Article Text

Download PDFPDF
Putting out fires: a qualitative study exploring the use of patient complaints to drive improvement at three academic hospitals
  1. Jessica J Liu1,
  2. Leahora Rotteau2,
  3. Chaim M Bell1,2,
  4. Kaveh G Shojania1,2
  1. 1 Division of Internal Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  2. 2 Centre for Quality Improvment and Patient Safety (C-QuIPS), University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Jessica J Liu, University of Toronto Centre for Quality Improvement and Patient Safety (C-QuIPS), 525 University Ave, Rm 630, Toronto, ON M5G 2L3, Canada; jesskelleher{at}


Background and objectives Recent years have seen increasing calls for more proactive use of patient complaints to develop effective system-wide changes, analogous to the intended functions of incident reporting and root cause analysis (RCA) to improve patient safety. Given recent questions regarding the impact of RCAs on patient safety, we sought to explore the degree to which current patient complaints processes generate solutions to recurring quality problems.

Design/setting Qualitative analysis of semistructured interviews with 21 patient relations personnel (PRP), nursing and physician leaders at three teaching hospitals (Toronto, Canada).

Results Challenges to using the patient complaints process to drive hospital-wide improvement included: (1) Complaints often reflect recalcitrant system-wide issues (eg, wait times) or well-known problems which require intensive efforts to address (eg, poor communication). (2) The use of weak change strategies (eg, one-off educational sessions). (3) The handling of complaints by unit managers so they never reach the patient relations office. PRP identified giving patients a voice as their primary goal. Yet their daily work, which they described as ‘putting out fires’, focused primarily on placating patients in order to resolve complaints as quickly as possible, which may in effect suppress the patient voice.

Conclusions Using patient complaints to drive improvement faces many of the challenges affecting incident reporting and RCA. The emphasis on ‘putting out fires’ may further detract from efforts to improve care for future patients. Systemically incorporating patients’ voices in clinical operations, as with co-design and other forms of authentic patient engagement, may hold greater promise for meaningful improvements in the patient experience than do RCA-like analyses of patient complaints.

  • qualitative research
  • patient satisfaction
  • quality improvement

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors (JL, LR, CM, KGS) made substantial contributions to the conception or design of the work, and analysis and interpretation of data for the work. JL, LR, CM and KGS were equally involved in drafting the work or revising it critically for important intellectual content, gave final approval for the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The research ethics boards from all three hospital sites approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.