Dear Editor,

According to MM Bismark et Al (1) complaints that are brought to a Commissioner in NZ 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 like those of the NZQHS are very scarce. We had only a possibility in this field: to carry out a survey to explore if an independent patient’s agency could facilitate local learning and action to improve the quality of health services.

Two hundred forty complaints and accounts of presumed untoward events presented by people to our voluntary Patients Agency in Milan (Cittadinanzattiva) were analysed. Every complaint enclosed one or more clinical records. Our aim was to compare allegations contained in the written complaints and the results of a retrospective case records review. 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. According to the patients the cause of the complaint was: *A delay in diagnosis and treatment (89 cases). *The failure or a complication in the technical performance of an indicated operation (82 cases), or of an indicated invasive procedure (24 cases ). *Lack of care or attention, failure to attend, lack in monitoring of a patient (19 cases). *Delay or failure in treatment (9 cases). *Others (9 cases). In the physician record review, 87 out of 240 complaints were associated with a preventable adverse event (mainly occurring in hospital); 22 were serious and preventable, 12 of them from a failure or a complication of an indicated operation.

We know that there are a number of potential shortcomings in our study. Nevertheless, the survey confirm what kind of useful information about substandard medical care we can gather also from this type of documentation. With no patient lawyer or representative (4) present in the hospital, and with claim management firmly controlled by the medical experts, who wishes to complain will be more motivated if the management of the claims was supported by an independent Agency to ensure objectivity before the disputes, taking on responsibility for reporting the incident to the interested organization and for feed-back to the citizen. But, in my opinion, the Italian voluntary Patients Agencies have a very weak voice.

Roberto Natangelo
Retired Physician
Cittadinanzattiva (Active Citizenship. Via Mecenate n. 25. 20138 Milan. Italy)
e-mail: roberto.natangelo @ libero.it

References

1. – Bismark MM, Brennan TA, Paterson RJ, Davis PB, Studdert DM. Relationship between complaints and quality of care in New Zealand: a descriptive analysis of complainants and non-complainants following adverse events. Qual Saf Health Care 2006;15:17-22.

2. – Convegno: “La comunicazione pubblica in sanità” (Meeting: Public communication in health service) Associazione Stampa Medica Italiana. Atti interventi. Roma 6-10 maggio 2002.

3. - Wilson RM , Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The quality in Australian Health Care Study. Med J Aust 1995;153:458- 471.

4. - Entwistle VA, Andrew JE, Emslie MJ, Walker KA, Dorrian C, Angus VC, Conniff AO. Public opinion on systems for feeding back views to the National Health Service. Qual Saf Health Care 2003;12:435-442.