Abstract
Patient complaints are vital indicators of learning opportunities to improve care. Complaints are considered, within current research, as valid as the learning opportunities reported by staff through patient safety systems (Christiaans-Dingelhoff et al., 2011, Clwyd and Hart, 2013). However, there is little research exploring the barriers to why complaints are not used to their full potential. Therefore, this thesis presents an in-depth case study of a large teaching hospital in the South of England.
The aim of this study was to explore how the beliefs and customary practices of clinical leaders are influential in organisational learning from patient complaints in the clinical environment within a large acute care hospital in the south of England. This study focused on the customary practices within the professional hierarchy and how they impacted on organisational learning from patient complaints.
Data was collected between January and June 2017, comprising n=25 one-to-one interviews of clinical leaders (staff grade ST3 and band 6 or above), n=9 observations of meetings where complaints were discussed, and documentary analysis of the minutes of those meetings. Thematic analysis was applied to the data coded through Nvivo v11, from which three novel findings emerged. 1. Blame cultures were present in the clinical environment which created intimidating and pressurised opportunities to learn within the context of patient complaints. 2. Clinical leaders used the professional hierarchy to maintain power and to continue unsupportive customary practices towards complaints. 3. Clinical leaders often did not consider patient complaints to highlight any significant learning opportunities.
This thesis highlights a stark contrast between expectations towards learning from patient complaints by government reports, professional governing bodies, and the reality of the clinical environment. The concepts highlighted within this study enable a novel in-depth understanding of the barriers, and present solutions for further development. This study presents new ways of conceptualising organisational learning from patient complaints and has the potential to influence future studies and strategies to improve patient experience, reduce mortality and morbidity, reduce repetitive litigation costs and ultimately improve care.