title: Exploring patient strategies in response to untoward healthcare encounters.
abstract: BACKGROUND
  Increasing attention to patients' rights and their ability to choose their healthcare provider have changed the way patients can respond to untoward, disempowering and abusive healthcare encounters. These responses are often seen as crucial for quality improvement, yet they are little explored and conceptualized.
  
  
  OBJECTIVE
  To explore patients' potential responses to untoward healthcare encounters and looking at their possible consequences for care quality improvement as well as for the individual patient.
  
  
  METHODS
  The article is structured looking at two primary strategies: patient exit (leaving a healthcare provider) and patient voice (expressing grievances), derived from Hirschman (1970). These strategies were explored by the use of theoretical and empirical literature and applied to an individual patient case. The case functions as a pedagogical tool to illustrate and problematize what exit and voice strategies can mean for a single patient. Ethical considerations: The patient case is my version of a generalized scenario that is described elsewhere. It does not represent an individual patient's story, but aims to be realistic and recognizable.
  
  
  CONCLUSIONS
  Based on the existing literature, it is hypothesized that, in their current form, exit and voice strategies have a limited effect on care quality and can come at a price for patients. However, both strategies may be of value to patients and providers. Therefore, the healthcare system could empower patients to engage in action and could further develop ways for providers to effectively use patients' responses to improve practice and find ways to prevent patients from untoward experiences in healthcare.
authors.affiliation: Linköping University, Sweden.
authors.forename: A Jelmer
authors.initials: AJ
authors.lastname: Brüggemann
mesh_terms: D003657:Decision Making; D006801:Humans; D010352:Patient Dropouts; D057240:Patient Preference; D028701:Patient Rights / Q000941:ethics*; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011787:Quality of Health Care
keywords: Abuse in healthcare; patient dissatisfaction; patient exit; patient voice; quality of healthcare; untoward encounters