According to Bismark et al,1 complaints that are brought to a Commissioner in New Zealand offer a potentially valuable “window” on serious threats to patient safety. In Italy, the Consultative and Conciliatory Commissions (“Commissioni miste conciliative”) and the ombudsmen (second level organisations) supply unsatisfactory results or are not even established.2 Furthermore, epidemiological data such as those of the NZQHS are very scarce. We therefore carried out a survey to explore whether an independent patient agency could facilitate local learning and action to improve the quality of health services.
Two hundred and forty complaints and accounts of presumed untoward events presented by people to our voluntary patient agency in Milan (Cittadinanzattiva) were analysed. Every complaint included one or more clinical record. Our aim was to compare allegations contained in the written complaints and the results of a retrospective review of the case records. An expert physician examined all the clinical records produced and identified when an “avoidable adverse event” was present.3 A medicolegal expert independently reviewed 89 complaints. The causes of the complaints according to the complainants are shown in table 1.
Table 1 Patients' complaints and preventable adverse events (AEs).
| Reasons for complaining according to complainant | Total | Preventable AEs according to the expert | |
|---|---|---|---|
| All preventable | Preventable and serious | ||
| Delay in diagnosis and treatment | 89 | 36 | 7 |
| Failure or complication in the technical performance of an indicated operation | 82 | 30 | 12 |
| Failure of complication in the technical performance of an indicated invasive procedure | 24 | 9 | 1 |
| Lack of care or attention, lack of monitoring | 19 | 3 | 1 |
| Delay or failure in treatment | 9 | 2 | |
| Others | 9 | 7 | 1 |
| No reason | 8 | ||
| Total | 240 | 87 | 22 |
In the physician record review, 87 of the 240 complaints were associated with a preventable adverse event (mainly occurring in hospital); 22 were serious and preventable and 12 resulted from a failure or a complication of an indicated operation.
This study has a number of potential shortcomings. Nevertheless, the survey confirms the kind of useful information that can be gathered about substandard medical care from this type of documentation. With no patient lawyer or representative present in the hospital4 and with the management of claims firmly controlled by the medical experts, those wishing to complain will be more motivated if the management of the claims is supported by an independent agency to ensure objectivity before the disputes, taking on responsibility for reporting the incident to the interested organization and providing feedback to the citizen.
In my opinion, however, the Italian voluntary patient agencies have a very weak voice.
References
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