Table 3.
Summary of 12 context-mechanism-outcome (CMO) configurations for patient-centric complaint handling and system-wide quality improvement* (stage 3)
| Procedural pathway | Relevant programme theory | Mechanism reference | Context (C) | Mechanism (M) | Outcome (O) |
| Complaint handling | Invite | CMO135–49 | Clarity of complaints procedures and policies | Patients and families are more inclined to complain if they are aware of their rights and can easily access information that outlines procedures involved. | …and facilitates patient and family access to seek redress |
| CMO225 35–37 40–42 45 46 49–60 68 | Complainant characteristics and accompanying needs (eg, complainants burdened by health condition or language barriers) | Collaboration with support and advocacy services improves accessibility for commonly excluded patient groups. | …and increases the representativeness of complaints data | ||
| CMO317 40–43 46 49 58 61–64 | Stigma of complaints and staff attitude | Staff encouragement of, and signposting to, complaint procedures reduces anxiety and stigma that prevents patients and families from filing a complaint. | …and encourages patients and families to share their feedback | ||
| Respond | CMO417 21 22 24 25 38 42 48 65–67 | Staff coordination and response toolkits | Comprehensive and bespoke responding improves complainant satisfaction. | …and ensures that the complaints process provides redress | |
| CMO518–26 38 40–43 46 65 67 | National standards used to monitor the quality of complaint handling | Transparency increases accountability of complaint handling and encourages other patients and families to provide feedback. | …and encourages the use of complaints procedures | ||
| Quality monitoring and improvement | Report | CMO67–12 16 55 65 68–82 | Framework used to record insights held in complaints | An evidence-based reporting framework supports meaningful aggregation of complaints data. | … and leads to reliable and useful learning insights |
| CMO710 11 16 17 80 81 | Staff type responsible for reporting, accompanying incentives and received training in complaints reporting | Standardised training and guidelines for coders who are sufficiently removed from front-line practice will increase objectivity and consistency of reporting. | … and leads to data that represent patient voice | ||
| CMO816 17 48 65 71 | Informatics system used to create and retain complaints information | A centralised informatics system facilitates data monitoring and triangulation. | ….and allows for effective, continuous monitoring of care issues | ||
| Analyse | CMO916 52 69 75 83–92 | Frequency of complaints received at service (eg, sample size) | Conducting analysis at an appropriate organisational level enables the identification of trends of poor care. | …and helps identify system-wide care issues | |
| CMO104 5 7 10 16 69 81 93 | Staff analysis skills and data infrastructure (eg, automated dashboards, triangulation) | Combining quantitative trend analysis with targeted qualitative analysis produces granular, actionable lessons for improvement. | …and helps locate and prioritise improvement initiatives | ||
| Improve | CMO117 16 17 20 26 27 38 43 45 46 48 69 70 94 | Board priorities and leadership | Board priorities and leadership shape the degree to which complaints data are used for quality monitoring and improvement. | …and allows complainants to have a greater impact on care improvement | |
| CMO1216 17 36 42 43 46 60–64 87 95–98 | Organisational culture and stigma of complaints | A just culture that welcomes complaints as opportunities for learning counters negative impact of complaints on staff. | … and reduces staff apprehension towards complaints |
*References included 74 international academic papers and 10 England-based policy sources.