{
  "abstract": "Background Complaints are frequently viewed through a service-management lens, yet they offer rich population-level insight into trust, communication, and cultural expectations of healthcare. This study by the Scottish Ambulance Service explored what ‘attitude and behaviour’ complaints reveal about the relationship between patients and emergency care systems, and how such information can be used as a form of qualitative public-health data.Methods A qualitative descriptive design was used.Sample: 100 anonymised complaints received between January 2023 and June 2025 that were coded under ‘attitude and behaviour.’Data extraction: Complaint narratives were de-identified and imported into NVivo 14 for analysis.Analytic approach: Inductive thematic analysis was undertaken following Braun & Clarke’s six-phase model, guided by NHS Scotland’s Learning from Feedback and Duty of Candour frameworks. Each complaint was double-coded for tone, context, trigger event, and emotional sentiment.Validation: Themes were reviewed with a small working group of patient representatives, staff educators, and governance leads to ensure interpretive reliability and relevance.Synthesis: Findings were mapped against broader public-health constructs—trust, perceived fairness, and communication equity—to interpret implications for health-service engagement.Results Three cross-cutting themes emerged: (1) Perceived empathy gaps during high-pressure interactions; (2) Expectation mismatch between desired reassurance and operational limitations; and (3) Role misunderstanding, where patients misinterpreted clinical triage or non-conveyance decisions. These insights highlight how emotional and informational disconnects shape perceptions of respect and trust.Conclusion Complaint narratives constitute an under-recognised dataset for understanding public sentiment and health-system legitimacy. Treating them as qualitative population-health indicators can inform targeted communication campaigns, empathy training, and community education—strengthening both trust and equity within emergency and unscheduled care systems.",
  "authors": [
    {
      "affiliations": [
        "Patient Experience, Scottish Ambulance Service, Edinburgh, UK"
      ],
      "name": "Marie Kennedy"
    },
    {
      "affiliations": [
        "Patient Involvement, Scottish Ambulance Service, Edinburgh, UK"
      ],
      "name": "Chris Purnell"
    }
  ],
  "title": "P16-4 Listening as data: using complaint analysis to understand public trust and health service experience",
  "uid": "9d228808-2fd2-5c9f-aee5-a9b4e58d4fc8"
}