Does feeling respected influence return to work? Cross-sectional study on sick-listed patients' experiences of encounters with social insurance office staff.

BACKGROUND: Previous research shows that how patients perceive encounters with healthcare staff may affect their health and self-estimated ability to return to work. The aim of the present study was to explore long-term sick-listed patients' encounters with social insurance office staff and the impact of these encounters on self-estimated ability to return to work. METHODS: A random sample of long-term sick-listed patients (n = 10,042) received a questionnaire containing questions about their experiences of positive and negative encounters and item lists specifying such experiences. Respondents were also asked whether the encounters made them feel respected or wronged and how they estimated the effect of these encounters on their ability to return to work. Statistical analysis was conducted using 95% confidence intervals (CI) for proportions, and attributable risk (AR) with 95% CI. RESULTS: The response rate was 58%. Encounter items strongly associated with feeling respected were, among others: listened to me, believed me, and answered my questions. Encounter items strongly associated with feeling wronged were, among others: did not believe me, doubted my condition, and questioned my motivation to work. Positive encounters facilitated patients' self-estimated ability to return to work [26.9% (CI: 22.1-31.7)]. This effect was significantly increased if the patients also felt respected [49.3% (CI: 47.5-51.1)]. Negative encounters impeded self-estimated ability to return to work [29.1% (CI: 24.6-33.6)]; when also feeling wronged return to work was significantly further impeded [51.3% (CI: 47.1-55.5)]. CONCLUSIONS: Long-term sick-listed patients find that their self-reported ability to return to work is affected by positive and negative encounters with social insurance office staff. This effect is further enhanced by feeling respected or wronged, respectively.

Duelling with doctors, restoring honour and avoiding shame? A cross-sectional study of sick-listed patients' experiences of negative healthcare encounters with special reference to feeling wronged and shame.

AIMS: The aim of this study was to examine if it is plausible to interpret the appearance of shame in a Swedish healthcare setting as a reaction to having one's honour wronged. METHODS: Using a questionnaire, we studied answers from a sample of long-term sick-listed patients who had experienced negative encounters (n=1628) and of these 64% also felt wronged. We used feeling wronged to examine emotional reactions such as feeling ashamed and made the assumption that feeling shame could be associated with having one's honour wronged. In statistical analyses relative risks (RRs) were computed, adjusting for age, sex, disease-labelling, educational levels, as well as their 95% CI. RESULTS: Approximately half of those who had been wronged stated that they also felt shame and of those who felt shame, 93% (CI 91 to 95) felt that they had been wronged. The RR was 4.5 (CI 3.0 to 6.8) for shame when wronged. This can be compared with the other emotional reactions where the RRs were between 1.1 (CI 0.9 to 1.3)-1.4 (CI 1.2 to 1.7). We found no association between country of birth and feeling shame after having experienced negative encounters. CONCLUSIONS: We found that the RR of feeling shame when wronged was significantly higher compared with other feelings. Along with theoretical considerations, and the specific types of negative encounters associated with shame, the results indicate that our research hypothesis might be plausible. We think that the results deserve to be used as point of departure for future research.

When do patients feel wronged? Empirical study of sick-listed patients' experiences with healthcare encounters.

BACKGROUND: The way in which patients experience encounters with healthcare professionals seems to affect care outcome, but very little is known about reactions evoked by experiences of negative encounters. AIMS: To examine how patients perceive healthcare encounters, with a special focus on negative encounters and feeling wronged. METHODS: A questionnaire was sent to 10,042 long-term sickness absentees (response rate 58%). Attributable risk (AR) with 95% confidence intervals (CIs) was calculated regarding relations between experiences of different types of negative encounters with healthcare staff and of feeling wronged. To test the consistency of our results, we also analysed the AR for positive experiences and feeling respected. RESULTS: Of 5802 participants, 1628 reported having experienced negative encounters, and 1036 of them also reported having felt wronged. The types of negative encounters with the highest AR for feeling wronged were 'nonchalant behaviour': AR 71.1 (95% CI 66.3-75.8) and 'treated me with disrespect': AR 54.8 (95% CI 49.8-59.8). Males in general tended to have higher ARs for feeling wronged than females, as had respondents with psychiatric diagnoses in comparison to other patients. CONCLUSION: The present study indicates high ARs of feeling wronged among long-term sickness absentees if exposed to negative encounters in healthcare. Nonchalance and disrespect were the most important factors in this regard, but the different types of negative encounters were very much intertwined. Feeling wronged seems to be an outcome based on several experiences of negative encounters, either in a series of events or bundled together in a single event.

The tip of an iceberg? A cross-sectional study of the general public's experiences of reporting healthcare complaints in Stockholm, Sweden.

Objectives To investigate the hypothesis that complaints of adverse events related to encounters with healthcare personnel are underreported and to identify barriers to filing such complaints. Design A cross-sectional study, where a questionnaire was sent to the respondents asking whether or not they have filed complaints of adverse events. Respondents were also asked whether they have had reasons for doing so but abstained, and if so their reasons for not complaining. The authors also asked about participants' general experience of and trust in healthcare. Setting The County of Stockholm, Sweden. Participants A random sample of 1500 individuals of the general population registered by the Swedish National Tax Board as living in the County of Stockholm in April 2008. Of the selected group, aged 18-99 years, 50% were women and 50% men. Response rate was 62.1%, of which 58% were women and 42% were men; the median age was 49 years. Primary and secondary outcome measures Primary outcome measures were whether the participants have filed a formal complaint with the Patients' Advisory Committee and whether they have had reason to file a complaint but have refrained from doing so. Secondary outcome measures were the participants' general experience of and trust in healthcare. Results Official complaints have been filed by 23 respondents (2.7%, 95% CI 1.7% to 3.7%), while 159 (18.5%, 95% CI 15.9% to 21.1%) stated that they have had legitimate reasons to file a complaint but have abstained (p<0.001). The degree of under-reporting was greater among patients with a general negative experience of healthcare (37.3%, 95% CI 31.9% to 42.7%) compared with those with a general positive experience (4.8%, 95% CI 2.4% to 7.2%). The reasons given for abstaining were, among others, 'I did not have the strength', 'I did not know where to turn' and 'It makes no difference anyway'. Respondents with a general negative experience also had lower trust in healthcare. Conclusions The authors found a considerable discrepancy between the actual complaint rate and the number of respondents stating that they have had reasons to complain but have abstained. This indicates that in official reports of complaints, the authors only see 'the tip of an iceberg'.

Respectful encounters and return to work: empirical study of long-term sick-listed patients' experiences of Swedish healthcare.

Aims To study long-term sick-listed patients' self-estimated ability to return to work after experiences of healthcare encounters that made them feel either respected or wronged. Methods A cross-sectional and questionnaire-based survey was used to study a sample of long-term sick-listed patients (n=5802 respondents). The survey included questions about positive and negative encounters as well as reactions to these encounters, such as 'feeling respected' and 'feeling wronged'. The questionnaire also included questions about the effects of these encounters on the patients' ability to return to work. Results Among patients who had experienced positive encounters, those who also felt respected (n=3327) demonstrated significantly improved self-estimated ability to return to work compared to those who did not feel respected (n=79) (62% (95% CI 60% to 64%) vs 34% (95% CI 28% to 40%)). Among patients with experiences of negative encounters, those who in addition felt wronged (n=993) claimed to be significantly more impeded from returning to work compared to those who did not feel wronged (n=410) (50% (95% CI 47% to 53%) vs 31% (95% CI 27% to 35%)). Conclusions The study indicates that positive encounters in healthcare combined with feeling respected significantly facilitate sickness absentees' self-estimated ability to return to work, while negative encounters combined with feeling wronged significantly impair it.

How are homeless people treated in the healthcare system and other societal institutions? Study of their experiences and trust.

AIMS: To elucidate the perceived treatment that the homeless have received from the healthcare and other societal organisations and to present homeless persons' trust in the healthcare system and suggestions of necessary changes for improving it. METHODS: Homeless individuals in special houses and institutions in the County of Stockholm were asked to answer a short version of a public health survey, including added questions about how they experienced the healthcare providers' attitudes towards them and how much trust they had in the healthcare system. A total of 155 homeless persons (123 male and 32 female) were interviewed. RESULTS: Three-quarters of the participants stated that they had fairly or very high trust in healthcare services and also felt that they had been fairly or very well treated. Fewer females than males reported being treated well and they declared a lower degree of trust in the healthcare system. The homeless suggest that extra resources be set aside to organise their healthcare, including a higher level of knowledge of the medical problems prevailing in the group. Those who felt badly treated also asked for less neglect and disrespect from the healthcare staff. CONCLUSIONS: Even though a majority experience that they are being well treated within the healthcare system, the study also indicated disadvantages in the treatment of homeless persons in Sweden. The study also reveals an imbalance between the official ethical framework in Sweden and of the specific moral of some individual healthcare providers. One way to facilitate their entry into the healthcare system might be to create special surgeries for the homeless.