Empirical Evidence on Violations of Patient Rights in the Republic of Slovenia

  • Anka Mohorič Kenda
  • Robert Leskovar Universsity of Maribor, Faculty of Organizational Science, Kidričeva cesta 55a, 4000 Kranj
  • Rajko Pirnat University of Ljubljana, Faculty of Law, Poljanski nasip 2, 1000 Ljubljana
  • Duško Uršič University of Maribor, Faculty of Economics and Business, Raylagova ulica 14, 2000 Maribor
  • Milan Pukšič Eurogen d.o.o., Malgajeva ulica 17, 1000 Ljubljana
Keywords: patient complaints, violations of patient rights, simulation model, quality and management in health care


The objective of the study was to: a) Analyse the causes of patient complaints on a large sample of the population of the Republic of Slovenia, and b) Develop a discrete simulation model used for the handling of patient complaints. Data obtained from the survey (N=1195), was used in the determination of parameters while legislation in the field of patient rights was employed to determine the structure of the simulation model. The model was used to simulate activities for different categories and paths of complaints. The most commonly identified causes of patient complaints were identified as follows: violation of legislative stipulations (93.6%), deterioration of health (93.1%), suspected improper treatment (91.7%), staff unavailability (91.1%), disregard of violations (90.9%) and loss of documentation (89.4%). Through improved transparency and safe electronic access, the simulation of patient complaints process enables feedback for policy makers to foster the quality of healthcare services.

Author Biographies

Robert Leskovar, Universsity of Maribor, Faculty of Organizational Science, Kidričeva cesta 55a, 4000 Kranj
Rajko Pirnat, University of Ljubljana, Faculty of Law, Poljanski nasip 2, 1000 Ljubljana
Duško Uršič, University of Maribor, Faculty of Economics and Business, Raylagova ulica 14, 2000 Maribor


Abteilung Arbeit und Sozialpolitik in Deutschland (2003) Gesundheitsreform in Deutschland, Sind Elemente aus anderen Ländern Europas übertragbar auf unsere Reform (Berlin: Friderich-Ebert-Stiftung).
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.
Beckman, H. B., Markakis, K. M. & Suchman, A. L. (1994) The doctor patient relationship and malpractice. Lessons from plaintiff depositions, Archives of Internal Medicine, 154(12), pp. 1365–1370.
Bonfil, X., Roqué, M., Aller, B.M, Osorio D, Foradada C, Vives R & Rigau D. (2013) Development of quality of care indicators from systematic reviews: the case of hospital delivery, Implementation Science, (8)42, pp. 1:10.
Brand, C.A, Khan, M. M, Wright, O., Jone, R. N., Morris, J. N., Travers, C. M., Tropea, J., Gray, L. C. (2011) Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol, BMC Health Services Research, 11(281), pp. 1-8.
Conry, M. C., Humphries, N., Morgan, K., McGowan, Y., Montgomery, A., Vedhara, K., Panagopoulou, E, Mc Gee, H. (2012) A 10 year (2000–2010) systematic review of interventions to improve quality of care in hospitals, BMC Health Services Research, 12(275), pp. 1-16.
Dutch Health Care Performance Report (2010) (Amsterdam: National Institute for Public Health and the Environment Ministry of Health, Welfare and Sport, Netherlands).

Evelin, S., Bernard, B., Michael, C., Melanie, S. & Peter, P. G. (2007) Public trust in health care: A comparison of Germany, the Netherlands, and England and Wales, Health Policy, 81, pp. 56-67.
Faranz, A., Burt, J. & Rolan, M. (2014) Measuring Patient Experience: Concepts and Methods, Patient, 7(3), pp. 235–241.
Garbutt, J., Bose, D. & McCawley, B.A. (2003) Soliciting patient complaints to improve performance.Joint Commission Journal on Quality and Safety, 29(3), pp. 103–112.
Geraedts, M., Schwartze, D. & Molzahn, T. (2007) Hospital quality reports in Germany: patient and physician opinion of the reported quality indicators, BMC Health Services Research, 7(1), pp. 1-6.
Hsieh, S.Y. (2009) Factors hampering the use of patient complaints to improve quality: an exploratory study, International Journal of Nursing Practice, 15(6), pp. 534-542.
Hysong, S. J, Teal, C. R., Khan, M. J. & Haidet, P.(2012) Improving quality of care through improved audit and feedback, Implementation Science, 7, 45: 1-10.
Karpukhin, I. N., Korablin, Yu. P. & Neznanov, A. A. (2012) The Models of Time in Simulation, Automatic Documentation and Mathematical Linguistics, 46(3), pp.133-137.
Kathy, H. B. (2010) Managing complaint’s in Health and social care, Nursing Management, 17(1), pp. 12-17.
Ketelaar, A. B. M. N., Faber, M. J., Braspenning, J. C. & Westert, G. P. (2014) Patients’ expectations of variation in quality of care relates to their search for comparative performance information, BMC Health Services Research, 14(617), pp. 1-7.
Kljajić, M. (1994) Teorija sistemov (Kranj: Moderna organizacija).
Kötter, T., Blozik, E. & Scherer, M. (2012) Methods for the guideline-based development of quality indicators–a systematic review, Implementation Science, 7(21), pp. 1-22.
Knez, R. (2014) Uveljavljanje pravic do zdravljenja v tujini (Maribor: Pravna fakulteta Univerze v Mariboru).
Kuske, S., Maass, C., Weingärter, V. & Schrappe, M. (2013) Patient-safety indicators: a systematic review, criteria-based characterization and prioritization, Journal of Public Health, 21(2), pp. 201–214.
Leskovar, R.,Acceto, R.,Baggia, A., Lazarevič, Z., Vukovič, G. & Požun, P. (2011) Discrete event simulation of administrative and medical processes, Zdravniški vestnik, 80(5), pp. 345-353. Levesque, J. F., Harris, M. F. & Russell, G. (2013) Patient-centred access to health care: conceptualizing access at the interface of health systems and populations, International Journal for Equity in Health, 12(18), pp. 1-9.
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. 185–208.
Ministrstvo za zdravje RS (2012) Državno poročilo o stanju na področju varstva pacientovih pravic 2011 (Ljubljana: Ministrstvo za zdravje RS).
Montini, T., Noble, A. A. & Stelfox, T. H. (2008) Content analysis of patient complaints, International Journal of 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.
Sage, W. M. (2002) Putting the patient in patient safety: linking patient complaints and malpractice risk, JAMA, 287(22), pp. 3003–3005.
Shang, D. C., Hann, C. J. & Lung, K. S. (2012) A Novel Approach for Evaluating the Risk of Health Care Failure Modes, Journal of Medical Systems, 36(6), pp. 3967-3967.
Sheaff, R., Chambers, N., Charles, N., Exworthy, M., Mahon, A., Byng, R., Mannion, R. How managed a market? Modes of commissioning in England and Germany, Health Services Research, 13(S8), pp. 1-10.
Stelfox, H. T., Gandhi, T. K. & Orav, E. J. (2005) The relation of patient satisfaction with complaints against physicians and malpractice lawsuits, The American Journal of Medicine, 118(10), pp. 1126–1133.
The Medical Protection Society limited (2012) NHS Complains in UK, Regulation and Principles (London: The Medical Protection Society limited).
Thom, D. H., Hall, M. A. & Palson, L.G. (2004) Measuring patients' trust in physicians when assessing quality of care, Health Affairs, 23(4), pp. 124-132.
U.K. Department of Health (2013)The Handbook to the NHS Constitution (London; U.K. Department of Health).
Verschuuren, M., Gissler, M., Kilpeläinen, K., Tuomi-Nikula, A., Sihvonen, A., Thelen, J., Gaidelyte, R., Ghirini, S., Kirsch, S., Prochorskas, R., Scafato, E., Kramers, P. & Aromaa, A. (2013) Public health indicators for the EU: the joint action for ECHIM (European Community Health Indicators & Monitoring), Archives of Public Health, 71(1), pp. 1-7.
Wofford, M. M, Wofford, J. L. & Bothra, J. (2004) Patient complaints about physician behaviors: a qualitative study. Academic Medicine, 79(2), pp. 134–138.

Conference Paper