Abstract

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Abstract: Alex Gillespie

It has been argued that some hospitals are sometimes resistant to learning from patient feedback. But few studies have actually analysed defensiveness in practice. Using concepts of individual and organizational defensiveness, I analyse 150k online responses of staff to critical feedback on the Care Opinion website. The aim is to identify the linguistic strategies through which defensiveness operates.

Alongside responses indicative of a learning culture, three potentially problematic transformations are observed: psychologizing (patient reported safety incidents are reconceptualized as ‘experiences’ and ‘concerns’), individualization (problems are re-framed as one-off or peculiar), and selective focus (picking up on administrative issues while de-emphasizing clinical issues). Although these defensive transformations are carried out by individuals, they are interpreted in terms of organizational structures which restrict the options for responders to take ownership over or act on critical feedback.

Being able to identify defensiveness toward critical patient feedback has implications, not only for identification and intervention, but also for researchers to avoid being complicit in defensiveness.

Abstract: Mary Adams

Drawing from sociological and socio-legal studies of patient-doctor dispute, we analyse 41 discursive interviews with healthcare staff drawn from 8 different NHS services. We found that patients’ complaints were received most often by staff as a challenge to fundamental relationships of trust and gratitude. The content of a complaint was often marginalised to the act of complaining. Complaints were most often discussed in relation to local typologies of patient motive – driven by ignorance, distress or self-interest; accordingly, health professionals positioned themselves to receive patient concerns as informed decision-makers, empathic listeners or service gate-keepers.

We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care.

Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism is exercised contemporary healthcare work.