Healthcare Professionals' Responses to Complaints: A Qualitative Interview Study With Patients, Carers and Healthcare Professionals Using the Theoretical Domains Framework and COM-B Model

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2024-12-08 DOI:10.1111/hex.70118

Vivi Antonopoulou, Paulina M. Schenk, Alison R. McKinlay, Paul Chadwick, Carly Meyer, Beckie Gibson, Falko F. Sniehotta, Fabiana Lorencatto, Ivo Vlaev, Angel M. Chater

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Abstract

Background

Patient complaints in healthcare settings can provide feedback for monitoring and improving healthcare services. Behavioural responses to complaints (e.g., talking or apologising to a patient) can influence the trajectory of a complaint for instance, whether a complaint is escalated or not. We aimed to explore healthcare professional (HCP) and service user (patient and carer) views on complaints' management and the perceived factors influencing responses to complaints within a healthcare setting by applying behavioural frameworks.

Method

A qualitative study was conducted using online or phone-based interviews with eleven HCPs and seven patients or carers. All participants (N = 18) had experience responding to or submitting a formal complaint in secondary and tertiary public healthcare settings in the United Kingdom. The interviews were structured using the Capability-Opportunity-Motivation-Behaviour (COM-B) Model. We analysed the transcripts using inductive thematic analysis. Then, themes were deductively mapped onto the COM-B Model and the more granular Theoretical Domains Framework (TDF).

Results

Ten themes were generated from the analysis representing the influences on HCPs' responses to complaints from HCP and patient/carer perspectives. This included (with TDF/COM-B in brackets): ‘Knowledge of complaint procedure’ (Knowledge/Capability), ‘Training and level of skill in complaints handling’ (Skills/Capability), ‘Regulation of emotions associated with complaints’ (Behavioural regulation/Capability), ‘Confidence in handling complaints’ (Beliefs about capabilities/Motivation), ‘Beliefs about the value of complaints’ (Beliefs about consequences/Motivation) and ‘Organisational culture regarding complaints’ (Social influences/Opportunity). Staff highlighted strong support systems and open discussions as part of positive organisational cultures regarding complaints (Social influences/Opportunity), and a lack of certainty around when to treat issues raised by patients as a formal complaint or informal feedback (Knowledge/Capability).

Conclusion

Our study findings highlight the importance of strong support systems and organisational openness to patient feedback. These findings can be used to design targeted interventions to support more effective responses and enhance patient-centred approaches to complaints management in healthcare settings.

Patient and Public Contribution

Patient and public involvement (PPI) was integral in this research. The NIHR PRU in Behavioural and Social Sciences had a dedicated PPI strategy group consisting of six external representatives from the patient and public community (Newcastle University, 2024). These six PPI members actively participated in shaping the research by reviewing and providing feedback on all questionnaire items before the data collection. They were actively involved in supporting participant recruitment by advertising this study on their PPI platform, The Voice^R,1 and through their online social networks. During the analysis stages of the research, preliminary findings were discussed with the PPI group to support ‘sense checking’ and interpretation of the results.

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背景：医疗机构中的患者投诉可以为监督和改善医疗服务提供反馈。对投诉的行为反应（如与患者交谈或道歉）会影响投诉的发展轨迹，例如，投诉是否会升级。我们旨在探讨医疗保健专业人员（HCP）和服务用户（患者和护理人员）对投诉管理的看法，以及通过应用行为框架来探讨影响医疗保健环境中投诉应对措施的因素：采用在线或电话访谈的方式对 11 名医疗保健人员和 7 名患者或护理人员进行了定性研究。所有参与者（N = 18）均有在英国二级和三级公共医疗机构回应或提交正式投诉的经历。访谈采用能力-机会-动机-行为（COM-B）模型进行结构化设计。我们采用归纳式主题分析法对访谈记录进行了分析。然后，将主题演绎映射到 COM-B 模型和更细化的理论领域框架（TDF）上：结果：分析产生了十个主题，分别从保健医生和患者/护理人员的角度反映了影响保健医生对投诉所做反应的因素。其中包括（括号内为 TDF/COM-B）：对投诉程序的了解"（知识/能力）、"处理投诉的培训和技能水平"（技能/能力）、"与投诉相关的情绪调节"（行为调节/能力）、"处理投诉的信心"（对能力的信念/动机）、"对投诉价值的信念"（对后果的信念/动机）和 "有关投诉的组织文化"（社会影响/机会）。员工强调，强有力的支持系统和公开讨论是积极的投诉组织文化的一部分（社会影响/机会），而对于何时将患者提出的问题作为正式投诉或非正式反馈处理则缺乏确定性（知识/能力）：我们的研究结果强调了强大的支持系统和组织对患者反馈的开放性的重要性。这些发现可用于设计有针对性的干预措施，以支持更有效的回应，并加强医疗机构以患者为中心的投诉管理方法：患者和公众的参与（PPI）在本研究中不可或缺。行为与社会科学领域的 NIHR PRU 有一个专门的 PPI 战略小组，由来自患者和公众社区的六名外部代表组成（纽卡斯尔大学，2024 年）。这六名患者和公众参与策略小组成员在数据收集前对所有问卷项目进行了审核并提供了反馈意见，从而积极参与了研究的制定工作。他们还积极参与支持参与者招募工作，在其 PPI 平台 The VoiceR1 上并通过其在线社交网络宣传本研究。在研究分析阶段，我们与公众宣传小组讨论了初步研究结果，以支持对结果进行 "感觉检查 "和解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.