Communication: Perception and RecallPatients’ and relatives’ complaints about encounters and communication in health care: Evidence for quality improvement
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.
Section snippets
Sample and setting
The study took place in a university hospital in Sweden. The hospital offers specialised medical and nursing care, and has 1100 beds. The hospital has 55,000 admissions and more than 710,000 out-patient visits yearly, and serves patients from the local area as well as central Sweden. Some specialities also provide medical treatment for patients from other parts of the country and abroad.
From 2002 to 2004, 1784 complaints were reported to the local Patients’ Advisory Committee about the quality
Results
The analysis resulted in three categories in which the patients or the relatives described dissatisfaction with the professional encounters during their visit or stay at the hospital: “Not receiving information or being given the option to participate”, “Not being met in a professional manner” and “Not receiving nursing or practical support”. The categories contain 14 sub-categories. Complaints occurred throughout all parts of the visit or stay and included different departments as well as
Discussion
Insufficient information, insufficient respect and insufficient empathy were the most common complaints related to professional encounters and communication. Several patients stated that one of the reasons for filing a complaint was an expectation that their experience would lead to improvements and that no other patient should have to endure the same anxiety. These findings are in agreement with those of another Swedish study [30], where narrative interviews were conducted with six patients
Conclusion
Insufficient information, insufficient respect and insufficient empathy were the most common complaints related to professional encounters and communication. Patients and relatives experienced unnecessary anxiety and reduced confidence in health care after negative professional encounters. Health professionals need to understand the patient's perspective and the consequences of a negative encounter for the individual patient or relative.
Conflict of interest
None.
Acknowledgements
We acknowledge Eva Åkerlind, the head of the local Patients’ Advisory Committee, and Ewa Lundgren, the head of the Department of Surgery for their support and encouragement.
We confirm all patients and personal identifiers have been removed or disguised so the persons described are not identifiable and cannot be identified through the details of the story.
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