Healthcare Complaints as an Indicator of Hospital Safety Performance: Putting the “Patient” into Patient Safety



Organizational safety has traditionally been investigated through employee (e.g., frontline staff, managers) reports on risk. However, due to factors such as a lack of awareness of safety problems, social desirability, and cultural norms, there is need for alternative measures. Increasingly, in the field of healthcare, it is suggested that organizational risk can be identified and profiled through information provided by patients. It is supposed that, due to their experience of front-line care, and their independence from organizational culture, patients can provide useful information on hospital risk. We explore this idea through analyzing the risk-related information reported in healthcare complaints submitted by patients (and their families) to hospitals in the UK National Health Service (NHS). Healthcare complaints (n = 2,017, containing 2.5 million words) from 59 hospitals in England were analyzed use the Healthcare Complaints Analysis Tool. In total, 334 complaints reported major or catastrophic harm, with 535 (out of 1,715) high severity problems in clinical care being reported. Hospitals were found to differ considerably in the variation in the proportion of complaints reporting major or catastrophic harm (range: 0%-48%), or high clinical severity problems (range: 0%-25%). Furthermore, multiple regression found complaint severity was associated with standardised hospital mortality rates, in comparison to staff reported safety incidents, which had no relationship with mortality rates. The study suggests that information from external stakeholders can be used to profile organizational risk.