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Formation of the Complaint Management Team and the Database

With the eventual goal of linking together all areas responsible for addressing patient complaints, the
Complaint Management Team was created in January 1997 to develop a coding and reporting mechanism.
The team was composed of representatives from the risk management, patient accounts, and patient relations
charge to the team was to 1. operationally define a negative comment, or complaint;
2. define common categories of complaints;
3. design a feedback and reporting mechanism of aggregate complaint data and common themes to be
used for organizational goal setting and improvement projects; and
4. establish reporting capabilities so the complaints could be used to support teams in their continuous
QI and project-focused performance improvement efforts. Each team member was assigned the responsibility of
reviewing sources and types of complaints received in their area. Within two weeks, the team reconvened to discuss the
definition ofcomplaintand to develop a coding strategy. What seemed simple at first triggered a complex debate. We
defined the term complaint as any dissatisfaction or dissatisfier voiced or written on a survey or letter by a patient, family
member, visitor, or other customer.
The team decided that there were different levels of complaints, with some warranting immediate
action and prioritization, and others that were merely good suggestions for continual improvement. Each coded complaint
would help us better understand our customers expectations. We decided on a code for major complaint to be added to
the database, defining it as something that required immediate action. The team used a template approach to the
coding of complaints. This method, described by Crabtree and Miller, 13 requires a decision on the level of detail desired in
the coding, and then on a method to revise and refine. As Crabtree and Miller state, the researcher is always walking a
fine line between premature closure and creating codes so encompassing that every line of text requires coding. (p 99) After
much discussion, the team developed two levels of coding major areas (limited to 15) and subcategories or types of
issuesto further define the complaint.
The next step was for the team to determine whether the coding categories fit into the real-world
data of complaints on surveys. A sampling of 20 surveys with comments were selected from different areas within the
hospital. Three staff members independently read each comment and assigned a code. After all surveys were read and
coded, a discussion ensued. The coders found that the coding scheme did not enable them to adequately differentiate
among the comments. Using the template methodology, we modified the codebook to address deficiencies and add
codes, and then went through each code to develop an operational definition. New descriptor words were
added, and additional surveys were reviewed and tested. The new codes and definitions allowed for easier categorization,
but, as with many template coding processes, it was clear that developing the codebook would be an evolutionary
process. At the same time, we wanted to limit the size of the coding manual, so that each line would not need a separate
code. To avoid coder drift and to allow for review by an independent reader, we decided that entering of the verbatim text
(or as close to verbatim as possible on long Copyright 2000 Joint Commission on Accreditation of Healthcare Organizations