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• Healthcare Complaints: a valid metric for quality of care?
  Adam M Ali
  Published on: 4 January 2017

• Published on: 4 January 2017

  Healthcare Complaints: a valid metric for quality of care?

  • Adam M Ali, Frank Knox Fellow

  I read with interest the paper by Gillespie and Reader presenting the Healthcare Complaints Analysis Tool (HCAT) (1). The authors suggest that the HCAT could be used "as an alternative metric of success in meeting standards" and as a way "to benchmark units or regions". However, this makes the assumption that the volume and strength of complaints received is an accurate reflection of the standard of care being delivered....

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  I read with interest the paper by Gillespie and Reader presenting the Healthcare Complaints Analysis Tool (HCAT) (1). The authors suggest that the HCAT could be used "as an alternative metric of success in meeting standards" and as a way "to benchmark units or regions". However, this makes the assumption that the volume and strength of complaints received is an accurate reflection of the standard of care being delivered. In fact, it may be more heavily influenced by the ability and willingness of patients (or their relatives) to make a complaint. A hospital or unit could have a poor standard of care but receive few complaints, especially if it has a high proportion of patients from demographic groups that are less likely to complain. For example, a recent report from the Parliamentary and Health Service Ombudsman found far fewer complaints from the elderly than would be expected based upon their service usage (2). Patients from certain ethnic minorities and less affluent social grades have also been identified as groups less likely to complain (3). Moreover, many complaints may be verbalised but not formally articulated in a written statement (4). The HCAT may have a valuable role in organising complaints, but using it to benchmark quality as the authors suggest could be misleading and give a false sense of reassurance. We must have a mechanism to systematically assess poor quality care and whilst written patient complaints can be part of this, it should not be regarded as an independent metric of quality.

  1. Gillespie A and Reader TW. The Healthcare Complaints Analysis Tool: development and reliability testing of a method for service monitoring and organisational learning. BMJ Qual. Saf. 2016 25:937-946

  2. Breaking down the barriers: older people and complaints about health care. Parliamentary and Health Service Ombudsman December 2015. Available at: http://www.ombudsman.org.uk/about-us/news-centre/press- releases/2015/frail-older-people-too-afraid-to-complain-about-poor-care [accessed 11/12/16]

  3. Fear of raising concerns about care. A research report for the Care Quality Commission. April 2013. Available at: https://www.cqc.org.uk/sites/default/files/documents/201304_fear_of_raising_complaints_icm_care_research_report_final.pdf [accessed 11/12/16]

  4. Cornwell J, Levenson R, Sonola L, Poteliakhoff E. Continuity of care for older hospital patients. A call for action. The King's Fund, March 2012. Available at: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/continuity -of-care-for-older-hospital-patients-mar-2012.pdf [accessed 11/12/16]

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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