Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association

Responses by hospital complaints managers to recommendations for systemic reforms by health complaints commissions

Jennifer Smith-Merry A D , Merrilyn Walton B , Judith Healy C and Coletta Hobbs B
+ Author Affiliations
- Author Affiliations

A Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.

B School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building, NSW 2006, Australia. Email:;

C School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, ACT 0200, Australia. Email:

D Corresponding author. Email:

Australian Health Review -
Submitted: 29 July 2016  Accepted: 30 August 2016   Published online: 21 October 2016


Objective This paper explores how hospital complaints managers react to recommendations for systemic quality reforms by health complaints commissions in response to complaints by patients in Queensland and New South Wales.

Methods Semi-structured qualitative interviews were conducted with complaints managers in 17 hospitals. Interview transcripts were then thematically analysed and data on responses to health complaint commissions was organised in relation to Valerie Braithwaite’s typology of motivational postures.

Results Respondents supported involvement by an independent authority where patients had serious complaints about the services they received in hospital, but wanted more negotiation with commissions on service improvement recommendations.

Conclusions Hospital complaints managers mostly responded as virtuous or rational actors to the symbolic power of complaints commissions. This may be context dependent because Australian health commissions operate within a pro-reform context as a result of recent publicity around health system failures.

What is known about the topic? Little is known about regulatory relationships between complaints commissions and hospitals. There has been no Australian research considering how complaints managers respond to commission recommendations for quality improvements and reforms to hospital services.

What does the paper add? The paper uses a novel theoretical framework based on regulatory theory to understand and describe the reactions of complaints managers to commission recommendations.

What are the implications for practitioners? Commissions should seek commentary from complaints managers through open dialogue before making final recommendations. This will ease the progress of reforms and make recommendations more acceptable and ‘genuine’ in the specific context of the hospital.

Additional keywords: health ombudsman, patient grievances, quality regulation.


[1]  Braithwaite J, Makkai T, Braithwaite V. Regulating aged care: ritualism and the new pyramid. Cheltenham, MA: Edward Elgar; 2007.

[2]  Braithwaite V. Defiance and motivational postures. In: Weisburd D, Bruinsma G, editors. Encyclopedia of criminology and criminal justice. New York: Springer Science+Business Media; 2014. pp. 915–24.

[3]  Gray G, Silbey S. The other side of the compliance relationship. In: Parker C, Nielsen V, editors. Explaining compliance: business responses to regulation. Cheltenham, MA: Edward Elgar; 2011. pp. 123–38.

[4]  Healy J. Improving health care safety and quality: reluctant regulators. Aldershot: Ashgate; 2011.

[5]  Beaupert F, Carney T, Chiarella M, Satchell C, Walton M, Bennett B, Kelly P. Regulating healthcare complaints: a literature review. Int J Health Care Qual Assur 2014; 27 505–18.
Regulating healthcare complaints: a literature review.CrossRef | 25115053PubMed |

[6]  Taylor DMcD, Wolfe RS, Cameron PA. Analysis of complaints lodged by patients attending Victorian hospitals, 1997–2001. Med J Aust 2004; 181 31–5.

[7]  National Health Performance Authority. 6.2 – Initial indicators for hospitals and local hospital networks. Canberra: National Health Performance Authority; 2012. Available at: [verified 21 May 2015].

[8]  Walton M, Smith-Merry J, Healy J, McDonald F. Health complaint commissions in Australia: time for a national approach to data collection. Aust Rev Public Affairs 2012; 11 1–18.

[9]  Dugdale P, Healy J. The Australian health care system, 2014. In: Mossialos E, Wenzl M, Osborn R, Anderson C, editors. International profiles of health care systems, 2014. New York: The Commonwealth Fund; 2015. pp.11–20.

[10]  Thomas D. Medicine called to account: health care complaints mechanisms in Australasia. Sydney: University of New South Wales; 2002.

[11]  Healy J, Walton M. Health ombudsmen in polycentric regulatory fields: England, New Zealand and Australia. Aust J Public Adm 2016;
Health ombudsmen in polycentric regulatory fields: England, New Zealand and Australia.CrossRef |

[12]  Australian Council for Safety and Quality in Health Care (ACSQHC). Better practice guidelines on complaints management for health care services. Canberra: ACSQHC; 2004. Available at: [verified 21 May 2015].

[13]  Harrison R, Walton M, Healy J, Smith-Merry J, Hobbs C. Patient complaints about hospital services: applying a complaint taxonomy to analyse and respond to complaints. Int J Quality Health Care 2016; 28 240–45.

[14]  Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 77–101.
Using thematic analysis in psychology.CrossRef |

[15]  Northern Sydney Local Health District. Have your say. 2016. Available at: [verified 18 August 2016].

[16]  Runciman B, Merry A, Walton M. Safety and ethics in healthcare: a guide to getting it right. Aldershot: Ashgate; 2007.

[17]  Taitz J, Genn K, Brooks V, Ross D, Ryan K, Shumack B, Burrell T, Kennedy P. System-wide learning from root cause analysis: a report from the New South Wales Root Cause Analysis Review Committee. Qual Saf Health Care 2010; 19 e63
| 20671073PubMed |

[18]  Ayres I, Braithwaite J. Responsive regulation: transcending the regulation debate. Oxford: Oxford University Press; 1992.

[19]  Sparrow M. The regulatory craft: controlling risks, solving problems and managing compliance. Washington, DC: The Brookings Institution; 2000.

[20]  Braithwaite J. Leading from behind with plural regulation. In: Healy J, Dugdale P, editors. Patient safety first: responsive regulation in health care. Sydney: Allen & Unwin; 2009. pp. 24–43.

[21]  Adler-Nissen R. Symbolic power in European diplomacy: the struggle between national foreign services and the EU’s External Action Service. Rev Int Stud 2014; 40 657–81.
Symbolic power in European diplomacy: the struggle between national foreign services and the EU’s External Action Service.CrossRef |

[22]  Barnett M, Finnemore M. The politics, power, and pathologies of international organizations. Int Organ 1999; 53 699–732.
The politics, power, and pathologies of international organizations.CrossRef |

[23]  Hurd I. Legitimacy, power and the symbolic life of the UN Security Council. Glob Gov 2002; 8 35–51.

[24]  Sutton C. The doctors who love playing ‘God’ and are accused of killing or maiming their patients.; 2013. Available at: [verified 15 June 2016].

Export Citation