|Year : 2015 | Volume
| Issue : 1 | Page : 15-19
Patient complaint's profile in a teaching hospital
Alireza Jabbari1, Marzieh Jafarian Jazi2, Elahe Khorasani3, Raja Mardani4, Maryam Mofid5
1 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
3 Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
4 Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
5 Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||17-Dec-2014|
Health Services Management, Student Research Committee, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Introduction: Patient satisfaction represents the physician and medical staff's competence and shows the observance of patient's rights and as well the quality of treatment and complaint is expressing dissatisfaction, which requires the accountability and auditing. Now-a-days complaint handling is considered as an essential part of the health care system to promote health standards. Because complaint handling constitutes identifying the main causes of the problem, organizing performances and identifying reliable sources to find the reason of the complaint. In this study, the researchers intend to identify the sources, people, subjects of the complaints and the action taken in this regard in a teaching hospital in Isfahan. Methods: This paper is a descriptive cross-sectional study. The population of the study has been all the cases that have referred to the hospital's complaints unit. For data collection, we observed and checked the existing documents in complaints unit that due to the problems with data recording only the data related to 4 months of the year 2012 and those related to 1 month of 2013 were investigated. Results: On the basis of the results of this study, it can be demonstrated that the major subject of complaints has been the issues of public concerns and welfare of the hospital and the hospital's service quality. Most complaints filed by the patients and their families has been about the physicians and the hospital staff that finally, most of them have been settled in the complaints unit and in the next steps, raising complaint were not reasonable. Conclusion: According to the results it can be said that by detecting the subjects, resources, and people that have been complaining about in the hospital, weaknesses in providing the services were identified and by regarding them they can improve the service providing. Moreover, by sharing the findings from various hospitals, different experiences in this context can be utilized.
Keywords: Complaint, Iran, patient satisfaction, patient′s rights, teaching hospital
|How to cite this article:|
Jabbari A, Jazi MJ, Khorasani E, Mardani R, Mofid M. Patient complaint's profile in a teaching hospital. Int J Health Syst Disaster Manage 2015;3:15-9
|How to cite this URL:|
Jabbari A, Jazi MJ, Khorasani E, Mardani R, Mofid M. Patient complaint's profile in a teaching hospital. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2019 Dec 14];3:15-9. Available from: http://www.ijhsdm.org/text.asp?2015/3/1/15/147139
| Introduction|| |
According to the theories of modern management, the principle of customer focus and applicants' satisfaction is considered as one of the main orientations. In administrative systems, peoples' satisfaction of government is considered as one of the main indicators to measure the efficiency and the development and also components such as service quality, how to handle and deal with clients and proper informing are the factors that triggers satisfaction of service recipients and governmental agencies' clients.  However, the role of quality in the success and failure of organizations is so remarkable that only the organizations, which focus their institution's activity on meeting customer demands and satisfying their needs at the lowest cost and highest quality have been able to survive.  Patients' satisfaction and respecting their rights is an issue of concern in the health care system that is referred to as the Charter of Rights.  Parsapour et al. also conducting a field study on the attitude of doctors, nurses and patients about the necessity for patient's rights, codified the draft of patient's Charter of Rights. He affirmed the Charter by doing written and in-person surveys of experts and holding advisory workshops. 
Patients as one of the most vulnerable social groups are exposed to the risk in terms of psychological, social and economic, and the international organization of human rights pay particular attention to the concept of patients' rights.  Hospitals should be a council for understanding and respecting the rights of patients, their families, doctors and other caregivers. All hospitals and health centers need to be aware of the ethical aspects of care and should respect it.  On the other hand, patient's satisfaction reflects the physician and the health staff's competence and also shows the observance of patient's rights and quality of treatment. 
In the meantime, complaint is expressing dissatisfaction which requires the accountability and auditing. Due to the availability of modern information systems and the increasing levels of education and public teaching, and also patients and their families' participation in the process of healthcare, their active role in clinical decision making has been increased. As a result, complaints about the quality of health care have increased dramatically. From the doctors' point of view, there are two golden rules for handling the complaints: The first one is to give an honest explanation and to do a quick apology. If these simple steps complete, the majority of cases do not reach the next steps. The second rule is that all complaints worth listening and learning. For this to be done effectively, organizations need to have good systems of complaints' feedback and its consequences individually and in team. If the physicians and other health care workers wish to handle the complaints and settle them effectively, they must first have a better understanding of their surroundings. Therefore, registration and handling the complaints has been considered as one of the major areas in the rule of clinical services. To that end in each hospital they should consider a room calling it "complaints handling unit." And a proper person should be appointed to investigate and settle the complaints of patients  However, complaints only reflect a small proportion of dissatisfaction with the health care system, and probably shows only the tip of an iceberg's peak.  Not all preventable adverse events will result in complaints and legal claim and not all poor treatment outcomes will lead to receive compensation. , In other words, lots of other problems are not raised for many different reasons such as the reluctance of the patient to complain.  A common view is that the major reason to complain is that most patients want their voices to be heard, and they like to be apologized. ,
Now-a-days complaints handling is considered as an essential part of the health care system to promote the health standards.  Babamahmoudi et al. also in a descriptive cross-sectional study examined all the patients in four medical training hospitals of Mazandaran University 24 h after the admission in the aspect of patient rights and concluded that due to the patients' dissatisfaction with respecting their rights, we need strategies to eliminate the obstacles in the Charter of Rights and to improve the conditions for the observance of the Charter of Rights in the hospital.  It seems that if a patient's Charter of Rights is worthy of gaining basic position in the society, doing extensive researches regarding the patient complaints is essential.  Because the complaint handling constitutes the identification of major causes of the problem, organizing operations and detecting valid resources to investigate the reason of complaint. Also performing an appropriate and desirable operation to eliminate the problem and preventing from its reoccurrence are of the necessities that should be examined.  Complaining can give the doctors feedback about their work performance, identify the domains of poor performance and provide an opportunity to develop strategies for promoting the quality of care, provide valuable information about patient experience in the health care system and reflect something beyond the dissatisfaction of health care system. , Therefore, this study aims at examining the status of complaints of the individuals who have referred to a teaching hospital in Isfahan so as to identify the challenges existing during this process and to offer the recommendations to improve it.
| Methods|| |
In study type, this is a descriptive and retrospective cross-sectional research and after obtaining permission from the university and the hospital data collection began. Population of the study has been the cases that had referred to the hospital's complaint unit. And for data collection we observed and reviewed the documents existing in the hospital's complaint unit. In this study the plaintiff's files in 2012 were reviewed. Due to changes in the hospital system, the researchers were able to extract the data related to 4 months of the year 2012 and those related to 1 month in 2013. In data collection checklist, we reviewed the complaint's reason, the source of complaints, the addressee of the complaint, and the outcome of complaints. The average time of complaints handling was also of the examined subjects, but it was not possible to be estimated due to the lack of accurate recorded information. For ethical considerations, data collected from the participants were kept confidential and it was analyzed without citing the personal characteristics. Data analysis was performed in Excel.
| Results|| |
Subject of the complaints is presented in the description of [Table 1].
|Table 1: Frequency distribution for subjects of the complaints in a teaching hospital in Isfahan|
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[Table 2] indicates the frequency distribution of the source of complaint.
|Table 2: Frequency distribution for the source of complaints in a teaching hospital in Isfahan|
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[Table 3] shows the frequency of complaints from different people.
|Table 3: Frequency distribution for the addressee of complaints in a teaching hospital in Isfahan|
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The findings resulted from the complaints in this teaching hospital is presented to the description in [Table 4].
|Table 4: Frequency distribution of complaint's outcome in a teaching hospital in Isfahan|
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| Discussion|| |
Today, complaints handling is considered as an essential part of the health care system to enhance the health standards. Results of this study indicate that in most sample months the major subject of complaints has been the quality of care, which allocated the highest percentage of complaints in July (63.6%). In June 2012 and April 2013 hospital's welfare and public issues has been among the important subjects, which has significantly allocated more complaints. Whereas in most months there have been fewer complaints about the subjects of costs and inappropriate treatment of staff. Comparing April 2013 with the average months of 2012 show that the rate of complaints about"inappropriate treatment of employees "and" hospital's welfare and public issues "has increased and about the" quality of care "and" costs has fallen.
It can also be said that patient and his family has been the largest source of complaints and hospital's staff have expressed much less complaints which of course may be due to the lack of declaration of formal complaint and thus recorded complaints of the staff.
However, in most cases the addressee of the complaints has been administrative staff and physicians and there have been fewer complaints about the service staff and nurses. Whereas, in June and April the majority of complaints have been about physicians and in July and April it has been about administrative staff and in September it has been about physicians and administrative staff.
About the consequences of cited complaints at the hospital, the highest results which have been resolved in the complaints unit counted for the ones in July, March, and April and the lowest rate was for the complaints in June and September, they declared that the complaints have not been reasonable. In June and September the least number of complaints have been referred to a higher unit and in July the number of unreasonable complaints which were referred to a higher unit allocated the fewer percentage of all and in March and April unreasonable complaints have been at the least percentage and this indicates that complaints in the last months of the year have been more reasonable. Haghi et al. in their study concluded that patients complain about the surgeons more than other doctors. Although most treatment actions have been true, they associate the factors with lack of ample justification of patients by physicians and failure to provide adequate explanations about the possible complications of medical procedures that plays an important role in filing the complaints.  Thus improving the quality of the communication between the patient and physician is proposed as an effective factor in preventing complaints and this indicates that the complaints have not been logical technically. Therefore, a proper physician-patient communication can be used to prevent the occurrence of these complaints.  Rangrazjedi and Rabeei in a study expressed the observance of the Charter of Rights of patients in public hospitals in Kashan with the rate of 74/67% and considered the strategies to increase the awareness of health care providers and patients mandatory in reception.  Actually with making the hospital staff, including doctors and administrative staff who have been rated for the highest number of the complaints aware of the patient's Charter of Rights, they can reduce the number of complaints from patients who have been the major source of complaints in this hospital. Davati et al. also state that the awareness rate of 68.4% of physicians on the Charter of Rights has been in the medium range and there is a significant correlation between the physicians "awareness rate about the patients "Charter of Rights and their medical experiences. As a result, the physicians awareness of patients' Charter of Rights is not in an acceptable level and to solve this problem a proper planning should be done. 
Athar in his study titled "investigating the complaints related to skin and beauty at the Department of Forensic Medicine in Tehran from 2002 to 2010" describes that respecting the medical ethics and professional commitment, good communication between the physician and treatment group with the patient and his family, the full explanation about the treatment and its possible complications, nonexaggeration in the treatment results, ongoing studies and updating medical knowledge, necessary skills and enough experience of the doctor, not using the methods that they have not passed the training courses on them, patients' correct selection and obtaining informed satisfaction, and the presumption of innocence may lead to reduction of complaints from the physicians. In fact, due to the high level of complaints about physicians in this study these guidelines can be used to alleviate these complaints. 
Mirzaaghai et al. in his study titled "investigating the recorded complaints at three hospitals affiliated to Tehran University of Medical Sciences and the effective factors on it" expressed that a total of 363 written complaints have been recorded. About 19.7% of complaints were from the outpatients and the other cases have been about hospitalized patients. Most subjects complained about have been on delays or cancellation of appointments with the rate of 29.7%. Inappropriate communication with the rate of 24%, dissatisfaction with health care providing having been ranked 21.4%, and welfare facilities rating 8.3% have been in the next rankings. The highest complaint frequency has been about the physicians rating 62.1% that in some cases is in agreement with our study. Complaints about the nurses with the rate of 10.2% have been in the next ranking whereas in the current study the nurses have not been the addressee of many complaints. 59.1% of complaints had been resolved in location where in some cases it is in one direction with this study, but in some cases the complaints have not been reasonable at all. 51.7% of complaints had been resolved within 2 days or less.
Mirzaaghai et al. in the whole states that as regards the delay or cancellation of appointments, and improper communication have been the most subjects of complaints, intervention in these fields should be considered. Furthermore sharing the complaints data among the hospitals can identify the prevalent spheres of problems and it can be used for strategic planning.  Most doctors and dentists of Tehran who have been the addressee of complaints have not committed any default in the viewpoint of experts in the Medical Council. And bulk of the complaints related to outcome of poor interaction between doctor and patient. Behavior based on the physician's professional commitments to the patients can prevent the occurrence of much of the complaints in the current study the reason of complaints about physicians had not been recorded while by recording them awareness of the weaknesses in this aspect could be achieved and an emprise could be done to improve it. But in whole the quality of services and public and welfare issues are among the matters that are important to this study. 
In a study conducted by Entman et al. and assessed by a specialized committee, it was shown that the quality of treatment provided by the gynecologists complained about have had no significant difference with those specialists who have never been complained about. In other studies, it has also proven that the quality of treatment is an important factor toward the patients and their relatives' complaints. While the quality of service in our study is one of the subjects of complaints with a high percentage. 
As a result, it can be concluded that one of the criteria that can be used to improve health services is to investigate the complaints and identifying the factors that have caused them. Complaints data is applied as an important tool for learning from unsatisfied patients. Patients' complaint is a symbol of dissatisfaction with the care and provided services by hospital staff and it is also the indicator of the existing gaps in service delivery system that reflects the hospitals' defects. , If a systematic approach occurs in all the parts of hospital for investigating patients' complaints, not only the performance will be better but also it will improve the quality of care. Comparing and sharing the complaints data among the hospitals is vital and can identify prevalent areas of problems. It can also be used for strategic planning and lessons taken from the complaints of a hospital can be used in other hospitals to eliminate the same shortcomings.
| Acknowledgments|| |
Special thanks to the hospital staff that helped us in providing information about the complaints addressing this organization.
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[Table 1], [Table 2], [Table 3], [Table 4]