A multi-perspective exploration of the understanding of patient complaints and their potential for patient safety improvement in general practice

Figures & data

Figure 1. Breakdown of themes and subthemes.

Table 1. Exemplar quotes from Theme 1 ‘Why patients submit complaints’ and subthemes.

Theme Subtheme	No (%) of participants	Exemplar quotes
1. Why patients submit complaints
1.1 Motivations	13 (45%)	‘I think it is an exercise in sounding out whether they have a case for litigation or not’ (Medico-legal expert 3) ‘certainly some [patients] want the money back that they spent on the medication say, and you know sometimes people have very limited incomes’ (GP 1).
		‘most people don’t really want to take you to court… they just want to make sure it doesn’t happen again to other people’ (GP 12).
1.2 Experience of care	23 (79%)	‘perhaps they might feel that they weren’t treated well… you know in terms of what the treatment should have been or was’ (GP 3).
		‘I felt the doctor was rude to me, dismissive of me, the nurse was dismissive of me, rude to me’ PP16 (GP).
		‘I touched on lack of resources and I think that’s a huge driver in complaints’. (Policymaker 1).
1.3 Barriers and facilitators	18 (62%)	‘more likely to complain, middle class people more than the poorer strata of society’ (GP 5).
		‘because I suppose of the power differentials between health professionals and patients, they don’t tell you if something’s going wrong’ (Practice nurse 1).
		‘I think as time has gone on there’s more empowerment of patients’ (GP 6).
		‘you’re talking about small communities, people actually know who their GP is, and you know and you’re likely to meet them at mass or in a social context as well’ (Practice nurse 1).
		‘that disappointment that might not have been complained about in-hours will be complained about in out-of-hours because it’s a strange clinician in a faceless institution’. (GP 5).

Table 2. Exemplar quotes from Theme 2 ‘Management of complaints’ and subthemes.

Theme Subtheme	No (%) of participants	Exemplar quotes
2. Management of complaints
2.1 Practice processes	28 (97%)	‘It’s about talking to them in the first instance I suppose and trying to alleviate it without it escalating’ (Practice nurse 3).
		‘In the place where I work currently I haven’t come across a general standard reporting procedure for complaints’ (Practice nurse 2).
		‘I would love to see a specific policy, SOP [standard operating procedure] on complaints’ (Practice nurse 2).
2.2. National Processes	29 (100%)	‘like I don’t know how it’s managed nationally, or broadly’ (Practice manager 1).
		‘I think it’s too weighted against the doctor, the doctor has absolutely no recourse to complain about a patient’. (GP 1).
		‘I suppose I think it’s functioning better than it has been in the past. There’s definitely renewed focus on complaints and learning from complaints’ (Policymaker 3).

Table 3. Exemplar quotes from Theme 3 ‘Impact of complaints’ and subthemes.

Theme Subtheme	No (%) of participants	Exemplar quotes
3. Impact of complaints
3.1 Impact on patient	17 (59%)	‘if that [the complaint] goes all the way, the patient is going to be up on a stand as well as the doctor, getting cross-examined, and I think patients don’t essentially realise that’ (Medico-legal expert 2).
		‘…the impact on the patient obviously is that if they feel particularly aggrieved about something, at least they have a process in place to bring it through’ (GP 12).
		‘it perhaps makes you feel negative about that patient or their family’. (GP 5).
3.2 Impact on staff member	23 (79%)	‘no doctor remembers any good things done, but he remembers all the bad things done, all the mistakes, and the complaints, and they’re the things that stick out in the memory, because they can be very personally very difficult, very stressful, very traumatic’ (GP 9).
		‘I know that I have heard doctors saying, well after this happened we do something differently. So there are definitely learnings that are there’ (Medico-legal expert 3).
		‘It would make you practice more defensively, if you had someone complain about a missed test result before then you’ll end up testing everybody for that thing and that’s probably not the right way of doing it either’ (GP 10).
3.3 Impact on GP practice	15 (52%)	‘because of that incident we have completely changed our practice protocols on repeat prescribing’. (GP 9). ‘You’ve staff who are already sort of under siege in terms of the workload, media focus, you know simply trying to work in overcrowded, difficult situations, and then on top of that you have very understandable complaints…So you have a morale issue’ (Policymaker 5).
3.4 Impact on wider system	17 (59%)	‘for every [complaint] …we do highlight to the powers that be and say listen there is additional resources required here… it is put on a list for when and if we do get money’. (Policymaker 1).
		‘it really identifies key learnings across the system but it's coming from… the voices of our patients… and how do we turn that into action how do we turn that into change’ (Policymaker 2).