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Qualitative complaints and their relation to overall hospital rating using an H-CAHPS-derived instrument
  1. Kyle Kemp1,2,
  2. Sarah Warren1,
  3. Nancy Chan1,
  4. Brandi McCormack1,
  5. Maria Santana2,
  6. Hude Quan2
  1. 1Analytics (DIMR), Alberta Health Services, Calgary, Canada
  2. 2Community Health Sciences, University of Calgary, Calgary, Canada
  1. Correspondence to Kyle Kemp, Analytics (DIMR), Alberta Health Services, 4520 16th Avenue NW, Suite 200, Calgary, Alberta, Canada T3B 0M6; kyle.kemp{at}


Background and objectives Due to the multitude of questions in the Hospital-Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) survey, it may be difficult to decide where quality improvement efforts should be focused. Our organisation has supplemented the survey with a ‘patient complaints’ section. The study objectives were to determine (1) the frequency of qualitative complaints and the demographic/clinical profile of patients lodging them, (2) the most frequent complaint themes and their association with overall experience scores and (3) whether overall experience scores varied based upon the complaint action taken by the patient or the degree of patient satisfaction in the handling of complaints.

Methods From April 2013 to March 2014, 8929 telephone surveys were completed by patients discharged from 93 acute care hospitals in Alberta, Canada. These were successfully linked with the corresponding inpatient record. Open-ended complaints were themed into categories. Mean differences in overall inpatient experience were assessed for each complaint theme, including overall and multiple complaints.

Results 1870 patients (20.9%) reported at least one open-ended complaint. Most frequent complaint themes were nursing (n=491; 5.5% of cohort), medications (n=219; 2.5%) and food (n=193; 2.2%). Increased odds of having a complaint were associated with younger age, being born in Canada and having no documented medical comorbidities. Protective factors were male gender, lower education level, urgent hospital admission, lower resource intensity and length of stay (LOS) <3 days.

Conclusions This is the first investigation of its type using H-CAHPS-based data in a Canadian context. Through replication of this study, other healthcare organisations may determine the association between open-ended complaints and their own overall experience scores.

  • Patient satisfaction
  • Quality improvement
  • Quality improvement methodologies
  • Surveys
  • Health services research

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