A mixed method analysis of patients' complaints: Underpinnings of theory-guided strategies to improve quality of care

Purpose: Patients' complaints can be predictors of patient care quality and safety. Understanding patients' complaints could help healthcare organizations target the areas for improvements. The purpose of this study is to use a mixed method analysis to a) examine the characteristics and categories of patients' complaints, b) explore the relationships of patients' complaints with professions and units, and c) propose theory-based strategies to improve care quality. Methods: This is a descriptive mixed method study. Data examined are patients' complaints filed at a university-affiliated hospital in China from January 2016 to December 2017. A qualitative content analysis was conducted to categorize complaints. A TwoStep cluster analysis was performed to provide an overall profile of patients' complaints. Chi-Square tests were conducted to investigate the relationships among complaints, professions, and units. Results: 838 complaints were filed, with 821 valid cases for analysis. Six categories surfaced from the qualitative analysis: uncaring attitudes, unsatisfactory quality of treatment or competence, communication problems, the process of care, fees and billing issues, and other miscellaneous causes. Physicians received most of the complaints (56.6%). The unit receiving the most complaints were outpatient clinics and medical support units (52.7%). The cluster analysis indicated four distinct clusters. Significant relationships existed between complaints and professions (χ2 (20) = 178.82, P < 0.01), and between complaints and units (χ2 (15) = 42.72, P < 0.01). Conclusions: Patients' complaints are valuable sources for quality improvements. Healthcare providers should be not only scientifically knowledgeable, but also humanistic caring. Caring-based theories may provide guidance in clinical practice. Keywords: Patient complaints, Patient safety, Quality improvements, Quality of health car