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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:

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:

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.