Wit movie reflection

224  |  Nursing Open. 2018;5:224–232.wileyonlinelibrary.com/journal/nop2

1  | INTRODUC TION

Countless number of encounters occur in healthcare organizations
every day. Encounter is a concept related to the words meeting, ap-
pointment or relationship but diverges as the encounter regularly
means more a personal contact between a few people that takes
place planned or unplanned, that come across and get in touch
with each other (Westin, 2008). Some healthcare encounters are
short and temporary while others are long- lasting and recurring.
Short and temporary healthcare encounters between patients and
caregivers require more things to be taken care of in a short pe-
riod of time (Holopainen, Nyström, & Kasén, 2014). Lack of time in
healthcare encounters can therefore be an obstacle to the develop-
ment of a caring relationship, as they require a high level of quality

communication between the patients and the professionals (Nåden
& Eriksson, 2002).

To ensure a good healthcare encounter, there must be sufficient
time for communication, enough resources and opportunities for
patients and professionals to create a meaningful relationship, re-
gardless of the duration of the encounter (Nygren Zotterman, Skär,
Olsson, & Söderberg, 2015). From the patient’s perspective, a mean-
ingful relationship is often described as individualized attention fo-
cusing on his or her needs (Attree, 2001) that allows him or her to be
involved in the decision- making process (Covington, 2005). A good
and meaningful relationship, from the patient’s perspective, is char-
acterized by gratitude and trust (Gustafsson, Gustafsson, & Snellman,
2013). This is in line with a person- centred perspective, which im-
plies working towards an integration of “being with,” the relational

Received: 23 October 2017  |  Accepted: 25 January 2018

DOI: 10.1002/nop2.132

R E S E A R C H A R T I C L E

Patients’ complaints regarding healthcare encounters and
communication

Lisa Skär1  | Siv Söderberg2

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2018 The Authors. Nursing Open published by John Wiley & Sons Ltd.

1Department of Health, Blekinge Institute of
Technology, Karlskrona, Sweden
2Department of Nursing Sciences, Mid
Sweden University, Östersund, Sweden

Correspondence
Lisa Skär, Department of Health, Blekinge
Institute of Technology, Karlskrona, Sweden.
Email: [email protected]

Abstract
Aim: To explore patient- reported complaints regarding communication and health-
care encounters and how these were responded to by healthcare professionals.
Design: A retrospective and descriptive design was used in a County Council in
northern part of Sweden. Both quantitative and qualitative methods were used.
Methods: The content of 587 patient- reported complaints was included in the study.
Descriptive statistical analysis and a deductive content analysis were used to investi-
gate the content in the patient- reported complaints.
Results: The results show that patients’ dissatisfaction with encounters and commu-
nication concerned all departments in the healthcare organization. Patients were
most dissatisfied when they were not met in a professional manner. There were dif-
ferences between genders, where women reported more complaints regarding their
dissatisfaction with encounters and communication compared with men. Many of
the answers on the patient- reported complaints lack a personal apology and some of
the patients failed to receive an answer to their complaints.

K E Y W O R D S

communication, nurse–patient relationship, patient advisory committee, patient complaints,
quality of health care

     |  225SKÄR and SÖdERBERG

part and “doing for,” the task- based part of nursing (McCormack
& McCane, 2010). Person- centred care has been shown to have a
significant impact on patient and caregiver interactions, health out-
comes and patient satisfaction with care (Ekman et al., 2011). Since
an encounter takes place between unique persons and in a moment
of mutual recognition, no person can know how the other is going
to experience an interaction due to the interpretive nature of inter-
action (Nåden & Eriksson, 2002). Therefore, is it important to focus
on communication and healthcare encounters between patients and
healthcare professionals.

1.1 | Background

Patient- reported complaints showing that most complaints are
around communication and interaction with healthcare profes-
sionals (Montini, Noble, & Stelfox, 2008). Patient- reported com-
plaints about healthcare encounters are an increasing issue (Cave &
Dacre, 1999; Friele, Kruikemeier, Rademaker, & Lawyer, 2013; Kline,
Willness, & Ghali, 2008; Wessel, Lynøe, & Helgesson, 2012), despite
an increased focus on patient – centred care (Skålen, Nordgren, &
Annerbäck, 2016). The number of patients who reported complaints
about Swedish health care more than doubled between 2007–2013
(Activity report Patients’ Advisory Committee 2014). From an inter-
national perspective, patients’ complaints about healthcare encoun-
ters are increasingly recognized in, for example, Germany (Schnitzer,
Kuhlmey, Adolph, Holzhausen, & Schenk, 2012), United Kingdom
(Lloyd- Bostock & Mulcahy, 1994; Nettleton & Harding, 1994), USA
(Garbutt, Bose, McCawley, Burroughs, & Medoff, 2003; Wofford
et al., 2004), Canada (Kline et al., 2008) and Australia (Andersson,
Allan, & Finucane, 2001). However, today, there are no comprehen-
sive international statistics regarding how widespread dissatisfac-
tion is with healthcare encounters, care and treatment, as patients’
complaints often are unstructured information expressed in the
patient’s own language and on their own terms to the healthcare
organization (Montini et al., 2008). According to Wessel et al. (2012),
complaints tend to be underreported by those with negative experi-
ences of healthcare encounters.

In Sweden, patients’ complaints are most often reported through
the Patients’ Advisory Committees (PAC). The PAC is responsible for
handling patients’ complaints and they act on behalf of the patients’
or their relatives and strive to solve the problems that have oc-
curred together with the involved healthcare professionals (SOSFS,
National Board of Health and Welfare, 2005). The PAC also aims to
restore the patients’ and relatives’ trust to the healthcare system,
viewing complaints as a valuable source of information about pa-
tients’ experiences. Complaints can thereby be used positively to
identify adverse incidents and to improve quality of care in the fu-
ture (Kline et al., 2008; Montini et al., 2008).

Research shows that patients’ reported complaints to the
PAC include descriptions of insufficient respect and empathy
(Jangland, 2011), experiences of neglect, rudeness, insensitive
treatment from healthcare professionals (Skär & Söderberg,
2012; Söderberg, Olsson, & Skär, 2012) and poor healthcare

provider–patient communication (Montini et al., 2008). Negative
healthcare encounters cause patients to experience unnecessary
anxiety about their health and thus reduce their confidence in
the healthcare system. This diminished confidence is affected by
healthcare providers’ lack of supportive patient- oriented commu-
nication skills as well as by the fact that the patients and health-
care professionals have different goals, needs and expectations
related to the healthcare encounters (Jangland, Gunningberg, &
Carlsson, 2009). The lack of adequate information and commu-
nication between patients and healthcare providers has been
shown to have a negative impact on patients’ experiences of
the quality of care they received (Attree, 2001). When patients
do not understand the information being given to them about
their health, it might be difficult to ask questions about care and
participate in decision- making for treatment or caring (Jangland
et al., 2009; Skär & Söderberg, 2012). High- quality communica-
tion between patients and healthcare professionals is therefore
significant for increasing patients’ satisfaction with healthcare
encounters and participation in decision- making (Kourkouta &
Papathanasiou, 2014; Petronio, DiCorcia, & Duggan, 2012; Torke
et al., 2012).

Patient- reported complaints may be part of the process of im-
proving the quality of healthcare encounters (Montini et al., 2008).
Moreover, it is not only the issues that gave rise to the patient-
reported complaints that are important; the way that the complaints
are handled and responded to is likewise important. Veneau and
Chariot (2013), stated that answers to complaints are often based
on medical information, lack comprehensiveness and show that the
healthcare organizations have little intention to investigate the issue
further. However, there is a lack of knowledge of how healthcare
professionals communicate and respond to patient- reported com-
plaints (Andersson, Frank, Willman, Sandman, & Hansebo, 2015).
Such knowledge may be used to improve the quality of healthcare
encounters and provide insight into how healthcare professionals
can create meaningful healthcare encounters. The aim of this study
was to explore patient- reported complaints regarding communica-
tion and healthcare encounters and how these were responded to
by healthcare professionals.

2  | THE STUDY

2.1 | Design

A retrospective and descriptive study design was used to examine
patient- reported complaints.

2.2 | Method

This study includes quantitative and qualitative approaches to
achieve the study aim. The quantitative approach was chosen
to statistically describe the character of the reported complaints
to the PAC. The qualitative deductive content analysis was cho-
sen to enhance the understanding of the written text of the

226  |     SKÄR and SÖdERBERG

complaints, focusing on the communication between the patients,
the involved healthcare professionals and the administrators from
the local PAC.

2.3 | Data collection

The study was conducted in collaboration with two adminis-
trators from the local PAC in the County Council of northern
Sweden, a region with five hospitals and 33 primary healthcare
centres. The criteria for inclusion were patient- reported com-
plaints concerning encounters and communication reported by
adult (over 18 years) patients themselves during January 2010–
December 2012. The chosen time period was based on that PAC
stored 3 years of complaints at a time. For some complaints, parts
of the patients’ records were attached. All identifying patient
details have been omitted in the presentation of this study’s re-
sults to protect the patients’ anonymity, in accordance with the
Helsinki declaration. The patient- reported complaints filed at the
PAC were covered by confidentiality. The results of the study are
therefore presented only at a group level and individuals cannot
be identified.

During the chosen time period, the PAC received 1792 patient-
reported complaints concerning issues related to the following
areas: i) encounters and communication; ii) medical maltreatment
and iii) organizational issues regarding rules/regulations. The admin-
istrators at the PAC sorted and classified the complaints in the file
archive based on the above- described areas. This sorting was part of
the PACs normally classification of complaints and it was performed
without a standardized system. To ensure that all complaints that
contained dissatisfaction with encounters and communication were
included in the analysis all submitted complaints (N = 1792) regard-
less of the area where the Patients’ Administrators had sorted them
in, were read through. This reading resulted in that all (N = 625) re-
ported complaints containing descriptions of dissatisfaction with
encounters and communication were selected for the analysis. In 38
of the 625 selected reports, only a short note indicating the date of
a phone call to the patient was found and thus these reports were
excluded from the analysis. The remaining 587 complaints were in-
cluded in the analysis.

2.4 | Statistical analysis

Statistical Package for Social Science (version 22.0; SPSS Inc.,
Chicago IL, USA) was used for the statistical analyses. Data in the
patient- reported complaints regarding gender, the type of organiza-
tion, clinical department, reason for the complaint and the type of
healthcare professionals who were the focus of the complaint, were
extracted to a data template and thereafter included in the SPSS
form. Descriptive statistics were used to describe the content and
frequencies and a Pearson’s Chi Square test was used to determine
the relationships and significant differences between the patient’s
gender and the type of units and professions cited in the patient-
reported complaints.

2.5 | Deductive content analysis

The written text in the complaints was analysed in parallel with the
statistical analysis, using deductive content analysis (Elo & Kyngäs,
2007). Deductive content analysis may be used when the structure
of the analysis is based on a specific structured knowledge such as
a theory or a model. In this study, the analysis was framed in terms
of pre- existing area; encounters and communication, used by the
administrators at the PAC when they filed the patient- reported com-
plaints into the file archive.

The first step in the analysis was to develop a categorization
matrix based on the pre- defined area encounters and communi-
cation. Then, all the complaints were reviewed for content and
coded for correspondence with one of the field in the area (cf., Elo
& Kyngäs, 2007). This means that all text in the patient- reported
complaints that describe any form of meetings, appointments and
relationships were sorted in the field encounters and that the con-
tent in the patient- reported complaints that describe any form of
information exchange, communication in form of a written dialog
between the patient and the healthcare professionals involved
were sorted in the field communication. The content in each field
was then compared based on differences and similarities and cat-
egories were formulated. The analysis resulted in two categories
in each field. The analysis process was non- linear and involved
repeated readings of the complaints. To reach a consensus in the
analysis, the two authors moved back and forth between content
in the complaints and the categories in the field and discussed
the content to ensure that the results covered all content in the
complaints.

2.6 | Ethics

The authors obtained access to the local PAC file archive after the
study received ethical approval from the Regional Ethical Review
Board in Sweden (Dnr 06- 050M).

3  | RESULTS

The patient- reported complaints (N = 587) each contained a writ-
ten letter from a patient describing the situation that had occurred
and indicating dissatisfaction with the healthcare encounter and/
or communication. Each complaint also contained a summary writ-
ten by the local PAC administrator as well as a checklist for actions
to solve the situation. Furthermore, the reported complaints con-
tained an answer from the healthcare professionals involved in the
situation and a conclusion regarding how the report was handled
and the outcome. Below presents a descriptive summary of the
patient- reported complaints characteristics and categories from
the deductive content analysis in the two fields; encounters and
communication. The qualitative findings are supported by quota-
tions from the text in the complaints, written with italic style in
the text.

     |  227SKÄR and SÖdERBERG

3.1 | Characteristics of patient- reported complaints

Of the 587 patient- reported complaints, 336 (57%) of these were
made by women. The 587 complaints concern all units in the health-
care organization and the clinical department that contained most
complaints was consultation outpatient visits (N = 195), followed
by surgery (N = 171). The complaints described different groups of
healthcare professionals who were the focus of the complaint and
the most common professions the complaints focus on were phy-
sicians (N = 357), followed by healthcare managers (N = 100) and
nurses (N = 79). Men’s complaints were more often directed against
physicians than were women’s complaints (72% vs. 53%), while
women were more likely than men to direct their complaints against
healthcare managers (22% vs. 11%). Healthcare manager could be
both a ward manager or a person in a higher management level not
based in a particular ward or clinic area. Significant differences were
found between the professional groups the complaints addressed
and the patient’s gender (p = .001) (Table 1).

The result further shows that physicians (N = 221) were most
involved in complaints in hospital care followed by healthcare

managers (N = 65) and nurses (N = 51). Significant differences were
found between the different professional groups the complaints in-
tended to address and the type of organization (p = .001) and clini-
cal department (p = .001) the complaint reflect. An overview of the
units and the professions that the complaints addressed is provided
in Table 2.

A description of the content, frequency and professions involved
in the patient- reported complaint is described in Table 3. The re-
sults show that 337 of the complaints describe negative attitudes/
behaviour and were distributed as lack of empathy (77%) and non-
chalant treatment (23%). Physicians and nurses reportedly showed
the greatest lack of empathy (79% vs. 69%), while healthcare manag-
ers were most responsible for patients not feeling involved in their
care (60%). No significant differences were noted between profes-
sionals (p = .419 vs. .552). In the field communication (N = 333), most
of the complaints were about the patients’ experiences of not being
involved/lack of participation in the care (55%), followed by a lack
of information and lack of possibilities for communication (45%).
No significant differences were noted between women and men
(p = .906 vs. .891).

3.2 | Areas and categories of the deductive
content analysis

3.2.1 | The field: Encounters

In the field encounters, two categories were identified; Lack of em-
pathy and Non- chalant treatment.

Category: Lack of empathy
The complaints often began with a summary of the reasons for the
patients’ unhappiness with the meeting. Patients were most dissat-
isfied when they were not met in a professional manner. The com-
plaints describe that inadequacies in meetings generated feelings
of not being met with respect, not being understood and not being
welcomed to the healthcare setting. Not being met with respect was
described when healthcare professionals did not value the patient as
a person. Another reason for reporting a complaint was that health-
care professionals could only attend to patients’ most necessary
needs when patients found the healthcare environment stressful.
The complaints described situations when the patients felt ignored
by the healthcare professionals due to insufficient time throughout
the caring encounter. One reported complaint described: “there was
no time for healthcare professionals to listen to my story so I had to
prioritize which needs I should present”. This meant that the patients
were dissatisfied with the meeting as focus was only at one of their
health instead of all their problems.

The complaints gave also examples of how patients liked to be met
by healthcare professionals such as through commitment and a genuine
interest by being seen as an important person. In the complaints, the
patients further expressed a desire for a resolution to the situation and
to prevent it from happening again, either to themselves or to other pa-
tients. The patients’ need for justice was another important reason for

TABLE  1 Units and professions that the patient- reported
complaint concerns

Women Men Total

p valueN/% N/% N/%

Type of organization

Hospital care 201/60 159/63 360/61

Primary health
care

119/35 83/33 202/35

No specific
organization

16/5 9/4 5/4

Total 336/100 251/100 587/100 .610

Type of clinical department

Consultation
outpatient
visits

115/34 80/32 195/33

Medicine 77/23 71/28 148/25

Surgery 110/33 61/24 171/30

Psychiatry 20/6 28/11 48/8

No specific
inpatient
care

14/4 11/4 25/4

Total 336/100 251/100 587/100 .038

Professionals involved

Physicians 177/53 180/72 357/61

Healthcare
managers

73/22 27/11 100/17

Nurses 53/16 26/11 79/13

No specific
profession

33/10 18/7 51/9

Total 336/100 251/100 587/100 .001

p ≤ .05 (Pearson’s Chi Square test).

228  |     SKÄR and SÖdERBERG

many of the complaints. One patient perceived in the complaint that: “I
had to wait longer than other patients for treatment or care”, another
patient describe: “I got less examinations then others”.

Category: Non- chalant treatment
The complaints described situations when healthcare profession-
als had shown negative attitudes in their behaviour towards the

patients. In some complaints, the patients were referred to as a
diagnosis rather than as a person when healthcare professionals
were talking among themselves, saying things such as “the bro-
ken leg”, “the painful lady” or “the mentally ill”. The patients de-
scribe in their complaints that these kinds of negative attitudes
and bad behaviour affected their dignity. The patients expressed
in the complaints that they would have become healthier sooner

Physician Healthcare managers Nurse
No specific
profession

p valueN/% N/% N/% N/%

Type of organization

Hospital care 221/62 65/65 51/67 –

Primary
health care

136/38 28/28 23/30 –

No specific
organization

– 7/7 2/2 –

Total 357/100 100/100 76/100 .001

Type of clinical department

Consultation
outpatient
visits

132/33 30/49 25/18 1/100

Medicine 115/30 3/4 30/20 –

Surgery 109/28 17/28 45/30 –

Psychiatry 26/6 1/1 22/14 –

No specific
inpatient
care

14/3 11/18 25/18 –

Total 396/100 62/100 147/100 1/100 .001

p ≤ .05 (Pearson’s Chi Square test).

TABLE  2 Organizations, type of clinical
department and involved professionals in
the patient- reported complaints

TABLE  3 Analysis fields and categories descriptions of frequencies according patients gender and profession involved in the patient-
reported complaints

Analysis fields and
categories

Women Men Total

p value

Physician Healthcare managers Nurse

p valueN/% N/% N/% N/% N/% N/%

Field: Encounter

Categories:

Lack of empathy 158/77 101/76 259/77 163/79 41/79 34/69

Non- chalant
treatment

47/23 31/24 78/23 44/21 11/21 15/31

Total 205/100 132/100 337/100 .906 207/100 52/100 49/100 .419

Field: Communication

Categories:

Not being
involved in care

99/55 82/54 181/55 111/51 40/60 14/56

Answers to the
patient’s
complaints

82/45 70/46 152/45 105/49 27/40 11/44

Total 181/100 152/100 333/100 .891 216/100 67/100 25/100 .552

p ≤ .05 (Pearson’s Chi Square test).

     |  229SKÄR and SÖdERBERG

if they had been warmly greeted and seen as individuals in their
encounters with healthcare professionals. The written text in the
complaints indicated that it was unacceptable that the healthcare
professionals engaged in this negative behaviour in their meetings
with patients.

Dissatisfaction with attitudes and/or negative behaviour in
meetings was also described in situations where the patients per-
ceived that they were not met in a professional manner. The com-
plaints contained examples of caring situations where the patients
received insufficient respect, such as a “lack of empathy” and “non-
chalant treatment from professionals who ignored their symptoms
and illnesses”. Such complaints described how the patients felt lost
and ignored in their meetings with healthcare professionals, which
in turn led to anxiety. Examples of insufficient respect were also de-
scribed in meetings when healthcare professionals talked about the
costs of treatment and drugs rather than about the actual treatment
of the patients’ symptoms and illnesses. One patient expressed in
the written complaints that: “these kinds of attitudes and/or be-
haviours, where they were not met in a professional way, negatively
affected their health”. As a result, the patients expressed in the com-
plaints that their confidence in health care began to diminish.

3.2.2 | The field: Communication

In the field communication, two categories were identified; Not
being involved in care and Answers to the patient’s complaints.

Category: Not being involved in care
The complaints described that patients experience insufficient infor-
mation: “I was not given an opportunity to receive adequate infor-
mation or participate in decision- making about my care”. Insufficient
information was highlighted because of the language deficits of the
provided care. The patients- reported complaints contained exam-
ples of situations when the patients suffered due to the methods
the healthcare professionals used to inform them. It was for example
of situations where: “healthcare professionals use a medical termi-
nology that I didn’t understand” or “information was given during
stressful circumstances with no time for questions”. The patients ask
therefore in their complaints for more information that could explain
their circumstances in a way they could understand.

The complaints further indicated that the patients felt that they
were not invited to participate in the communication about their
treatment and care. One patient expressed in the complaints that:
“it is difficult to take part in decision- making about care alternatives
when you not be invited”. The patients asked for more communi-
cation and their complaints gave examples of situations when the
professionals provided information without taking care of the pa-
tient’s individual needs. The content in the complaints describe that
the patients asked for questions about their needs and personal
conditions and an invitation for discussions of alternative treat-
ments. One patient’s complaints described: “I know best how I feel
so they (the professionals) should ask me”. The patient’s complaints
described further that healthcare professional lack interest about

their situation and the patient- reported complaints expressed the
patients’ disappointments.

Category: Answers to the patient’s complaints
The administrators at the PAC clearly documented the procedure
for how the complaints should be handled as well as the resulting
outcomes, describing the way they contacted the patients by phone
or mail to gather complementary information regarding the situa-
tions that had occurred. A checklist described how the administra-
tors should further handle the complaints, for example, asking for
the patient’s record to get more information about the situation and
contacting the involved healthcare professionals. The administra-
tors at the PAC always requested an answer and response from the
healthcare professionals concerned in the complaints, but responses
were received in only 490 cases (83%) of the total 587 complaints.
The distribution of answers in response to women’s and men’s com-
plaints was relatively equal (84% vs. 82%; p = .429).

The administrators at the PAC forwarded the physicians’ or re-
sponsible healthcare managers’ responses to the patients together
with a brief accompanying letter. The responses were often written
in a neutral and impersonal tone, such as “Mr. Karlsson, Your com-
plaint will be forwarded to the healthcare professional responsible
for your care.” About 264 (54%) of the answers were expressed in
an understanding tone, such as “Dear Mrs. Svensson, thanks for
your complaint. We understand your complaint and the described
situation.” Furthermore, 58 answers (12%) were expressed in an
apologetic manner, for example, “Dear Mrs. Jonsson, Thanks for
your complaint. We apologize for the situation that occurred. We
will investigate the situation that occurred and will return to you
as soon as possible.” A frequent tone in the responses suggested
that the healthcare professionals were not responsible for the situ-
ation, which, they explained, had occurred because the healthcare
professionals had followed established healthcare routines; for in-
stance: “Mrs. Larsson, Thanks for your complaint. The healthcare
professional your complaint applies to has followed routines for the
examination and treatment and they can therefore not be held re-
sponsible for the situation you are experiencing.” In 461 (94%) of the
total 490 answers, the healthcare professionals showed no intention
to act or correct the situation. The patient- reported complaints also
described that this lack of responsibility for the situation contributed
to the patients’ feeling that they had been treated with disrespect.

In 29 (5%) of the total 587 patient- reported complaints, a suc-
cessful handling of the situation was described. This occurred when
the healthcare professionals involved in the situations contacted the
patients and personally apologized to them. The healthcare manager
was sometimes included in these personal meetings, to provide an
opportunity for all invited parties to discuss the situation. The results
of the meeting were documented in the patient- reported complaints
and describe that the patients were satisfied with the meetings
when the healthcare professionals listened to them and their expe-
riences. Furthermore, they were pleased that they had identified a
solution together regarding how to have more caring encounters in
the future. In other examples, the involved healthcare professionals

230  |     SKÄR and SÖdERBERG

who participated in follow- up meetings had expressed their regret
about the situations that had occurred and explained why the pa-
tient was treated inadequately. Another example of a case that was
successfully handled was when the involved healthcare professional
and the healthcare management met with the patient personally and
apologized for the professional’s lack of empathy.

In 19 (3%) of the 587 patient- reported complaints, the admin-
istrators at PAC had documented how the patients’ dissatisfaction
with their healthcare encounters and communication should be used
in the future to improve health care and, furthermore, become a part
of the healthcare professionals’ continuing education to prevent
similar situations from occurring with other patients.

4  | DISCUSSION

This study explored patient- reported complaints regarding commu-
nication and healthcare encounters and how these were responded
to by healthcare professionals. The results indicate that the com-
plaints concerned all departments in the healthcare organizations
and were most common in hospital care. This corresponds with the
results of Kline et al. (2008), which indicated that patients’ com-
plaints are often associated with short and temporary healthcare
visits and encounters with higher clinical complexity. Furthermore,
these results show that while different healthcare professionals
were involved in the complaints, the most commonly involved pro-
fessionals were physicians, followed by healthcare managers and
nurses. Physicians and healthcare managers were most involved in
hospital care complaints related to consultation outpatient visits,
whereas nurses were most involved in complaints regarding surgery.
Schnitzer et al. (2012) noted that patients’ complaints about health-
care shortcomings to a higher extent involved physicians. A negative
relationship outcome between the physician and patient is described
to be characterized by disrespect or insensitivity (Falkenstein et al.,
2016). However, to preserve credibility in the patient–physician rela-
tionship, patients need support to handle experiences of shortcom-
ings in their healthcare encounters (Petronio et al., 2013).

The results that described satisfaction with encounters with phy-
sicians were based on receiving information through a dialogue that
included both empathy and listening. When patients receive informa-
tion about their health conditions, it is of great importance that the
information includes empathy and an invitation to participate in care
decision- making (Skär & Söderberg, 2012; Söderberg et al., 2012).
People who are ill seek information and explanations that will help
them to make meaning and form a coherent understanding regard-
ing what will happen to them (Nygren Zotterman, Skär, Olsson, &
Söderberg, 2016). A new patient law (The Patient Act 2014:821) was
implemented in Sweden in 2015 that aims to reinforce and clarify the
patient’s position and facilitate patients’ integrity, autonomy and par-
ticipation in care by being informed about their conditions and avail-
able treatments. However, patients are often not the focus of their care
because of deficiencies in communication, lack of continuity in care
and collaboration between several healthcare providers (Jangland,

2011). As a result, patients who lack information about their health
conditions or not participate in decision- making, have difficulties in
achieving good treatment results (SOSFS, National Board of Health
and Welfare, 2005:12). Explanations and information about their ill-
ness may validate a person’s experience, while a lack of explanations
negatively influences their experience of being ill (Attree, 2001).

The results further show that the most common dissatisfaction
with healthcare meetings involved being dissatisfied with profes-
sionals’ attitudes or approaches. The complaints described how
the patients were ignored and treated with indifference. Uncaring
behaviour affects patients’ dignity and thereby their health and
well- being (Eriksson, 2006). To protect and respect patients’ dignity,
healthcare professionals need to be aware of patients’ vulnerabil-
ity and the power they have in their meeting with patients (Croona,
2003). By recognizing patients’ expression of dissatisfaction, re-
search shows that activities that are critically examined prepared
healthcare professionals to change caring routines (Skålen et al.,
2016).

The results show further differences between genders, where
women reported more complaints regarding their dissatisfaction
with encounters and communication compared with men, which
Schnitzer et al. (2012) also noted in their study. Research (Williams,
Bennett, & Feely, 2003) shows that women are sometimes treated
different than men when seeking care. However, following a person-
centred approach, every patient should receive individualized care
(McCormack & McCane, 2010). This requires providing individual-
ized and holistic care, encouraging patient participation in the pro-
cess (Andersson et al., 2015), fostering empowerment and treating
the patients’ needs with respect and dignity despite type of illnesses
or gender (Leplege et al., 2007). When a healthcare organization
adopts a patient- centred approach to handling complaints and pre-
venting litigation due to mishandled healthcare communication, the
quality of care can improve (McCormack & McCane, 2010).

The results show that many of the answers on the patient-
reported complaints lack a personal apology and that some of the
patients not even received an answer to their complaints. This indi-
cates that professionals often do not take responsibility for how they
handle patients and behave in the context of health care. Research
by Gallagher, Waterman, Ebers, Fraser, and Levinson (2003) has
shown that following an adverse event, patients want an apology,
an explanation of what happened and someone to take responsibil-
ity, but there is a wide variation in whether healthcare profession-
als choose to apologize or not (Robbennolt, 2009). One reason that
professionals may avoid giving patients a personal apology is that
admitting mistakes increases the risk of being sued (Butcher, 2006).
Therefore, according to Kaldjian, Jones, and Rosenthal (2006) will
many physicians never admit their mistakes.

An apology can have powerful effects for both the person of-
fering it and the recipient and it contributes to improving the phy-
sician–patient relationship (Robbennolt, 2009). By considering
specific types of disclosure strategies, such as talking through short-
comings in encounters and discussing possible feelings of guilt and
shame with colleagues, professionals are more likely to personally

     |  231SKÄR and SÖdERBERG

come to terms with a negative patient relationship (Petronio et al.,
2012). Conversely, not receiving an apology following unsatisfactory
treatment or mistakes could affect patients negatively and create
suffering that prevents them from receiving emotional closure in the
situation. If a healthcare meeting lacks meaning for the patient, he or
she can experience great suffering (Eriksson, 2006). From a patient-
centred perspective, patient participation and involvement and re-
spect for the patient as an individual could be the first steps towards
a meaningful and dignified relationship (Kitson, Marshall, Bassett,
& Zeitz, 2012). Many complaints could easily be avoided with im-
proved communication and changed attitudes among healthcare
professionals (Jangland et al., 2009; Kourkouta & Papathanasiou,
2014). Therefore, healthcare professionals need knowledge about
the consequences of negative encounters for the individual pa-
tients (Croona, 2003). Professionals should realize that an apology
is interpreted as a signal that steps will be taken to avoid similar
consequences in the future (Robbennolt, 2009). There is also a con-
sensus that disclosing information regarding healthcare mistakes is
advantageous for patients, professionals and healthcare organiza-
tions in terms of reducing dissatisfaction with healthcare encoun-
ters and communication and increasing patients’ satisfaction with
quality health care (cf., Mazor et al., 2004). Therefore, it is import-
ant that the healthcare organization develops communication plans
and strategies to handle patients’ complaints (Coombs, Frandsen,
Holladay, & Johansen, 2010).

4.1 | Limitations

The limitations of this study are the subjective experiences reported
by patients in the complaints and that data were collected from one
single PAC in northern part of Sweden. However, a strength of this
study was the number of complaints during a time period of 3 years
included in the analysis. This retrospective and descriptive study in-
cluded both a qualitative and quantitative design which resulted in a
deep description of the findings. Furthermore, the analysis was con-
ducted jointly and reviewed independently by both authors, which
added rigour to the study (Creswell & Plano Clark, 2007). However,
even though the study was based on data in a Swedish healthcare
context, there are overarching implications that match existing
healthcare encounters and communication knowledge and practice
internationally.

5  | CONCLUSIONS

To conclude, this retrospective and descriptive study including both
qualitative and quantitative approaches shows that patient- reported
complaints regarding provided care stem from asymmetric commu-
nication, where the patients are not met in accordance with their
individual needs. From a person- centred perspective, this can have a
significant impact on patients’ satisfaction with healthcare encoun-
ters and experiences of quality of care. The results also revealed
that not all patients received closure in the form of an answer or

personal apology in response to their complaint. Transparency of
the shortcomings in healthcare encounters could help patients to
overcome negative experiences. These results stressed therefore
that patient- reported complaints should be used to identify why
shortcomings that have been highlighted for several years persist,
as well as, why healthcare professionals do not take responsibil-
ity for the complained- about matter. However, more knowledge is
needed about how healthcare organizations could address patient
complaints to improve the quality of care.

ORCID

Lisa Skär http://orcid.org/0000-0002-5731-2799

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How to cite this article: Skär L, Söderberg S. Patients’
complaints regarding healthcare encounters and
communication. Nursing Open. 2018;5:224–232.
https://doi.org/10.1002/nop2.132