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Is There a Mismatch Between the Perspectives of Patients and Regulators on Healthcare Quality? A Survey Study

Bouwman, Renée, PhD*; Bomhoff, Manja, PhD*; Robben, Paul, MD, PhD†‡; Friele, Roland, PhD

doi: 10.1097/PTS.0000000000000413
Original Article: PDF Only

Objectives Internationally, healthcare quality regulators are criticized for failing to respond to patients' complaints. Patient involvement is, therefore, an important item on the policy agenda. However, it can be argued that there is a discrepancy between the patients' perspective and current regulatory approaches.

This study examines whether a discrepancy exists between the perspectives of patients and regulators on healthcare quality.

Methods A questionnaire was sent to 996 people who had registered a complaint with the Dutch Healthcare Inspectorate to measure expectations of and experiences with the Inspectorate. A taxonomy was used to classify their complaints into the clinical, relationship, or management domains.

Results The response was 54%. More complaints about clinical issues (56%, P = 0.000) were investigated by the regulator than complaints about organizational (37%) and relational issues (51%). Patients with complaints about management issues less often indicated (13%, P = 0.002) that healthcare is improved by making their complaint than patients with complaints about clinical or relationship issues did (22%–23%). Patients who reported about relational issues with care providers attached more importance to issuing sanctions against the care provider than other patients (mean score 2.89 versus 2.62–2.68, P = 0.006).

Conclusions The predominant clinical approach taken by regulators does not match the patients' perspective of what is relevant for healthcare quality. In addition, patients seem to be more tolerant of what they perceive to be clinical or management errors than of perceived relational deficiencies in care providers. If regulators want to give patients a voice, they should expand their horizon beyond the medical framework.

From the *NIVEL, Netherlands Institute for Health Services Research; †Dutch Healthcare Inspectorate, Utrecht; and ‡Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam; and §TRANZO (Scientific Centre for Care and Welfare), Faculty of Social and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands.

Correspondence: Renée Bouwman, PhD, NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, Netherlands (e-mail:

The author discloses no conflict of interest.

This work was supported by ZonMw, the Netherlands Organization for Health Research and Development, Program Effective Regulation Grant Number 516001003.

R.B. participated in the design of the study and questionnaire, analyzed and interpreted the data, and drafted the article. M.B. and R.F. also participated in the design of the study. All authors helped draft the article. All authors critically revised and approved the article.

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