital intends to use patient complaints to improve quality of clinical care, a ???double-loop??? learning strategy should be adopted within the organisation. This study also argues that governments need to take more responsibility and demand more accountability from hospitals, in terms of complaints handling. The individual hospital would thus be able to respond to patient complaints in a systemic way. Hospitals need to be more accountable when using patient complaints to drive quality improvement in the future.

Bakgrund: Nya bestämmelser för klagomålshantering togs i bruk 2018 med syfte att stärka patienternas ställning och utveckla det systematiska arbetet med patientsäkerhet. En patient kan rapportera synpunkter och klagomål direkt till sin vårdgivare som är skyldig att ta emot ärendet och utreda vad som har hänt och vidta åtgärder. Forskning har visat att systematik saknas i hur verksamheter tar tillvara innehållet i ärenden som tas emot och det saknas en gemensam kategorisering. En process utvecklades inom Region Stockholm där patienter kan lämna synpunkter och klagomål via en e-tjänst på 1177 som sedan hanteras i regionens IT-stöd för avvikelsehantering. Syfte: Studiens syfte var att på aggregerad nivå undersöka inom vilka problemområden patienter rapporterar synpunkter och klagomål till vårdgivare inom akutsjukvård och primärvård via e-tjänsten samt om dessa ärenden kan bidra till lärande samt kvalitetsförbättring och ökad patientsäkerhet. Metod: Kvantitativ och kvalitativ forskningsansats det vill säga en blandad metod användes. Intervjuer genomfördes med vårdgivare och analyserades med en tematisk innehållsanalys utifrån en induktiv ansats. Problemområden kategoriserades om och jämfördes med Healthcare Complaints Analysis Tool (HCAT). Resultat: De flesta synpunkter och klagomål rapporterades inom problemområdet kommunikation med delproblemet bemötande. Det förelåg ingen markant skillnad i problemområden mellan akutsjukvård och primärvård. Intervjuer visade att vårdgivarna tog tillvara innehållet i synpunkter och klagomål på olika sätt för lärande och i sitt arbete med kvalitet och patientsäkerhet. HCAT-verktyget uppvisade ett överensstämmande resultat vid kategorisering av de tre största problemområdena av klagomål. Slutsats: Genom att systematiskt hantera synpunkter och klagomål på aggregerad nivå kan vårdgivarna få underlag till att bedriva ett ändamålsenligt arbete med kvalitet och patientsäkerhet. Användande av gemensamma kategoriseringar är en förutsättning för regionala och nationella jämförelser. / Background: New regulations for handling complaints were introduced in 2018 with the aim of strengthening the position of patients and developing the systematic work with patient safety. A patient can report complaints directly to their healthcare provider who is required to receive the case and investigate what has happened and act. Research has shown that there is a lack of systematicity in how caregivers make use of the content of cases that are received and there is a lack of common categorization. A process was developed within Region Stockholm where patients can submit complaints via an e-service, which is then handled in the region's IT -system for deviation management. Aim: The aim of the study was to investigate on an aggregated level in which problem areas patients report complaints to care providers in emergency care and primary care via the e-service and in if they can contribute to learning, quality improvement and increased patient safety. Method: A mixed methods approach has been used. Interviews were conducted with caregivers and analyzed with a thematic content analysis based on an inductive approach. Problem areas were recategorized and compared using the Healthcare Complaints Analysis Tool (HCAT). Results: Complaints reported to the caregivers were most common in communication and personal treatment. There was no difference in problem areas between emergency care and primary care. Interviews showed that the caregivers used the content of complaints in different ways for learning and in their work with quality and patient safety. The HCAT-tool showed consistent results in categorizing the top three problem areas of complaints. Conclusion: By the systematically handling of complaints on an aggregated level, the care providers can obtain a basis for carrying out an appropriate work with quality and patient safety. Use of collective categorizations is a prerequisite for regional and national comparisons.