From complaint material to quality improvement: Exploring the use of patient complaints or compensation claims in quality improvement initiatives-a scoping review

BACKGROUND: There is increasing interest in how patient complaint material can be used to highlight areas requiring quality improvement (QI) in healthcare. However, knowledge of using complaint material to initiate or monitor QI is limited. OBJECTIVES: This review explored the use of complaint material in QI by identifying problems related to substandard care that were addressed by QI initiatives, exploring how complaint material was used before or after a QI initiative, and mapping changes in complaint material after QI initiatives. METHODS: This scoping review followed the Joanna Briggs Institute methodology and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews reporting guideline. ELIGIBILITY CRITERIA: Studies were included if a QI initiative was initiated or monitored using complaint material. Eligible designs included observational studies, QI projects, pre-intervention and post-intervention studies and randomised controlled trials. Audio, online and symptom-based complaints were excluded. INFORMATION SOURCES: A systematic search was conducted on 10 December 2024 in Embase, Medline, CINAHL and Web of Science, and additional sources, with no language or date limitations. SYNTHESIS OF RESULTS: Substandard problems targeted by QI initiatives were categorised using the Healthcare Complaints Analysis Tool by two independent coders. Findings were synthesised narratively and summarised using frequency analyses where applicable. RESULTS: We identified 58 QI initiatives, most frequently targeting safety (n=39). Before QI, complaint material was usually analysed through review (n=19), counts (n=17), content categorisation (n=9) or root cause analysis (n=2). After QI, analyses included counts (n=34), rates (n=20), content categorisation (n=7) and review (n=4). Reviewing or categorisation methods were often unspecified. Among studies using complaints as an outcome, most reported complaint reductions (n=43), while a few reported increases (n=2) or mixed results (n=4). DISCUSSION: The QI initiatives primarily targeted patient safety and applied simple quantitative analyses. Some studies relied on reviews or categorisations without reporting the validation or reliability of the used tools. Improved reporting standards are needed to strengthen learning. Furthermore, while QI initiatives appear to have the potential to change complaint patterns, this finding should be interpreted with caution, as this is based on a scoping review. OTHER: Preregistered protocol: https://osf.io/6g4qw.

• ✓Some studies relied on reviews or categorisations without reporting the validation or reliability of the used tools.
• ✓Improved reporting standards are needed to strengthen learning.
• ✓Furthermore, while QI initiatives appear to have the potential to change complaint patterns, this finding should be interpreted with caution, as this is based on a scoping review.
• ✓OTHER: Preregistered protocol: https://osf.io/6g4qw.