Learning from complaints to the Health and Disability Commission Office: A case study into indicators of deterioration in aged residential care organisations in New Zealand

Abstract

Objective: To identify trends in complaints received by the Health and Disability Commissioner (HDC) about aged residential care (ARC) facilities in order to learn from and implement positive changes in care. Methods: A case study of 24 deidentified publicly available HDC cases across three large New Zealand ARC organisations was completed. Cross-case analysis first involved analysis of each case individually and then compared all cases using inductive thematic analysis with the intention of drawing a single set of conclusions. Results: The speed at which the events occurred was contributory to the complaint, with 58% of the cases being rapid in nature and with sepsis being the predominant contributing factor to rapid decline and death. Six main diagnoses were indicators of deterioration: nutrition/hydration was indicated in 22% of the cases, followed by sepsis 17%, wounds 17%, UTI/renal issues 15%, falls 15% and respiratory issues 15%. Conclusions: Trends in Health and Disability complaints across multiple organisations can become a powerful tool for widespread quality improvement. This review highlights that the speed of deterioration triggered many complaints, especially in cases of sepsis which is possibly overlooked as a contributing problem. Also, that nutrition/hydration was indicated in many complaints and is an important condition-indicator. Trends in complaints are not generalisable to all large organisations; however, they can be applied to individual facilities.