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Exploring healthcare staff responses to patient complaints

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Cambridge Institute of Public Health

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Robinson Way

CB2 0SR

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How perspectives from social sciences can help address practical questions of healthcare improvement

Annual Symposium of the Applied Social Science Group, University of Cambridge

16:00 Welcome: Dr Robbie Duschinsky, Head of the Applied Social Science Group within the Primary Care Unit and Director of Studies in Sociology at Sidney Sussex College, University of Cambridge

with Chair and Discussant, Dr Graham Martin, Director of Research, THIS Institute

16:05 'Patient feedback, hospital defensiveness and the possibilities for organizational learning'

Speaker: Alex Gillespie, Associate Professor, Department of Psychological and Behavioural Science, London School of Economics

16:35 'Staff Making Sense of ‘Patient Complaints’: interview and ethnographic findings from 8 NHS services'

Speaker: Dr Mary Adams, Senior Research fellow, King’s College London

17:05 Response from Dr Graham Martin, Director of Research, THIS Institute

17:30 Questions and discussion

18:00 CLOSE




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Alex Gillespie

Abstract

It has been argued that some hospitals are sometimes resistant to learning from patient feedback. But few studies have actually analysed defensiveness in practice. Using concepts of individual and organizational defensiveness, I analyse 150k online responses of staff to critical feedback on the Care Opinion website. The aim is to identify the linguistic strategies through which defensiveness operates.

Alongside responses indicative of a learning culture, three potentially problematic transformations are observed: psychologizing (patient reported safety incidents are reconceptualized as ‘experiences’ and ‘concerns’), individualization (problems are re-framed as one-off or peculiar), and selective focus (picking up on administrative issues while de-emphasizing clinical issues).

Although these defensive transformations are carried out by individuals, they are interpreted in terms of organizational structures which restrict the options for responders to take ownership over or act on critical feedback. Being able to identify defensiveness toward critical patient feedback has implications, not only for identification and intervention, but also for researchers to avoid being complicit in defensiveness.

About Alex Gillespie

Alex Gillespie is an Associate Professor in the Department of Psychological and Behavioural Science at LSE and Editor of Journal for the Theory of Social Behaviour. He has published six books and over a hundred papers. He is an expert on communication, divergences of perspective, misunderstandings, trust and listening. He has been involved in developing several tools, including: the Interpersonal Perception Toolkit for Communication Disorders, GUIDE, and the Healthcare Complaints Analysis Tool.


Mary Adams

Abstract

Drawing from sociological and socio-legal studies of patient-doctor dispute, we analyse 41 discursive interviews with healthcare staff drawn from 8 different NHS services. We found that patients’ complaints were received most often by staff as a challenge to fundamental relationships of trust and gratitude. The content of a complaint was often marginalised to the act of complaining. Complaints were most often discussed in relation to local typologies of patient motive – driven by ignorance, distress or self-interest; accordingly, health professionals positioned themselves to receive patient concerns as informed decision-makers, empathic listeners or service gate-keepers.

We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care.

Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism is exercised contemporary healthcare work.

About Mary Adams

Dr Mary Adams, a social anthropologist and registered midwife, is a Senior Research fellow at King’s College London in the Women & Children's Health Department. Her research interests are the anthropology of health and social care policy and of medicine, in Southern Africa and in the UK. Since 2016 she has been a King's Improvement Science Fellow, focusing her research on organisational responses to women and families harmed in maternity care.


About Graham Martin

Graham Martin is Director of Research at THIS Institute, leading applied research programmes and contributing to the Institute’s strategy and development.


This event is organised by the Applied Social Science Group, Primary Care Unit, University of Cambridge.

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Cambridge Institute of Public Health

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Robinson Way

CB2 0SR

United Kingdom

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