Dismissing the disgruntled: Swedish patient complaints management

Over the past decade the Swedish system for dealing with patient complaints has come under increasingly intense scrutiny from both healthcare providers and consumers. This article summarizes contemporary Swedish viewpoints on the debate by using sociological theory combined with anthropological field data. Its purpose is to prompt radical reappraisal of some attitudes underlying the current handling of patient complaints in Sweden and perhaps elsewhere.

The material presented here is partly a collation of literature and contemporary debate articles. A number of cases are explored including material taken from ongoing anthropological fieldwork among patients who are or have lodged complaints. Fieldwork was begun in May 2006 and consists of in-depth, semi-structured interviews, thus far with six patients, about their experiences lodging complaints. Contact with patients is ongoing as their stories continue to unfold. Interviews have also been conducted with representatives of patient support organizations and medico-legal specialists. The material is analyzed using recent sociological theory concerned with trust.

Patients who lodge complaints about their care are interested in achieving moral redress and trust restoration. The major authorities dealing with patient complaints in this case may, however, be mistrusted by those who have experience of them: practitioners and patients alike. In general, they seem to fail to fulfill patients' expectations of guaranteeing ethical standards within healthcare and they are felt to act as a disincentive to honest reporting of adverse incidents by practitioners.

This study is case specific and the particular findings are not readily generalizable to other countries. However, themes concerned with trust reparation that become evident pose questions about situations elsewhere that are analogous though not identical. Conclusions drawn are, therefore, intended not necessarily to be extrapolated but rather to provoke reflection about similar issues in other cases.

If practices and healthcare regulation structures are to become increasingly sensitive to patients' experience then it is essential that patients' stories and struggles are aired in those forums that influence decision makers' attitudes. This article attempts to bring patients' rights, expectations and perspectives to the fore in discussion about healthcare quality assurance.

By presenting patients as subject rather than object, the article intends to engage the reader in the patient's quest for moral reparation when trust is breached. The use of anthropological method helps give the perspectives or experience of those who are relatively disempowered their rightful place at the heart of discussions about healthcare quality.