Vivi Antonopoulou, Carly Meyer, Beckie Gibson, Angel Chater and Paul Chadwick
Healthcare complaints can be a valuable resource for monitoring quality of care and improving patient safety. Previous research has highlighted the various factors influencing patients to raise a concern or a complaint to health professionals, but there is much less research exploring the factors influencing how complaints are responded to. Various influences play a role in first response behaviour which include: psychological, social, environmental, cultural, and organisational influences. Given that health professionals’ first response is an important influence on the path to a complaint, it is important to understand the structure of these influences and how these influences shape the behaviour.
This project aims to investigate how health professionals’ first response to patients’ complaints could be improved by a behavioural science approach. This involves identifying the key actors, behaviours and influences on behaviour involved in healthcare professionals first response to a patient-raised complaint; second, to explore and describe the causal relationships between key actors, behaviours and influences on behaviour involved in health professionals’ first response to patient-raised complaint; third, to depict the key actors, behaviours and influences on behaviour and their associations using a behavioural systems mapping approach.
Three characteristics of health professionals first responses that should influence the choice of methods could be used to investigate this issue. Firstly, first responses are health professional behaviours and can therefore be explored using theories of health professional behaviour change. Secondly, it is an interpersonal behaviour which suggests theories and methods from social sciences may be usefully applied. Thirdly, the behaviour is embedded within a complex system and therefore, research into health professional behaviour should be sensitive to context, and particularly the significant pressures experienced by frontline staff which are often beyond their direct control. Behavioural systems mapping provides a framework for researchers to identify complex patterns of causation within systems and the interplay between proximal and distal influences on behaviour. This evolving methodology draws upon theories and methods of psychology and systems science (see Chadwick and Hale, 2021).
Stage 1: A systematic review of published and unpublished studies (“grey literature”) in electronic databases including reported primary qualitative or/and quantitative data on healthcare professionals’ management of patient-raised complaints has been conducted. Data were thematically analysed extracting key themes and deductively coded onto the TDF and the COM-B domains.
Stage 2: Primary data collection study using semi-structured interviews with patients/carers, liaison officers and healthcare professionals has been conducted to supplement the systematic review findings exploring the factors that influence healthcare professionals’ responses to patient complaints.
Stage 3: A stakeholder workshop with a range of patient groups (patients) and professional associations (healthcare professionals, other stakeholders) has taken place. The behavioural systems map based on the outputs of the systematic review and the qualitative interviews was presented to the stakeholder groups for validation. Participants in the workshop discussed additional influences, relationships among factors, and opportunities for intervention within the system.
DHSC policy partners have requested that the PRU undertakes this initial project as an explorative study outlining the evidence base on first response behaviour which could then be extended as part of a larger programme of work.