Patients’ and relatives’ complaints about encounters and communication in health care: Evidence for quality improvement

Abstract

Objective

The aim of this study was to describe patients’ and relatives’ complaints to the local Patients’ Advisory Committee about their encounters and communication in health care.

Methods

Complaints (n = 105) regarding patients’ and relatives’ dissatisfaction with communication and encounters in health care, registered at a local Patients’ Advisory Committee between 2002 and 2004, were included. The texts were analysed using content analysis.

Results

Three categories were identified: “Not receiving information or being given the option to participate”, “Not being met in a professional manner” and “Not receiving nursing or practical support”. Insufficient information, insufficient respect and insufficient empathy were described as the most common reasons for a negative professional encounter.

Conclusion

Patients and relatives experienced unnecessary anxiety and reduced confidence in health care after negative professional encounters.

Practice implications

The complaints reported to the Patients’ Advisory Committee could be used more effectively in health care and be regarded as important evidence when working with quality improvement. To systematically use patient stories, such as those obtained in this report, as a reflective tool in education and supervision could be one way to improve communication and bring new understanding about the patient's perspective in health care.

Introduction

High quality in the communication with the patient is important during medical treatment as well as in nursing to reach patient satisfaction. Studies that describe quality of care from the patient's perspective list good relations with health professionals and adequate information as important factors for both patients and relatives [1], [2], [3], [4], [5].

The interaction between the patient and the professional is a dyadic, and the outcome is influenced by many different factors. A communication framework, described by Feldman-Stewart et al. [6], [7] consists of four main components that occur between the patient and the health professional. These are as follows: first, the focus of the interaction including each participant's communication goals; second, the participants themselves—the patient's and professional's needs, skills, values, beliefs and emotions that affect the communication; third the communication process including how messages are verbally and non-verbally conveyed and received; and fourth the environment in which the communication occurs, also including external factors such as education, expectations and personal experiences.

Much research has been done on communication between patients and health professionals. For example, the power of the information communicated by the voice was studied among surgeons, and it was suggested that “how” a message is conveyed may be as important as “what” is said [8]. The physician–patient communication was studied among primary care physicians and surgeons. Physicians with no-claim seemed to conduct longer visits, educate patients more, check understanding more and use more humour during the visit than physicians with claims [9]. A study by Kuzel [10] showed that negative outcomes in the clinician–patient relationship, dominated by stories of disrespect or insensitivity, were reported as more common than technical errors in diagnosis and treatment.

The Institute for Healthcare Improvement (IHI) emphasizes that the health care system needs to be more patient-centred and to involve the patients and families in the design of care. Patient-centred care requires respect for patients’ values and expressed needs, information and communication, coordination of care, involvement of family, and concordance between the patient and health professionals [11]. Eldh [12] concludes that health care professionals should support patient participation by recognizing the patient as an individual and as a resourceful partner. The benefits of patient-centred care could be that patients are more motivated to follow treatment advice [13] and are more satisfied with health care [14].

Patient satisfaction is used as a common quality indicator in health care [15], [16]. A problem using patient satisfaction as a quality indicator depends on the complexities where different factors could affect the outcome, and the reliability and validity questioned [17]. Factors such as gratitude, faith and loyalty to health care providers, could influence patient satisfaction [18] as well as background factors such as age, health status and expectations of care [19], [20]. A patient's evaluation could be positive, even when care is poor [18]. Some researchers think that studying patient “dissatisfaction” is a more valuable concept than studying patient “satisfaction” [21], [22].

In Sweden there is a nationwide organisation for handling patients who are not satisfied with the health care. Both patients and relatives have the possibility of contacting their Patients’ Advisory Committee, located in every county council, to ask questions or to report unsatisfactory conditions. The committees act on the patients’ or relatives’ behalf. The complaints are filed in an electronic system, used nationwide, in different categories depending on the content: “care and treatment”; “organisation, regulations and resources”; and “encounters and communication”. Each complaint is investigated by the committee and feedback is given to each health professional involved as well as the head at the department, who have the possibility to respond. However a comprehensive summary of the complaints is not always reported to the organisation. Statistics show that reported complaints to Patient Advisory Committees regarding the quality of health care have increased from about 22,500 complaints in 2002, to about 25,000 complaints in 2006. If a case needs to be investigated further, patients could file an application to The Health and Medical Care Liability Board or to the Patient Insurance Company. These two procedures are independent, and the claims for financial compensation in case of patient injury in the medical treatment can be taken without the need for identifying a particular professional [23], [24].

Despite the national system to categorize the complaints at the Patient Advisory Committee, categories are too broad to be helpful for the departments in their improvement of health care. No detailed analysis has been conducted for the category “encounters and communication”. The patients or relatives in this study have made a conscious decision to report their dissatisfaction with professional encounters and are valuable sources for the health care organisation when working with quality improvement. Complaints and dissatisfaction with health professionals are often perceived negatively by health professionals; however, they could be turned to advantage and transformed into a valuable improvement tool. The aim of this study was to describe patients’ and relatives’ complaints to the local Patients’ Advisory Committee about their encounters and communication in health care.