Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia

Abstract

Objectives: (1) To determine the distribution of formal patient complaints across Australia's medical workforce and (2) to identify characteristics of doctors at high risk of incurring recurrent complaints.

Methods: We assembled a national sample of all 18 907 formal patient complaints filed against doctors with health service ombudsmen ('Commissions') in Australia over an 11-year period. We analysed the distribution of complaints among practicing doctors. We then used recurrent-event survival analysis to identify characteristics of doctors at high risk of recurrent complaints, and to estimate each individual doctor's risk of incurring future complaints.

Results: The distribution of complaints among doctors was highly skewed: 3% of Australia's medical workforce accounted for 49% of complaints and 1% accounted for a quarter of complaints. Short-term risks of recurrence varied significantly among doctors: there was a strong dose-response relationship with number of previous complaints and significant differences by doctor specialty and sex. At the practitioner level, risks varied widely, from doctors with <10% risk of further complaints within 2 years to doctors with >80% risk.

Conclusions: A small group of doctors accounts for half of all patient complaints lodged with Australian Commissions. It is feasible to predict which doctors are at high risk of incurring more complaints in the near future. Widespread use of this approach to identify high-risk doctors and target quality improvement efforts coupled with effective interventions, could help reduce adverse events and patient dissatisfaction in health systems.

Keywords: Health policy; Health services research; Patient satisfaction; Quality improvement.

Figure 1

Cumulative distribution of complaints and doctors named in complaints.

Figure 2

Probability of recurrent complaints over time. *Curves adjusted for doctor age and sex, practice location, specialty, state and complaint year. ^†Dots on the curves indicate points in time when actual complaints occurred (ie, x-axis), but have no meaning in relation to predicted probability of complaints (ie, y-axis). ^‡Ages reported refer to mid-points of the period over which the doctor was followed.