Table 3

Summary of 12 context-mechanism-outcome (CMO) configurations for patient-centric complaint handling and system-wide quality improvement* (stage 3)

Procedural pathwayRelevant programme theoryMechanism referenceContext (C)Mechanism (M)Outcome (O)
Complaint handlingInviteCMO135–49 Clarity of complaints procedures and policiesPatients and families are more inclined to complain if they are aware of their rights and can easily access information that outlines procedures involved.…and facilitates patient and family access to seek redress
CMO225 35–37 40–42 45 46 49–60 68 Complainant characteristics and accompanying needs (eg, complainants burdened by health condition or language barriers)Collaboration with support and advocacy services improves accessibility for commonly excluded patient groups.…and increases the representativeness of complaints data
CMO317 40–43 46 49 58 61–64 Stigma of complaints and staff attitudeStaff encouragement of, and signposting to, complaint procedures reduces anxiety and stigma that prevents patients and families from filing a complaint.…and encourages patients and families to share their feedback
RespondCMO417 21 22 24 25 38 42 48 65–67 Staff coordination and response toolkits Comprehensive and bespoke responding improves complainant satisfaction.…and ensures that the complaints process provides redress
CMO518–26 38 40–43 46 65 67 National standards used to monitor the quality of complaint handlingTransparency increases accountability of complaint handling and encourages other patients and families to provide feedback.…and encourages the use of complaints procedures
Quality monitoring and improvementReportCMO67–12 16 55 65 68–82 Framework used to record insights held in complaintsAn evidence-based reporting framework supports meaningful aggregation of complaints data.… and leads to reliable and useful learning insights
CMO710 11 16 17 80 81 Staff type responsible for reporting, accompanying incentives and received training in complaints reportingStandardised training and guidelines for coders who are sufficiently removed from front-line practice will increase objectivity and consistency of reporting.… and leads to data that represent patient voice
CMO816 17 48 65 71 Informatics system used to create and retain complaints informationA centralised informatics system facilitates data monitoring and triangulation.….and allows for effective, continuous monitoring of care issues
AnalyseCMO916 52 69 75 83–92 Frequency of complaints received at service (eg, sample size)Conducting analysis at an appropriate organisational level enables the identification of trends of poor care.…and helps identify system-wide care issues
CMO104 5 7 10 16 69 81 93 Staff analysis skills and data infrastructure (eg, automated dashboards, triangulation)Combining quantitative trend analysis with targeted qualitative analysis produces granular, actionable lessons for improvement.…and helps locate and prioritise improvement initiatives
 ImproveCMO117 16 17 20 26 27 38 43 45 46 48 69 70 94 Board priorities and leadershipBoard priorities and leadership shape the degree to which complaints data are used for quality monitoring and improvement.…and allows complainants to have a greater impact on care improvement
CMO1216 17 36 42 43 46 60–64 87 95–98 Organisational culture and stigma of complaintsA just culture that welcomes complaints as opportunities for learning counters negative impact of complaints on staff.… and reduces staff apprehension towards complaints
  • *References included 74 international academic papers and 10 England-based policy sources.