title: What patients' complaints and praise tell the health practitioner: implications for health care quality. A qualitative research study.
abstract: OBJECTIVE
  In order to identify which health care aspects play a role in patient satisfaction and quality of health care, the present study analyses a large number of instances of complaint and praise.
  
  
  METHODS
  One thousand two hundred and thirty-five instances of complaint and one thousand five hundred thirty-six of praise submitted from patients or other souces (i.e. a patient's family member or a legal representative) to a northern-Italian hospital were analysed.
  
  
  METHODS
  We adopted Reader and colleagues' (2014) patients' complaint taxonomy, in conjunction with a detailed content analysis of relationship and communication of information aspects.
  
  
  RESULTS
  The most frequent causes of complaint concerned care system management (68.1%), particularly the time taken to access treatment, and relationship aspects (52.8%). The importance of relationship aspects was confirmed by the expression of gratitude through praise (89%). The most critical factor of the relationship domain was effective communication of information to the patient (39.3%). Frequently patients complained of: (i) having received information that was inconsistent with the truth, (ii) having had difficulty in obtaining information, and (iii) untimely communication of information. Clinical aspects did not seem to be the main factors that triggered a complaint (36,8%), and, when indicated, they were almost always associated with relationship issues.
  
  
  CONCLUSIONS
  This study indicates that not only complaints, but also instances of praise, are a potentially important source of information regarding health care aspects that play a role in patient satisfaction and quality of care. Our findings underline the relevance of relationship aspects in determining patients' satisfaction with the care received. In particular, health practitioners should focus their attention on how information is understood, translated and applied by patients.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V.le Berti Pichat, 5, 40127Bologna, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Mattarozzi
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V.le Berti Pichat, 5, 40127Bologna, Italy.
authors.forename: Fiamma
authors.initials: F
authors.lastname: Sfrisi
authors.affiliation: "Ufficio Relazioni con il Pubblico e con le Associazioni di Volontariato", Sant'Orsola Malpighi Hospital, Via Albertoni 15, 40138Bologna, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Caniglia
authors.affiliation: "Medicina Legale e Gestione Integrata del Rischio", Local Health Trust, Sant'Orsola Malpighi Hospital, Via Massarenti 9, 40138Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: De Palma
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V.le Berti Pichat, 5, 40127Bologna, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Martoni
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D003142:Communication; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D061214:Patient Safety / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care / Q000706:statistics & numerical data*
keywords: communication in health care; medical errors; patient satisfaction; patients’ complaints; patients’ praise; patient–doctor relationship; quality of health care