# Complaint Category and Subcategory Structure Examination

## Overview

This document provides a detailed examination of the 4-level SHCT (Saudi Health Council for Treatment) taxonomy implemented for the complaint system. The taxonomy is organized hierarchically with 4 levels: Domain, Category, Subcategory, and Classification.

## Summary Statistics

- **Total Categories**: 106
- **Level 1 (Domains)**: 3
- **Level 2 (Categories)**: 9
- **Level 3 (Subcategories)**: 42
- **Level 4 (Classifications)**: 52

## Taxonomy Structure

### LEVEL 1 - DOMAINS (3)

#### 1. CLINICAL
**Parent Domain**: Clinical domain covers all clinical-related complaints

**Level 2 Categories**:
- Quality
- Safety

---

#### 2. MANAGEMENT
**Parent Domain**: Management domain covers administrative, operational, and institutional issues

**Level 2 Categories**:
- Accessibility
- Institutional Issues

---

#### 3. RELATIONSHIPS
**Parent Domain**: Relationships domain covers communication, privacy, consent, and behavioral issues

**Level 2 Categories**:
- Communication
- Confidentiality
- Consent
- Humanness / Caring

---

## Detailed Breakdown

### 1. CLINICAL DOMAIN

#### 1.1 QUALITY CATEGORY

**Subcategories** (Level 3):
- **Diagnosis**
  - Errors in Pre-marriage lab test
  - Errors in diagnosis
  - Errors in diagnostic imaging
  - Errors in lab results

- **Examination**
  - Diagnostic Imaging not performed
  - Examination not performed
  - Inadequate/incomplete assessment
  - Lab tests not performed
  - Loss of a patient sample
  - Not having enough knowledge regarding patient condition

- **Patient Journey**
  - Lack of follow up
  - Miscoordination
  - Patient flow issues

- **Quality of Care**
  - Insensitive to patient needs
  - No Frequent rounding on patient
  - No assistance from staff in feeding a patient
  - Rough treatment
  - Rushed, not time to see patients
  - Substandard clinical/nursing care

- **Treatment**
  - Inadequate pain management
  - Ineffective treatment
  - Patient Discharged before completing treatment
  - Treatment plan issues
  - Treatment plan not followed

#### 1.2 SAFETY CATEGORY

**Subcategories** (Level 3):
- **Medication & Vaccination**
  - Dispensing errors
  - Dispensing medication without prescription
  - Insufficient medication prescribed
  - Medication shortages
  - No medication prescribed
  - Prescribing errors
  - Prescription of expired medication
  - Refusal to vaccinate
  - Vaccination timing errors

- **Safety Incidents**
  - Equipment failure/malfunction
  - Hospital acquired infection
  - No patient ID band
  - Patient Fall
  - Patient death
  - Wrong surgery / Wrong site surgery
  - Wrong treatment

- **Skills and Conduct**
  - Improper practice of infection control
  - Poor hand-hygiene
  - Practice without a clinical license

---

### 2. MANAGEMENT DOMAIN

#### 2.1 ACCESSIBILITY CATEGORY

**Subcategories** (Level 3):
- **Access**
  - Appointment cancellation
  - Appointment scheduling refusal
  - Scheduling far appointment

- **Delays**
  - Delayed test result
  - Examination delay in emergency
  - Treatment delay

#### 2.2 INSTITUTIONAL ISSUES CATEGORY

**Subcategories** (Level 3):
- **Administrative Policies**
  - Inadequate reception service
  - Non-compliance with visiting hours
  - Paperwork delays

- **Environment**
  - Building not accessible for special needs
  - Elevators not available/Failure
  - Heating, Ventilation, Air condition (HVAC) Failure
  - Poor cleanliness/sanitizing

- **Finance and Billing**
  - Miscalculation
  - Pricing variations
  - Unnecessary health services

- **Resources**
  - Medical supply shortage
  - Unavailable Beds
  - Unavailable ambulance

- **Safety & Security**
  - Fire and safety hazards
  - Lack of parking slots
  - Theft and lost

---

### 3. RELATIONSHIPS DOMAIN

#### 3.1 COMMUNICATION CATEGORY

**Subcategories** (Level 3):
- **Patient-staff communication**
  - Communication of wrong information
  - Failure to clarify patient case to family
  - Miscommunication with Patient

#### 3.2 CONFIDENTIALITY CATEGORY

**Subcategories** (Level 3):
- **Privacy**
  - Breach of confidentiality
  - Breach of patient privacy

#### 3.3 CONSENT CATEGORY

**Subcategories** (Level 3):
- **Consent Process**
  - Consent not explained
  - No/Invalid consent obtained

#### 3.4 HUMANNESS / CARING CATEGORY

**Subcategories** (Level 3):
- **Assault and Harassment**
  - Discrimination
  - Inappropriate/aggressive behavior

- **Emotional Support**
  - Inadequate emotional support

---

## Implementation Details

### Database Schema

The taxonomy is implemented in the `ComplaintCategory` model with the following key fields:

- `id`: UUID primary key
- `level`: Integer (1-4) indicating hierarchy level
- `parent_id`: UUID foreign key to parent category
- `name_en`: English name
- `name_ar`: Arabic name
- `code`: Alphanumeric code (for levels 3 and 4)
- `domain_type`: Type of domain (CLINICAL, MANAGEMENT, RELATIONSHIPS)
- `description_en`: English description
- `description_ar`: Arabic description
- `is_active`: Boolean flag
- `hospitals`: Many-to-many relationship with hospitals

### Data Loading

The taxonomy data is loaded using the management command:
```bash
python manage.py load_shct_taxonomy
```

This loads the standardized SHCT taxonomy from a data file into the database.

### API Endpoint

Categories are loaded via the `api_load_categories` endpoint which returns:
- All 4 levels of the hierarchy
- Parent-child relationships via `parent_id`
- Level information for proper categorization
- Bilingual names (English/Arabic)
- Descriptions for user guidance

### Frontend Implementation

The public complaint form uses cascading dropdowns:
1. **Hospital** selection triggers category loading
2. **Domain** (Level 1) - 3 options
3. **Category** (Level 2) - filtered by selected domain
4. **Subcategory** (Level 3) - filtered by selected category (required)
5. **Classification** (Level 4) - filtered by selected subcategory (optional)

Each level displays descriptions to help users understand the context and make informed selections.

---

## Key Observations

### 1. Domain Balance
- **CLINICAL**: 5 subcategories (Quality, Safety)
- **MANAGEMENT**: 2 subcategories (Accessibility, Institutional Issues)
- **RELATIONSHIPS**: 4 subcategories (Communication, Confidentiality, Consent, Humanness/Caring)

### 2. Code Distribution
- **Level 3 (Subcategories)**: Most have codes for identification
- **Level 4 (Classifications)**: All have codes for granular classification
- Codes follow snake_case naming convention (e.g., `errors_in_diagnosis`)

### 3. Hierarchical Depth
- Not all branches go to Level 4
- Some categories stop at Level 3 (e.g., most subcategories are leaf nodes)
- Level 4 classifications provide the most granular categorization

### 4. Coverage Areas
The taxonomy comprehensively covers:
- Clinical quality and safety
- Medication and treatment errors
- Administrative and operational issues
- Physical environment and resources
- Communication and interpersonal relationships
- Privacy and consent procedures
- Staff behavior and conduct

---

## Usage in Complaint System

When a complaint is submitted via the public form:

1. User selects **Hospital**
2. System loads applicable categories
3. User selects **Domain** (required)
4. User selects **Category** (required)
5. User selects **Subcategory** (required)
6. User may select **Classification** (optional)

The selected taxonomy levels are stored in the Complaint model:
- `domain`: ForeignKey to Level 1 category
- `category`: ForeignKey to Level 2 category
- `subcategory`: CharField storing the code of Level 3 category
- `classification`: CharField storing the code of Level 4 category

This structure allows for:
- **AI-powered classification**: The AI can analyze descriptions and suggest appropriate taxonomy levels
- **Trend analysis**: Aggregate complaints by domain, category, or subcategory
- **Reporting**: Generate reports at any level of granularity
- **Benchmarking**: Compare performance against SHCT standards

---

## Maintenance

The taxonomy should be updated when:
- SHCT releases new categories or codes
- Hospital-specific categories need to be added
- Existing categories are deprecated or modified
- Descriptions need improvement for user clarity

To reload the taxonomy:
```bash
python manage.py load_shct_taxonomy
```

---

## Conclusion

The implemented 4-level SHCT taxonomy provides a comprehensive, standardized framework for categorizing patient complaints across clinical, management, and relationship domains. The hierarchical structure enables both high-level trend analysis and granular classification for detailed investigation and process improvement.