Understanding Patient Experience Through Narrative Complaint Analysis: A Mixed Methods Study in a Rural Academic Health System

Patient Experience (PX) is recognized as an independent dimension in assessing healthcare quality and is associated with the quality domain of patient-centeredness. A better understanding of PX can help clinical providers enhance care, guide further research, and inform quality improvement and policies. Our study aims to identify, classify, and prioritize patients’ complaints and grievances at a rural health care system to inform strategic improvement planning. We conducted standard inductive qualitative thematic analysis and quantitative Pareto analyses of narrative comments received from patients and families via phone calls, emails, or standard letters at the four settings under study (one major academic medical center and three smaller ambulatory care centers) from January 2021 to April 2022. Our analysis of a total of 3,257 patients’ feedback on their care experience identified five themes and 23 sub-themes with 4,747 code counts. We found that the top three complaints from patients and their families were lack of response or communication from office staff; not being treated with respect causing adverse feelings; and patients not receiving right or proper treatment and care. Additionally, patients faced issues with timely scheduling of appointments and referrals, as well as not being provided complete information or explanations throughout their care journey. This study provides an approach for understanding the factors that impact patient experience in the health system we studied. This work prompted subsequent strategic initiatives to redesign Patient Relations processes and empower front line service recovery at two of the largest hospitals in the health system.