| Background:With the development of social economy and the improvement of national living standards,people’s demand and requirements for medical and health services are also expanding.Along with this is the growing number of medical disputes,the frequent occurrence of violent injuries to doctors,and the worsening of relations between doctors and patients.At the same time,as an important way for doctors and patients to communicate and an important window for medical quality and safety improvement,medical complaints have become increasingly important in preventing medical disputes and promoting continuous improvement in hospitals.The"Regulations on the Prevention and Handling of Medical Disputes" in 2018 and the "Measures for Complaint Management of Medical Institutions" in 2019 have been issued successively,which has led to certain developments in the organization and staffing of hospital medical complaints in China.But There are still some deficiencies in the healthcare complaint management and the handling and analysis of complaint information.By understanding the current status of medical complaints and medical complaint management in hospitals in China,we can find problems in medical complaints and management,which are conducive to the standardized management of medical complaints,and give full play to the role of medical complaint management in preventing medical disputes and promoting continuous improvement of medical quality to promote the establishment of a harmonious relationship between doctors and patients.Objective:In this study,through a statistical analysis of the outpatient complaint records and interviews with stakeholders of a tertiary hospital in Shandong Province to understand the current situation of the healthcare complaint and their complaint management system to identify and analyze the deficiencies and suggestions for improvement on this,to provide a reference for further improvement of hospital medical and health services and improve the level of hospital complaint management.Methods:In this study,the key stakeholder interviews method and non-participating observation method were first used to understand the current status of healthcare complaint and hospital complaint management,and to look for barriers in the complaint management process.Secondly,based on the medical complaint electronic record of the outpatient office of the hospital,on the basis of the Healthcare Complaint Analysis Tool(HCAT)established by Tom Reader in the United Kingdom,the new HCAT in line with the actual situation of the hospital is established.Then,using the HCAT to encode healthcare complaint information,and making statistic analysis of the encoded complaint information to understand the current status of outpatient healthcare complaints.After that,using the complaint frequency-correlation analysis method to analyze the key issues of outpatient complaints,find out the key issues that affect the outpatient service.Finally,using the results of the medical complaint information analysis,combined with the second stage of interviews and the compilation of literature information,the hospital’s medical complaint management and the causes of problems in medical complaints are analyzed,and recommendations for improvement are discussed.Results:(1)The healthcare complaint management system and process are still imperfect in hospital,mainly due to the following problems:the utilization of complaint for public online channels is low.the division of responsibilities of various departments is unclear,which cause difficult coordination and handling of complaints for multiple departments complain;the records of some complaint information are not standardized and incomplete,and the feedback records of other departments are lacking;the lack of a unified analysis specifications and complaint analysis tools;only part of the information is reported,and there is no monitoring and evaluation mechanism for regular reporting and complaints.(2)From January 2018 to June 2019,outpatient complaint office received a total of 869 complaints from various channels,which generally showed a slow upward trend.The government affairs hotline has gradually become the main source of complaints.Outpatient complaints mostly come from the patients themselves,and about one third of the complaints come from the families of the patients,mainly the families of the children.The proportion of complaints against doctors is largest(47.4%),followed by medical technicians(17.2%).Among them,complaints against doctors and nurses are mostly doctor-patient relationship issues,and complaints from medical technicians and administrative staff are mostly management problem.Among the complained departments,the proportion of clinical departments is relatively high,reaching 66.3%.The proportion of different complaints in different departments is different(p=110.786,r<0.01).The clinical departments have the most questions about the doctor-patient relationship,and the other departments have the most management problems.(3)Among the three dimensions of complaints,the hospital management dimension has the most problems,accounting for 45%of all complaints.Among them,the problems related to hospital work flow are more prominent,mainly during the admission stage;the second is the doctor-patient relationship issues,accounting for all complaints 36%,mainly in the examination and diagnosis stage;the last is clinical problems,accounting for 19%of all complaints,and also occurs in the examination and diagnosis stage.Among all complaints,most complaints only have mild complaints.Most complaints(92%)did not cause obvious physical harm to patients.The vast majority(96.3%)were moderate and all serious The injuries all occurred in clinical problems.(4)Among outpatient complaints,work flow,respect for the rights of patients,medical safety and medical quality complaints are the key issues affecting the quality of outpatient medical services and patient satisfaction.The result of the combined effect of factors.Among them,the management of the hospital,the attitude and behavior of the medical staff to the patient,the patient’s dissatisfaction with the medical service and the treatment,and the poor use of the medical service are the main factors;the delay of medical or non-medical procedures,prescribe and diagnose improperness is considered to are secondary factor.From the patient’s perspective,patients’ over high expectations for medical services are the main reason.Conclusions and SuggestionsAlthough the hospital has established a relatively perfect complaint management organization,system and process,but in the system and authority setting of healthcare complaints,the complaint information collection,sharing,analysis and utilization,the satisfaction evaluation and supervision mechanism construction in complaint still need to be improved.The HCAT based on Reader has applicability in the analysis of medical complaints in hospitals in China.This tool provides a reference for discovering problems in hospital management and medical service provision.In terms of healthcare complaint management,hospitals need to promote the establishment and improvement of a complaint management system,improve the medical complaint management evaluation supervision and medical risk prediction and prevention system,and actively prevent complaint spillover;at the same time,we must strengthen the integrated management of complaint information and promote the standardization of information to promote information sharing and utilization.In terms of hospital management and medical service improvement,from the medical side,the hospital needs to strengthen the daily management of the hospital to optimize the process of medical treatment;actively carry out training and evaluation of doctor-patient communication,enrich the form of doctor-patient communication;strengthen the medical staff Professional skills training and the construction of medical ethics to improve the management level of the hospital and the quality of medical services.From the perspective of patients and society,the hospital should strengthen cooperation with all sectors of the society,carry out health knowledge education through various forms,help people establish reasonable medical service psychological expectations,and improve the understanding between doctors and patients. |
PDF Full Text Request