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Introduction: eCTAS is a real time electronic triage decision-support tool designed to improve patient safety and quality of care by standardizing the application of the Canadian Triage and Acuity Scale (CTAS). The tool dynamically calculates a recommended CTAS score based on the presenting complaint, vital signs and selected clinical modifiers. The primary objective was to assess consistency of CTAS score distributions across 35 emergency departments (EDs) by 16 presenting complaints pre and post eCTAS implementation. Methods: This retrospective cohort study used population-based administrative data from January 2016 to December 2018 from all hospital EDs in Ontario that had implemented eCTAS with at least 9 months of data. Following a 3-month stabilization period, we compared data for 6 months post-eCTAS implementation to the same 6-month period the previous year (pre-implementation) to account for potential seasonal variation, patient volume and case-mix. We included triage encounters of adult (≥18 years) patients if they had one of 16 pre-specified high-volume, presenting complaints. A paired-samples t-test was used to determine consistency by estimating the absolute difference in CTAS distribution for each presenting complaint, by each hospital, pre and post eCTAS implementation, compared to the overall average of the 35 EDs. Results: There were 183,231 triage encounters in the pre-eCTAS cohort and 179,983 in the post-eCTAS cohort from 35 EDs across the province. Triage scores were more consistent with the overall average after eCTAS implementation in 6 (37.5%) presenting complaints: chest pain (cardiac features) (p < 0.001), extremity weakness/symptoms of cerebrovascular accident (p < 0.001), fever (p < 0.001), shortness of breath (p < 0.001), syncope (p = 0.02), and hyperglycemia (p = 0.03). Triage consistency was similar pre and post eCTAS implementation for the presenting complaints of altered level of consciousness, anxiety/situational crisis, confusion, depression/suicidal/deliberate self-harm, general weakness, head injury, palpitations, seizure, substance misuse/intoxication or vertigo. Conclusion: A standardized, electronic approach to performing triage assessments increased consistency in CTAS scores across many, but not all, high-volume CEDIS complaints. This does not reflect triage accuracy, as there are no known benchmarks for triage accuracy. Improvements in consistency were greatest for sentinel presenting complaints with a minimum allowable CTAS score.

Extant service recovery research treats apology as a dichotomy, in that it is either present or absent, but how it is conveyed is neglected. Based upon social psychological research, this study argues that an apology comprises three different components: empathy, intensity, and timing, which make each apology unique. It is shown that how well an apology is delivered across failure types (outcome vs. process) drives service recovery satisfaction, not its mere presence. Empathy, intensity, and timing separately impact satisfaction. The more empathic and intense the apology is given, the more satisfied respondents are. A late apology decreases satisfaction ratings. Effect sizes indicate that empathy has the strongest impact on service recovery satisfaction followed by intensity and timing. The effect of empathy is stronger for process failures than for outcome failures. Interestingly, the apology's overall effect size is comparable to that of compensation in case of a process failure.

Background: Laparoscopic cholecystectomy remains one of the procedures most commonly performed by general surgeons in Canada. Significant complications after cholecystectomy are rare but can have devastating consequences on the patient, surgeon, and healthcare system. This is especially true for common bile duct injuries (BDIs). This study aimed to provide a 20-year review and examination of trends in Canadian medicolegal data related to postcholecystectomy complaints. Methods: This was a 20-year retrospective review of the Canadian Medical Protective Association's (CMPA) repository of medicolegal cases involving cholecystectomy-related complaints between 2003 and 2022. Cases included all those in which the physician contacted the CMPA for assistance, including civil legal actions, medical regulatory complaints, and hospital complaints. Data analysis was limited to descriptive statistics using SAS software. Results: A total of 488 cases were closed, with initial events occurring from 1991 to 2021. There was a trend of decreasing complaints during the study period (p = 0.0004), with the majority of patients identifying as female (66%) and being generally healthy (ASA grade I/II 73.6%). The top 5 complications leading to complaint initiation were BDI (35.9%), leak (15.2%), bowel injury (12.7%), sepsis (10.9%), and hemorrhage (10.2%). A total of 555 physicians were involved, with 484 operating surgeons named in complaints. Most surgeons (70%) had been in practice for 11 years or more. The mean time from incident to case closure was 63.2 + 42.3 months. Cases of BDI were significantly more likely to result in a favourable medicolegal outcome for the patient (77%) compared to all cholecystectomy cases (54%). Conclusion: This study demonstrated that the majority of postcholecystectomy complaints involved generally healthy female patients. Unsurprisingly, BDI was the most common complication resulting in a complaint, and these cases were more likely to result in a successful claim for the patient. Surgeons later in practice were more likely to be named in a complaint than their colleagues early in practice.

Firms are increasingly turning to social media platforms for complaint handling. Previous research and practitioners' reports highlight the benefits of complaint handling on social media, urging firms to provide prompt and detailed responses to complaints. However, little research has explored the possible drawbacks of such practices, especially when responses inadvertently further publicize complaints. Utilizing two unique data sets in a series of observational and quasiexperimental analyses, this research provides the first evidence of \"complaint publicization\" in social media, a phenomenon in which firm responses to complaints on popular social media platforms increase the potential public exposure of complaints. This negative effect can outweigh any positive customer care–signaling impact from firm responses. The authors show that a response strategy that engenders a high level of complaint publicization (e.g., providing detailed responses through multiple communication exchanges with a complainant) could negatively impact perceived quality and firm value, diminish the positive impact of a firm's own posts, and increase the volume of future complaints. Additional analyses reveal that these adverse impacts are stronger for firms that are targeted by retail investors. The authors also uncover specific response strategies and styles that could mitigate these effects.

Despite substantial benefits of an effective complaint management for companies, there is ample evidence that many firms do not handle customer complaints appropriately. This paper aims at providing a theoretical explanation for this surprising phenomenon. Drawing on psychological and organizational theory, the authors introduce the concept of defensive organizational behavior towards customer complaints as well as provide a rich conceptualization and operationalization of this phenomenon. Moreover, in an empirical study, they systematically analyze how defensive organizational behavior towards customer complaints is driven by organizational antecedents and, based on a dyadic data set, how it affects customer post-complaint reactions.[PUBLICATION ABSTRACT]

This research examines complaint calls in the public healthcare setting to address claims that some service users have been dissatisfied with Trusts' handling of complaints. Rather than apply a traditional social scientific method, this research takes an interactional approach to analyse real recordings of initial telephone encounters between complainants and call handlers. This has permitted a detailed examination of the interactional structures of complaints handling calls, displaying systematic features and recurrent phases of activities across the dataset. This empirical study is based on a collection of telephone recordings gathered at Health and Social Care Trusts throughout Northern Ireland, amounting to over four and a half hours of naturally occurring data. Each recording was meticulously transcribed and analysed using an inductive method known as Conversation Analysis (CA) which takes as its core concerns, sequence, and action. Using the CA toolkit, the data reveal some valuable insights into complaining in institutional talk and show how the norms and values of the institution emerge in and through the talk as systematic features. The findings from this research provide unique and detailed understandings of how the complaints handling call progresses. Beginning with call handler methods for eliciting the complaint to the complainant's production of the experience as a narrative account, through to institutional business where a distinctive syntactic offer format emerges as the call handler orients to problem-solving. In examining how talk is formulated in this domain, it will be possible to produce outcomes that provide linguistically informed contributions to Trusts for future call handler training. Overall, this work contributes to knowledge by providing original research on an interactional environment on which little was previously known. Furthermore, it will provide a basis on which to build future research in this distinctive institutional setting.