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.
| Identifer | oai:union.ndltd.org:ADTP/187298 |
| Date | January 2005 |
| Creators | Hsieh, Yahui Sophie, Public Health & Community Medicine, Faculty of Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Public Health and Community Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Yahui Sophie Hsieh, http://unsworks.unsw.edu.au/copyright |
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