Parte inicial
5.5.2 Primera Unidad: Encuéntrame
The aim of this part of the study was to gain understanding of the causes and
situations that give rise to patients’ complaints, through interviews with key personnel within the organisations that handle complaints.
6.2 Methods
The methodology chosen was to undertake face-to-face, individual interviews with those key individuals in the regulatory body and the insurers who deal directly with the patient and/or osteopath involved in a complaint. These individuals communicate directly with and advise the parties to a complaint, record the details of the case, and take appropriate action. Their direct involvement, in an intermediary role, over a number of years means that they have observed the narrative, the emotions, and the course of many complaints, and have synthesised in their own minds an understanding of how and why complaints come about.
The relevant intermediary person(s) in each organisation were identified and invited to participate in an interview. In addition, we invited the member of staff at the professional association (British Osteopathic Association) who often provides first line advice to osteopaths. They were sent the letter of invitation, Information Sheet, and Consent Form as attached in Appendix 8.
Semi-structured interviews were conducted using the interview Question Schedule in Appendix 8. They were conducted in a quiet room within the interviewee’s work- place. The interviewer asked the Intermediary in turn about the typical course of types of complaints, grouped as shown in the left hand column of Table 3.1 in Chapter 3, and covered complaints at all levels of severity, from those that do not progress, to those that involve court proceedings and claims for compensation. Questions
explored views, events and emotions around what causes the patient to instigate that type of complaint, how the osteopath typically reacts at each stage, and what actions or reactions cause escalation or resolution. The question schedule was piloted with a member of staff prior to use. Interviews were digitally recorded.
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In order to minimise the risk of identities of individual parties to a complaint being identified, interviewees were asked not to mention individual cases or identities but to try to give an overview of the course of different types of complaint.
For the analysis, the recordings of the interviews were transcribed verbatim, in full, by an independent transcriber. The results were not reported as narrative, in order to minimise this risk that the narrative might suggest to any patient that the story was their own. A thematic analysis was conducted, interpreting the text and seeking to summarise, generalise and draw out themes (Braun and Clarke 2006). The analysis was conducted mainly by AF, with independent validation from JL on one interview and an experienced researcher within the research centre (Dr V. Cross) on another. An iterative approach was adopted, developing a conceptual framework from reading and re-reading the transcripts. Each script was then coded individually using the themes identified, and the main themes from each transcript identified so that
differences could be highlighted. Reflexive notes by the interviewer were used to add insight to the interviewee stand-points and to make interviewer bias explicit.
Participant feedback was used to validate the trustworthiness of the results.
6.3 Results
Face-to face interviews were conducted with participants from GOsC, BOA, and three staff from the providers of indemnity insurance. These personnel were highly
experienced, all having dealt with complaints for seven years or more. The interviewees are identified in the text and tables of verbatim quotes using codes to show whether they came from the staff at GOsC (R1), BOA (P1), or the professional indemnity insurers (coded as I1, I2, and I3 respectively). All interviews were
conducted by the same interviewer (AF). The researchers interpreted and summarised the participants’ views as objectively as possible. The researchers’ views and biases were recorded, and are described in the Discussion section later in the chapter.
Most of the themes that emerged in the analysis were common across all interviewees and we considered that saturation was reached in identification of themes. There were some differences in viewpoint between the interviewees, discussed in a later section. The themes that emerged are shown in the small boxes in Figure 6.1; these were grouped into larger concepts, shown in the larger boxes. The full conceptual
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framework that emerged from the data is shown in Figure 6.1, and represents the interviewees’ combined views of how complaints arise. The four large boxes
represent the highest level concepts in our framework, and the smaller boxes show the themes that contribute to each concept. The four concepts also convey the narrative of the complaint over time. The event that is voiced by the patient as a complaint – called here the Trigger – is actually the second point on the time-line of the
complaint. Prior to the trigger event, there will have been one or more Underpinning Factors, antecedents to the complaint that may be present from the outset of the therapeutic encounter. Once the Trigger event has occurred, there are two sets of factors that determine the manner in which the complaint progresses. The patient will explicitly or implicitly have in mind a Desired Outcome they want to achieve. Then there are a number of Resolution Factors that determine the likelihood of complaints being formalised and progressed or alternatively coming to a speedy or satisfactory resolution.
In the following pages, the conceptual model is presented graphically in Figure 6.1, and then a textual commentary is given for each of the concepts and the themes within them, together with illustrative verbatim quotes. The text attempts to faithfully
describe the participants’ views that emerged at interview, and not the researchers’ opinions on these views.
63 Figure 6.1 The thematic framework emerging from the interviews