• Users Online: 84
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 34-37

The share of adverse events from patients' complaints: A case study


1 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
3 Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
4 Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
5 Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Date of Web Publication25-Jun-2014

Correspondence Address:
Raja Mardani
Health Services Management, Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.135354

Rights and Permissions
  Abstract 

Introduction: Adverse events are among the important challenges that health systems in all countries are grappling with and they are attempting to minimize them and reduce the damages caused by them. In the meantime, complainant is expressing dissatisfaction, which needs the accountability and auditing. Only a small proportion of dissatisfaction with the Health Care System is reflected in complaints. This paper aims at investigating the proportion of adverse events in the complaints of individuals referring to the Deputy of Treatment of an Iranian Province, which is the authority to respond the complaints from the real and legal people, who are health services providers. Materials and Methods: This is a cross-sectional retrospective descriptive research. The population of the study has been the cases of complaints referring to the Deputy of Treatment in 2012. All the registered cases have been studied. For data collection, we used extended checklists of the Deputy of Treatment in which their face and content validity have been approved by the experts. Data was extracted from the files and it was described using the frequency distribution table in Excel. Results: The findings showed that in 2012, 587 cases of complaint were submitted to the Deputy of Treatment, of which 504 cases (85/86%) were related to the first six months of the year and 83 cases (14/14%) were for the second half of the year. Most complaints from individuals were about the "physician", and from the healthservice providers have been related to the "hospital". The results of the study also indicated that the care processes have been the major subject of the complaints. Conclusion: According to the findings of the research, adverse events have been ranked as the third reason for complaints. Failure to provide appropriate and correct treatment has been the most common in interpreting adverse events. Since most of the errors and malpractices are revealed after the patient or his family's complaint, investigation of the complaints referred to the regulatory systems of health service areas by revealing frequency of errors and occurred malpractices, and also by providing appropriate and effective solutions can reduce adverse events and provide the consumers of health services with more satisfaction.

Keywords: Adverse events, deputy of treatment, Iran, medical malpractices, medical department, medical error, never event,patients′ complaints, risk management


How to cite this article:
Jabbari A, Khorasani E, Jazi MJ, Mofid M, Mardani R. The share of adverse events from patients' complaints: A case study. Int J Health Syst Disaster Manage 2014;2:34-7

How to cite this URL:
Jabbari A, Khorasani E, Jazi MJ, Mofid M, Mardani R. The share of adverse events from patients' complaints: A case study. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2024 Mar 28];2:34-7. Available from: https://www.ijhsdm.org/text.asp?2014/2/1/34/135354


  Introduction Top


In a healthcare organization that is committed to the patient safety, occurrence of an event or a serious incident could trigger investigation regarding the underlying causes and common factors especially if the event causes death or disability. [1] "Undesirable events" are among the important challenges that health systems in all countries are grappling with and they are also attempting to minimize them and reduce the damages caused by them. [2]

Undesirable events are not always due to an error. For example, one of the unwanted medication incidents is "adverse drug reactions", which according to the definition of the World Health Organization (WHO) is 'complication that usually occurs in using normal dose of the drug'. Responding reporting systems, convince and compel the hospitals to report the adverse events by creating the inhibiting mechanisms (fine, sending petitions and complaint). [3]

In the meantime, the complainant expressing discontent needs to be responded and investigated. The complaint reflected only a small proportion of dissatisfaction with the Health Care System. [1] Not all preventable noisome events lead to complain and legal proceedings and not all poor outcomes lead to receiving the compensation. [4] A common view is that the major reason for the patients' complaints is, "they want their voices to be heard and to obtain apology". [5],[6]

Patients' view and his experience of health services has been one of the four areas of the Rule of Clinical Services regarded by the World Organization and the patient's rights besides his satisfaction of healthcare services is among the most important issues of this element of the Rule of Clinical Services. [7] The concept of clinical governance started in health literature and healthcare management due to the clinical report of the WHO in 2000 declaring that one of the responsibilities of governments is to accept the trustee in the field of health and healthcare management. [8]

According to the modern management theories, customer focus and applicants' satisfaction is considered as one of the main orientation. In the health system, patients' satisfaction is also considered as one of the main indicators of efficient evaluation and development and some factors like quality of services, how to handle and deal with clients and proper informing causes the clients to be satisfied. [9] Today, despite the efforts of the medical community and medical staff and also progression of medical technology, the patients' complaints and dissatisfaction is growing. Although, on the one hand this can be caused by medical errors, but on the other hand it is rooted in the failure of doctors to communicate with the patients. [10]

It is essential that all the medical institutions should respond to any serious incident by investigating and researching ideally. Foreign official agencies like, the Ministry of Health can also do an independent investigation. If the research is ideally conducted, it leads to understand the underlying reasons and causing factors and may lead to propose the solutions. Finally, the publication of this information and awareness of other medical institutions can lead to collaboration and development of appropriate strategies after the investigation associated with the common risks, such as surgery on the patients' wrong site. [3]

This paper aims at investigating the proportion of adverse events, in the complaints of individuals referring to Deputy of Treatment of an Iranian Province, which is the authority to respond the complaints from the real and legal people who are health service providers.


  Materials and Methods Top


This is a cross-sectional retrospective descriptive research regarding the study type, after getting permission from the university and the Deputy of Treatment, data collection began. The population of the study has been the cases of complaints referring to the Deputy of Treatment in 2012. All the registered cases have been studied. For data collection we used extended checklists of the Deputy of Treatment which their face and content validity has been approved by the experts. According to the change of information system of the complaint unit, researchers were able to extract the information related to the first 6 months of the year, completely and those related to the second half of the year in details by investigating the complaints forms.

In the second half of 2012, due to the lack of a unified recorded data, only those complaints were investigated which forms were available. But in the first 6 months of the year, due to the lack of written forms of customer complaints, all the complaints including writing, phone, and email were extracted. For ethical considerations, the collected data of individuals kept confidential and it was analyzed without mentioning the individual's characteristics. The data was described using the frequency distribution table in Excel.

Findings

The surveys indicated that, 587 cases of complaint were submitted to the Deputy of Treatment of which 504 cases (85/86%) in 2012, were related to the first six-months of the year and 83 cases (14/14%) were for the second-half of the year. As there was not a precise distinguished documentation in hand from the complaints relating to the first-half of the year, so in the cases where it was not possible to use data related to the first six-months of the year, only the complaints related to the second-half have been deliberating. The obtained results of the receiving complaints to the Deputy of Treatment in the second half of 2012 showed that out of 83 cases of complaints 58 cases have been male (69/8%), 24 cases have been female (28/9%), and one case has been a legal person (1/2%). Most complaints from individuals have been about the physicians. [Table 1] shows the frequency distribution of complaints from individuals in the second half of 2012.
Table 1: The frequency distribution of complaints from individuals in the second half of 2012

Click here to view


Most complaints about healthcare providers are to sue the hospital. [Table 2] shows the frequency distribution of complaints from the healthcare providers in the second half of 2012.
Table 2: The frequency distribution of complaints from the healthcare providers in the second half of 2012

Click here to view


The results of the study indicated that the care processes have been the major subject of the complaints. [Table 3] shows the frequency distribution of the complaints' subject in the second half of 2012.
Table 3: The frequency distribution of the complaints' subject in the second half of 2012

Click here to view


According to the surveys conducted, the maximum time for complaints handling in the Deputy of Treatment has been 234 days and the minimum time has been one day. Mean time for complaints handling was calculated 27/3 days. Due to the long difference between the maximum handling time and all other handling times and the confounding effect of it, the middle number is considered for the average handling time, which has been 17/5 days. How to inquest to the complaints for both real and legal people are in various forms. [Table 4] shows the frequency distribution of the way to handle the complaints in separation.
Table 4: Frequency distribution of the way to handle the complaints in the Deputy of Treatment in 2012

Click here to view



  Discussion Top


Based on the findings, resulted from this study 69/8% of claimants have been male which is in correspondent with Hedayati et al., studies [11] that conducting a cross-sectional descriptive study have examined all the complaints of malpractice cases in various specialized fields of Forensic Medicine Department during the years 2009-2012.

Hejazi et al., also conducting a retrospective descriptive study surveyed all the cases of claims against the Pediatricians in Orumie Medical Council in a period of ten years. Based on the findings of the study, in all cases, the child's father has claimed against the physician. Most cases of complaints have been about the public non-university centers and the major error is a kind of imprudence. [12]

Based on the results of the current research failure, to provide the appropriate and correct treatment have been most frequent in adverse events. Rafizadeh Tabai Zavareh, and et al., in their research titled "investigating the general practitioners malpractices' frequency of the complaints referring to the commission of forensics in Tehran in 2003-2005" examined all the cases involving general practitioners that have been referred to Tehran Commission, since the beginning of 2003 till the end of 2005, and they have reported that the major reason for the general practitioners' malpractices is the failure of appropriate medicine treatment, [13] which has a good correlation to the findings of the current study.

Mirzaaghai et al., in their study have analyzed 363 cases of recorded and written complaints in three hospitals during two years. Most subjects complained about the delayed or canceled appointments with the rate of 7/29% and then 24% has been about bad communication. [6] According to the findings of the present study among the care processes, wrong communication with the patient or his relatives has been the most frequent in the complaints.


  Conclusion Top


The great attention to the issue of wasted resources in the health system doubles the necessity to increase the major part of the losses resulting from irregularities, errors and failures associated with health services. Avoidable or unavoidable adverse events may occur in the treatment of patients by healthcare providers. Since most of the errors and malpractices are revealed after the patient or his family's complaint, investigation of the complaints referred to the regulatory systems of health service areas by revealing frequency of errors and occurred malpractices, and also by providing appropriate and effective solutions can reduce adverse events and provide the consumers of health services with more satisfaction.

 
  References Top

1.Allen LW, Creer E, Leggitt M. Developing a patient complaint tracking system to improve performance. Jt Comm J Qual Improv 2000;26:217-26.  Back to cited text no. 1
    
2.Akbari Sari A, Doshmangir. An overview of methods for identifying and measuring adverse events in healthcare and their strengths and weaknesses. Jhosp 2009;8:51-6.  Back to cited text no. 2
    
3.Sadat S. A review of studies on the history of appearance, formation, operation and development of the system of monitoring patient safety with emphasis on the characteristics of patient safety reporting systems. Tehran: Monitoring and accreditation aff airs of treatment Center, Ministry of Health and Medical Education;2009:20-25.  Back to cited text no. 3
    
4.Studdert DM, Thomas EJ, Burstin HR, Zbar BI, Orav EJ, Brennan TA. Negligent care and malpractice claiming behaviour in Utah and Colorado. Med Care 2000;38:250-60.  Back to cited text no. 4
    
5.Simanowitz A. Standards, attitudes and accountability in the medical profession. Lancet 1985;2:5467.  Back to cited text no. 5
    
6.Mirzaaghai F, Moeinfar Z, Eftekhari S, Rashidian A, Sedeghat M. Reviewing complaints recorded at three hospitals affiliated to Tehran University of Medical Sciences and the factors affecting it from April 2007 to February 2008. Hospital 2011;19-28.  Back to cited text no. 6
    
7.Babamahmoudi F, Meftahi M, Khademlou M, Hesamzade A. Patient Bill of Rights observance of the patients in the teaching hospitals of Mazandaran University of Medical Sciences. J Med Ethics History Med 2011;27-44.  Back to cited text no. 7
    
8.Silimperi DR, Franco LM, Veldhuyzen van Zanten T, MacAulay C. A framework for institutionalizing quality assurance. Int J Qual Health Care 2002;14:S67-73.  Back to cited text no. 8
    
9.Fong N. Western Australian Clinical Governance Guidelines. Information series no. 1.2.: Department of health government of Western Australia. 2005:1-8.  Back to cited text no. 9
    
10.Akhlaghi MH, Tofighizavare F, Samadi. Malpractice complaints referred to Medical Commission Legal Medicine Organization in the field of obstetrics and gynecology during the years 2001 and 2002; causes and methods of prevention. SJFM 2004;10:70-4.  Back to cited text no. 10
    
11.Hedaiati M, Nejadnik M, Setare M. The factors affecting the final verdict in medical errors complaints. J Isfahan Med School 2012;29.  Back to cited text no. 11
    
12.Hejazi S, Zeinali M, Farokheslamlou H. Study of pediatric malpractice claims Registered at URMIA Medical Council during 10 Year Period (1995-2005). URMIA Med J 2009;20:123-30.  Back to cited text no. 12
    
13.Rafizadeh Tabai Zavareh S, Haj Manoochehri R, Nasaji Zavareh M. Evaluation frequency of failure of General Practitioners in the complaints referred to Tehran Center Legal Medicine Commission from 2003 to 2004. SJFM 2007;13:152-7.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed3755    
    Printed246    
    Emailed0    
    PDF Downloaded245    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]