title: Patients' perspectives on the role of their complaints in the regulatory process.
abstract: BACKGROUND
  Governments in several countries are facing problems concerning the accountability of regulators in health care. Questions have been raised about how patients' complaints should be valued in the regulatory process. However, it is not known what patients who made complaints expect to achieve in the process of health-care quality regulation.
  
  
  OBJECTIVE
  To assess expectations and experiences of patients who complained to the regulator.
  
  
  METHODS
  Interviews were conducted with 11 people, and a questionnaire was submitted to 343 people who complained to the Dutch Health-care Inspectorate. The Inspectorate handled 92 of those complaints. This decision was based on the idea that the Inspectorate should only deal with complaints that relate to 'structural and severe' problems.
  
  
  RESULTS
  The response rate was 54%. Self-reported severity of physical injury of complaints that were not handled was significantly lower than of complaints that were. Most respondents felt that their complaint indicated a structural and severe problem that the Inspectorate should act upon. The desire for penalties or personal satisfaction played a lesser role. Only a minority felt that their complaint had led to improvements in health-care quality.
  
  
  CONCLUSIONS
  Patients and the regulator share a common goal: improving health-care quality. However, patients' perceptions of the complaints' relevance differ from the regulator's perceptions. Regulators should favour more responsive approaches, going beyond assessing against exclusively clinical standards to identify the range of social problems associated with complaints about health care. Long-term learning commitment through public participation mechanisms can enhance accountability and improve the detection of problems in health care.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Renée
authors.initials: R
authors.lastname: Bouwman
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Manja
authors.initials: M
authors.lastname: Bomhoff
authors.affiliation: Dutch Health-care Inspectorate, Utrecht, The Netherlands.|Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Robben
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.|TRANZO (Scientific Centre for Care and Welfare), Faculty of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands.
authors.forename: Roland
authors.initials: R
authors.lastname: Friele
mesh_terms: D000328:Adult; D005260:Female; D033161:Government Regulation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000592:standards*; D012449:Safety; D011795:Surveys and Questionnaires
keywords: complaints; government regulation; health-care quality; health-care safety; public participation