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      A mixed method analysis of patients' complaints: Underpinnings of theory-guided strategies to improve quality of care


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          Patients' complaints can be predictors of patient care quality and safety. Understanding patients' complaints could help healthcare organizations target the areas for improvements. The purpose of this study is to use a mixed method analysis to a) examine the characteristics and categories of patients' complaints, b) explore the relationships of patients' complaints with professions and units, and c) propose theory-based strategies to improve care quality.


          This is a descriptive mixed method study. Data examined are patients' complaints filed at a university-affiliated hospital in China from January 2016 to December 2017. A qualitative content analysis was conducted to categorize complaints. A TwoStep cluster analysis was performed to provide an overall profile of patients' complaints. Chi-Square tests were conducted to investigate the relationships among complaints, professions, and units.


          838 complaints were filed, with 821 valid cases for analysis. Six categories surfaced from the qualitative analysis: uncaring attitudes, unsatisfactory quality of treatment or competence, communication problems, the process of care, fees and billing issues, and other miscellaneous causes. Physicians received most of the complaints (56.6%). The unit receiving the most complaints were outpatient clinics and medical support units (52.7%). The cluster analysis indicated four distinct clusters. Significant relationships existed between complaints and professions ( χ 2 (20) = 178.82, P < 0.01), and between complaints and units ( χ 2 (15) = 42.72, P < 0.01).


          Patients' complaints are valuable sources for quality improvements. Healthcare providers should be not only scientifically knowledgeable, but also humanistic caring. Caring-based theories may provide guidance in clinical practice.

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          Most cited references 17

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          The prevention and handling of the missing data

           Hyun Ki Kang (2013)
          Even in a well-designed and controlled study, missing data occurs in almost all research. Missing data can reduce the statistical power of a study and can produce biased estimates, leading to invalid conclusions. This manuscript reviews the problems and types of missing data, along with the techniques for handling missing data. The mechanisms by which missing data occurs are illustrated, and the methods for handling the missing data are discussed. The paper concludes with recommendations for the handling of missing data.
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            Transformation of the education of health professionals in China: progress and challenges.

            In this Review we examine the progress and challenges of China's ambitious 1998 reform of the world's largest health professional educational system. The reforms merged training institutions into universities and greatly expanded enrolment of health professionals. Positive achievements include an increase in the number of graduates to address human resources shortages, acceleration of production of diploma nurses to correct skill-mix imbalance, and priority for general practitioner training, especially of rural primary care workers. These developments have been accompanied by concerns: rapid expansion of the number of students without commensurate faculty strengthening, worries about dilution effect on quality, outdated curricular content, and ethical professionalism challenged by narrow technical training and growing admissions of students who did not express medicine as their first career choice. In this Review we underscore the importance of rebalance of the roles of health sciences institutions and government in educational policies and implementation. The imperative for reform is shown by a looming crisis of violence against health workers hypothesised as a result of many factors including deficient educational preparation and harmful profit-driven clinical practices.
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              Workplace violence, psychological stress, sleep quality and subjective health in Chinese doctors: a large cross-sectional study

               Tao Sun,  Lei Gao,  Fujun Li (2017)
              Background Workplace violence (WPV) against healthcare workers is known as violence in healthcare settings and referring to the violent acts that are directed towards doctors, nurses or other healthcare staff at work or on duty. Moreover, WPV can cause a large number of adverse outcomes. However, there is not enough evidence to test the link between exposure to WPV against doctors, psychological stress, sleep quality and health status in China. Objectives This study had three objectives: (1) to identify the incidence rate of WPV against doctors under a new classification, (2) to examine the association between exposure to WPV, psychological stress, sleep quality and subjective health of Chinese doctors and (3) to verify the partial mediating role of psychological stress. Design A cross-sectional online survey study. Setting The survey was conducted among 1740 doctors in tertiary hospitals, 733 in secondary hospital and 139 in primary hospital across 30 provinces of China. Participants A total of 3016 participants were invited. Ultimately, 2617 doctors completed valid questionnaires. The effective response rate was 86.8%. Results The results demonstrated that the prevalence rate of exposure to verbal abuse was the highest (76.2%), made difficulties (58.3%), smear reputation (40.8%), mobbing behaviour (40.2%), intimidation behaviour (27.6%), physical violence (24.1%) and sexual harassment (7.8%). Exposure to WPV significantly affected the psychological stress, sleep quality and self-reported health of doctors. Moreover, psychological stress partially mediated the relationship between work-related violence and health damage. Conclusion In China, most doctors have encountered various WPV from patients and their relatives. The prevalence of three new types of WPV have been investigated in our study, which have been rarely mentioned in past research. A safer work environment for Chinese healthcare workers needs to be provided to minimise health threats, which is a top priority for both government and society.

                Author and article information

                Int J Nurs Sci
                Int J Nurs Sci
                International Journal of Nursing Sciences
                Chinese Nursing Association
                28 June 2018
                10 October 2018
                28 June 2018
                : 5
                : 4
                : 377-382
                [a ]East Carolina University College of Nursing, Greenville, NC, USA
                [b ]The Affiliated Hospital of Qingdao University, Qingdao, China
                [c ]East Carolina University, Greenville, NC, USA
                [d ]Duke University Medical Center, Durham, NC, USA
                Author notes
                []Corresponding author. Graduate Nursing Leadership, 3123 Health Sciences Building, College of Nursing East Carolina University, Greenville, NC, 27858, USA. weih16@ 123456ecu.edu
                © 2018 Chinese Nursing Association. Production and hosting by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Original Article


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