Healthcare Complaints Analysis Tool (HCAT) is a method for systematically analysing complaints, and grouping key insights reported within thousands of experiences reported by patients every year to healthcare institutions. The tool, which is free to use, allows staff to reliably determine the problems reported in complaints at three-levels of specificity; to grade their severity, the harm caused to patients, and where in the hospital system problems occurred.

“Many of the organisations we work with spend significant resources ‘managing’ complaints, but recognise that they need to get better at learning from them. HCAT provides an evidence-based methodology, approach and system to facilitate this.”

Clinical Leadership, Southern Trust, Northern Ireland

Step 1:

Read through the HCAT manual.

The manual provides instructions on how to use the Healthcare Complaints Analysis Tool (HCAT) to analyse complaints from patients and families regarding poor healthcare experiences.

Step 2:

Use the online HCAT training to become familiar with how to apply the tool.

Any person codifying complaints using the HCAT framework should do the training and periodic training refreshment is recommended to ensure that coders remain calibrated.

Step 3:

Analyse data codified using HCAT. There is an online tool that can help with graphing data.

We recommend a two step analysis:
1) quantitatively identify trends for in-depth analysis
2) qualitatively analyse complaints associated with the identified trend.

Step 4:

Produce a report or dashboard that can inform learning. Here is an example report.

This report should combine the high-level quantitative trends and benchmarking with in-depth qualitative analysis of the identified trends.

“Complaints are often reviewed on an individual basis but we needed a strategy to collectively analyse several hundred narrative complaints received over 12 months. HCAT provided us with a free, user-friendly yet comprehensive method to categorise a vast quantity of narrative data in a systematic manner.”

Centre for Quality and Patient Safety Research, Deakin University, Australia.

Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights

 Jackie van Dael, Tom W Reader, Alex Gillespie, Ana Luisa Neves, Ara Darzi, Erik Mayer

A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling. This paper has developed evidence-based recommendations for healthcare settings to effectively integrate patient-centric complaint handling with quality monitoring and improvement.

Patient complaints in healthcare systems: a systematic review and coding taxonomy

Tom W Reader, Alex Gillespie, Jane Roberts

Patient complaints have been identified as a valuable resource for monitoring and improving patient safety. This article critically reviews the literature on patient complaints, and synthesises the research findings to develop a coding taxonomy for analysing patient complaints.

The healthcare complaints analysis tool: development and reliability testing of a method for service monitoring and organisational learning

Alex Gillespie, Tom W Reader

Letters of complaint written by patients and their advocates reporting poor healthcare experiences represent an under-used data source. The lack of a method for extracting reliable data from these heterogeneous letters hinders their use for monitoring and learning. To address this gap, we report on the development and reliability testing of the Healthcare.

Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety.

Alex Gillespie, Tom W Reader

Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low-level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient-centered insights that localize issues and shed light on difficult-to-monitor problems.

“HCAT has proved to be a useful tool that has assisted us to better utilise complaints information to monitor and improve patient safety. Adding the HCAT dimension to our complaints analysis process has helped us identify where our systems and processes can be improved.”

Medical Project Manager, Southern Trust, Northern Ireland

Dr Tom Reader

Associate Professor

Department of Psychological and Behavioural Science (LSE)

Dr Kelsey Flott

Centre Manager

NIHR Patient Safety Translational Research Centre (Imperial College)

Dr Alex Gillespie

Associate Professor

Department of Psychological and Behavioural Science (LSE)

Professor Ara Darzi

Co-Director, Professor of Surgery

Institute of Global Healthcare Innovation
(Imperial College)

Jackie van Dael

Research Postgraduate

Patient Safety Translational Research Centre (Imperial College)

Mr Erik Mayer

Clinical Senior Lecturer & Transformation CCIO

NIHR Patient Safety Translational Research Centre (Imperial College)