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Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights
  1. Jackie van Dael1,
  2. Tom W Reader2,
  3. Alex Gillespie2,
  4. Ana Luisa Neves1,
  5. Ara Darzi1,
  6. Erik K Mayer1
  1. 1 Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
  2. 2 Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
  1. Correspondence to Jackie van Dael, Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London SW7 2AZ, UK; j.van-dael18{at}


Introduction A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling.

Aim To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement.

Method Literature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances.

Results A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture.

Discussion If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.

  • health policy
  • patient-centred care
  • patient safety
  • adverse events, epidemiology and detection
  • governance

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  • Twitter @JackievanDael, @ana_luisa_neves

  • Contributors JD and EKM conceived this project. JD, EKM, TWR and AG contributed to data analysis and synthesis. The manuscript was written by JD with contributions from ALN, TWR, AG, AD and EKM.

  • Funding This work is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre. Infrastructure support was provided by the NIHR Imperial Biomedical Research Centre.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement This study is a literature review and largely includes existing evidence. Anonymised interview data can be requested from JD ( External data sharing will however require separate approval from the healthcare organisation where the data were generated. Data sharing is therefore not guaranteed.