Cynthia S. Miller

Identifying medical center units with disproportionate shares of patient complaints.

BACKGROUND A pilot study was conducted to learn whether an academic medical centers database of patient complaints would reveal particular service units (or clinics) with disproportionate shares of patient complaints, the types of complaints patients have about those units, and the types of personnel about whom the complaints were made. RESULTS During the seven-year (December 1991-November 1998) study period, Office of Patient Affairs staff recorded 6,419 reports containing 15,631 individual complaints. More than 40% of the reports contained a single complaint. One-third of the reports contained three or more complaints. Complaints were associated with negative perceptions of care and treatment (29%), communication (22%), billing and payment (20%), humaneness of staff (13%), access to staff (9%), and cleanliness or safety of the environment (7%). Complaints were not evenly distributed across the medical centers various units, even when the data were corrected for numbers of patient visits to clinics or bed days in the hospital. The greatest proportion of complaints were associated with physicians. DISCUSSION Complaint-based report cards may be used in interventions in which peers share the data with unit managers and seek to learn the nature of the problems, if any, that underlie the complaints. Such interventions should influence behavioral and systems changes in some units. SUMMARY AND CONCLUSIONS Further experience should indicate how different types of complaints lead to different kinds of interventions and improvements in care. Tests of the system are also currently under way in several nonacademic community medical centers.

Malpractice, Patient Satisfaction, and Physician-Patient Communication-Reply

In Reply. —The Fallon Clinics experience is encouraging and suggests that it is possible to enhance patient perceptions of the interpersonal skills of physicians, perhaps even those with high malpractice claims experience. One possible explanation is that the process of obtaining feedback from peers led the clinicians to appreciate the problems so that they could address them. Another is that the training program actually imparted new skill. Understanding the relative importance of peer-provided feedback and providing physicians education concerning the skill to correct identified problems is needed in order to design education strategies that sustain behavioral changes over time. Dr Weyrauchs hypotheses are important, and we would argue that all the interpersonal skills in the world will not heal a physician-patient relationship marred by bias and condescension. Nonetheless, to the extent we looked, we did not find evidence that patients were more likely to see the high-frequency physicians as biased