Unlocking the potential for quality improvement of healthcare complaints made about general practice in Ireland
O'Dowd, Emily
O'Dowd, Emily
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Publication Date
2021-06-09
Type
Thesis
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Abstract
Healthcare complaints are an underutilised resource for quality and safety improvement. Previous research on healthcare complaints has focused on secondary care. However, there is also a need to consider quality of care in general practice. This PhD thesis aimed to ascertain the potential for healthcare complaints to support quality improvement in general practice. Four empirical studies were completed. In the first study, a systematic review of 21 studies was carried out to synthesise the extant research on complaints in general practice. This review highlighted the high proportion of clinical complaints in general practice, and the positive and negative impacts that complaints can have on health care systems. In the second study, the Healthcare Complaints Analysis Tool (HCAT), used in secondary care, was adapted for general practice. The adapted tool, HCAT(General Practice) [HCAT(GP)] was tested for reliability with 18 stakeholders using 20 fictionalised complaints. The HCAT(GP) was found to be reliable and valid. In the third study, the HCAT(GP) was used to analyse 230 general practice complaints to identify areas for quality improvement. This analysis identified both hot spots for harm (areas in care where harm occurred frequently) and blind spots (areas that are difficult for staff to observe) in care. In the final study, 29 stakeholders were interviewed in order to explore their perspectives on complaints in general practice. This study revealed an understanding by stakeholders of the potential benefits of complaints, but also highlighted a gap in knowledge between policymakers and practitioners on complaints systems, and a need to further support practitioners who receive complaints. Complaints made by patients expose issues around quality of care in general practice. Areas where harm occurs to patients in general practice need to be targeted for quality improvement, and future work needs to explore the implementation of the HCAT(GP) in practice.
Publisher
NUI Galway