Classification of Patient Complaints and Developing Patient Complaints Indicators

  • Anka Mohorič Kenda Farmed d.o.o.
Keywords: complaints, healthcare regulation, patient rights, patient complaint indicators, quality of healthcare, classification


Based on actual patient complaints, we have assessed the suitability of measurable elementary criteria for the selected patient complaint indicator aggregate. These indicators enable, as evidenced by the study, the monitoring and reporting of recorded patient rights violations. The data acquired from processed patient rights violations were obtained through a quantitative study via an electronic complaint form, which constitutes an integral part of the prototype interactive software solution. This solution was used for submitting and monitoring of patients’ complaints on violation of their rights. Based on the data acquired from anonymised cases (71 complaints) and study findings, it was established that the recorded requests for the processing of patient rights violations occur as a result of: (1) inadequate attitude of healthcare professionals (n = 38.03%), (2) inadequate actions by healthcare professionals (n = 57.75%), and (3) later consequences of violations (n = 4.22%). The proposed set of patient complaint indicators can lead to a significant contribution to national patient rights protection policies, to improvement of healthcare quality indicators, and to implementation of measures for better healthcare quality.


Ahmed, F., Burt, J. & Roland, M. (2014) Measuring patient experience: concepts and methods, Patient, 7(3): pp. 235-241,

Anderson, K., Allan, D. & Finucane, P. (2001) A 30-month study of patient complaints at a major Australian hospital, Journal of Quality in Clinical Practice. 21(4), pp. 109–111.

Bark. P., Vincent, C., Jones, A. & Savory, J. (1994) Clinical complaints: A means of improving quality of care, Quality of Health, 3(3), pp. 123–132.

Bates, K., Beddy, D., Whirisky, C., Murphy, M., O'Mahony, J. B. & Mealy, K. (2010) Deztermining the frequency of prescription errors in an Irish hospital, Journal of General Internal Medicine, 179(2), pp. 183-186,

Beckman, H. B., Markakis, K. M., Suchman, A. L. & Frankel, R. M. (1994) The doctor- patient relationship and malpractice. Lessons from plaintiff depositions, Archives of Internal Medicine, 154(12), pp. 1365–1370.

Benn, J., Wallance, L., Spurgeon, P., Rejman, M., Healey, A. & Vincent, C. (2009) Feedback from incident reporting: information and action to improve patient safety. Quality and Safety in Health, 18(1), pp. 11-21,

Birkeland S. (2011) Patient complaint cases in general practice University of Southern Denmark (Odense: Research Unit of General Practice Institute of Public Health, University of Southern Denmark).

Birkeland, S., Christensen, R., Damsbo, N. & Kragstrup, J. (2013) Patient Complaint Cases in Primary Health Care: What Are the Characteristics of General Practitioners Involved?, BioMed Research International,

Bouwman, R., Bomhoff, M., Robben, P. & Friele, R. (2015) Patients’ perspectives on the role of their complaints in the regulatory process, Health Expectations, 19, pp. 483–496,

Bouwman, R., Bomhoff, M. D., de Jong, J., Robben, P. & Friele1, R. (2015) The public’s voice about healthcare quality regulation policies. A population-based survey, BMC Health Services Research, 15(325), pp. 1-10,

Doyle, C., Lennox, L. & Bell, D. (2013) A systematic review of evidence on the links between patient experience and clinical safety and effectiveness, British Medical journal (BMJ), 3(1),

Fein, S. P., Heliborne, H. L., Spiritus, M. E., Seymann, G. B., Keenan, C. R., Shojania, K. G., Kagawa-Singer, M. & Wenger, N. S. (2007) The many faces of error disclosure: A common set of elements and a definition, Journal of General Internal Medicine, 22(6), pp. 755-761,

Friele, R. D., Sluijs, E. M. & Legemaate, J. (2008) Complaints handling in hospitals: an empirical study of discrepancies between patients' expectations and their experiences, BMC Health Services Research. 8, p. 199,

Friele, R. D., Kruikemeier, S., Rademakers, J. J. & Coppen, R. (2012) Comparing the outcome of two different procedures to handle complaints from a patient's perspective. Journal of Forensic and Legal Medicine, 20(4), pp. 290-295,

Garbutt, J., Bose, D., McCawley, B. A., Burroughs, T. & Medoff, G. (2003) Soliciting patient complaints to improve performance, Journal on Quality and Patient Safety, 29(3), pp. 103–112.

Gillespie, A. & Reader, T. (2015) Healthcare Complaints Analysis Tool, ver. 3 (London: The London School of Economics and Political Sciences).

Gillespie, A. & Reader, T. (2015) Healthcare Complaints Analysis Tool, version 3 (London: The London School of Economics and Political Science. Department of Social Psychology).

Hickson, G. B., Clayton, E. W., Entman, S. S., Miller, C. S., Githens, P. B., Whetten-Goldstein, K. & Sloan, F. A. (1994) Obstetricians’ prior malpractice experience and patients’ satisfaction with care, Journal of the American Medical Association (JAMA), 272, pp. 1583–1587.

Harrison, R., Merrilyn, W., Healy, J., Sith-Merry, J. & Hobbs, C. (2016) Patient complaints about hospital services: applying a complaint taxonomy to analyse and respond to complaints, International Journal for Quality in Health Care, 28(2), pp. 240–245,

Hickson, G. B., Pichert, J. W., Federspiel, C. F. & Wright Clayton, E. (1997) Development of an early identification and response model of malpractice prevention, Law & Contemporary Problems, 60(1), pp. 7–29, 10.2307/1191993.

Hickson, G. B., Federspiel, C. F., Pichert, J. W., Miller, C. S., Gauld-Jaeger, J. & Bost, P. (2002) Patient Complaint and Malpractice Risk, Journal of the American Medical Association (JAMA), 287(22), pp. 2951-2957.

Hickson, G. B., Federspiel, C. F., Blackford, J., Pichert, J. W., Gaska, W., Merrigan, M. W. & Miller, C. S. (2007) Patient complaints and malpractice risk in a regional healthcare center, Southern Medical Journal, 100(8), pp. 791-796.

Hsieh, Y. S. (2009) Taking patients' voices into account within quality systems: a comparative study, International Journal of Health Care Quality Assurance, 22(3), pp. 289–299,

Hsieh, S. Y. (2010) Factors influencing the pathways in response to complaints, International Journal of Health Care Quality Assurance, 23(3), pp. 301-311,

Hsieh, Y. S. (2012) An exploratory study of complaints handling and nature, International Journal of Nursing Practice, 18(5), pp. 471–480.

Johnsson, P. M. & Ovretveit, J. (2008) Patient claims and complaints data for improving patient safety, International Journal of Health Care Quality Assurance, 21(11), pp. 60-74,

Kaplan, H. C., Brady, P. W., Dritz, D. K., Hooper, D. K., Linam, W. M., Froehle, C. M. & Margolis, P. (2010) The influence of context on quality improvement success in health care: a systematic review of the literature, Milbank Q, 88(4), pp. 500-559.

Lombarts, M. J. M., Rup, I., Vallejo, P., Sunol, R. Klazinga, N. S. (2009) Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project, Quality and Safety in Health Care, 18(Suppl I), pp. i28–i37,

Lloyd-Bostock, S. & Mulcahy, L. (1994) The social psychology of making and responding to hospital complaints: an account model of complaint processes, Law & Policy, 16(2), pp. 123–147.

Mahood Levin, C. & Hopkins, J. (2014) Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient-Centered Representation, The Joint Commission Journal on Quality and Patient Safety, 40(11), pp. 484-492.

Mazor, K. M., Reed, G. W., Yood, A. R., Fischer, A. M., Baril, J. & Gurwiz, J. H. Disclosure of medical Errors. What factors influence How Patients Respond?, Journal of General Internal Medicine, 21(7), pp. 704-710,

Montini, T., Noble, A. A. & Stelfox, T. H. (2008) Content analysis of patient complaints, Published by Oxford University Press in association with the International Society for Quality in Health Care, International Journal for Quality in Health Care, 20(6), pp. 412-420,

Nettleton, S. & Harding, G. (1994) Protesting patients: a study of complaints submitted to a Family Health Service Authority. Sociology of Health & Illness, 16(1), pp. 38–61.

Nicolay, C. R., Purkayastha, S., Greenhalgh, A., Benn, J., Chaturvedi, S., Philips, N. & Darzi, A. (2012) Systeatic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare, British Journal of Surgery, 99, pp. 324-335.

OECD (2017) Health at a Glance 2017: OECD Indicators (Paris: OECD Publishing).

Pichert, J. W., Hickson, G. & Moore I. (2008) Advances in Patient Safety: New Directions and Alternative Approaches. Vol. 2: Culture and Redesign. Using Patient Complaint to Promote Patient Safety (Rockville, MD: Agency for Healthcare Research and Quality).

Reader, T., Gillespie, A. & Roberts, J. (2014) Patient complaints in healthcare systems: a systematic review and coding taxonomy, BMJ Quality & Safety, 23(8), pp. 1–12,

Robinson, L., Cotton, J., Sarkar, S. & Thompson, P. J. (2014) A 36-month study of patient complaints at a tertiary fertility centre, Human Fertility, 17(1), pp. 45-49. Epub 2013 Dec 6.

Robbennolt, K. J. (2008) Apologies and Medical Error, Springer Journal, 467(2), pp. 376–382,

Sage, W. M. (2002) Putting the patient in patient safety: linking patient complaints and malpractice risk, JAMA, 287: pp. 3003-3005.

Schouten, L. M., Huscher, M. E., van Everdingen, J. J., Hujisman, R. & Grol, R. P. (2008) Evidence for the impact of quality improvement collaborative: Systematic review, British Medical Journal, 336, pp. 1491-1494.

Schnitzer, S., Kuhlmey, A., Adolph, H., Holzhausen, J. & Schenk, L. (2012) Complaints as indicators of health care shortcomings: which groups of patients are affected, International Journal for Quality in Health Care, 24(5), pp. 476–482.

Skaleń, C., Nordgren, L. & Annerbäck, E. M. (2016) Patient complaints about health care in a Swedish County: characteristics and satisfaction after handling, Nursing Open 3(4), pp. 203-211, pp. 203-211,

Tingle J. (2011) Ensuring safe health care and dealing appropriately with patient complaints. British Journal of Nursing, 20(21), pp. 1386-1387,

Wofford, M. M., Wofford, J. L., Bothra, J., Kendrick, S. B., Smith, A. & Lichstein, P. R. P. (2004) Patient complaints about physician behaviors: a qualitative study. Academic Medicine, 79(2), pp. 134–138.