‘It’s sometimes hard to tell what patients are playing at’: How healthcare professionals make sense of why patients and families complain about care

This article draws from sociological and socio-legal studies of dispute between patients and doctors to examine how healthcare professionals made sense of patients’ complaints about healthcare. We analyse 41 discursive interviews with professional healthcare staff working in eight different English National Health Service settings to explore how they made sense of events of complaint and of patients’ (including families’) motives for complaining. We find that for our interviewees, events of patients’ complaining about care were perceived as a breach in fundamental relationships involving patients’ trust or patients’ recognition of their work efforts. We find that interviewees rationalised patients’ motives for complaining in ways that marginalised the content of their concerns. Complaints were most often discussed as coming from patients who were inexpert, distressed or advantage-seeking; accordingly, care professionals hearing their concerns about care positioned themselves as informed decision-makers, empathic listeners or service gate-keepers. We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care. Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism exercised contemporary healthcare work.

Wavelet Analysis of the Pressure Fluctuations of Bottom Outlet of Kamal-Saleh Dam

Non-stationary signals are frequently encountered in a variety of engineering fields. The inability of conventional Fourier analysis to preserve the time dependence and describe the evolutionary spectral characteristics of non-stationary processes requires tools which allow time and frequency localization beyond customary Fourier analysis. The spectral analysis of non-stationary signals cannot describe the local transient features due to averaging over the duration of the signal [1]. The Fourier Transform (FT) and the short time Fourier transform (STFT) have been often used to measure transient phenomena. These techniques yield good information on the frequency content of the transient, but the time at which a particular disturbance in the signal occurred is lost [2, 3]. Wavelets are relatively new analysis tools that are widely being used in signal analysis. In wavelet analysis, the transients are decomposed into a series of wavelet components, each of which is a time-domain signal that covers a specific octave band of frequency. Wavelets do a very good job in detecting the time of the signal, but they give the frequency information in terms of frequency band regions or scales [4]. The main objective of this paper is to use the wavelet transform for analysis of the pressure fluctuations occurred in the bottom-outlet of Kamal-Saleh Dam. The “Kamalsaleh Dam” is located on the “Tire River” in Iran, near the Arak city. The Bottom Outlet of the dam is equipped with service gate and emergency gate. A hydraulic model test is conducted to investigate the dynamic behavior of the service gate of the outlet. The results of the calculations based on the wavelet transform is then compared with those obtained using the traditional Fast Fourier Transform.

Numerical and Experimental Investigation of Dynamic Characteristics of the Bottom Outlet of Vaniar Dam

Dynamic characteristics of the service gate of Vaniar Dam are studied in this paper. Feature of pressure fluctuations induced by turbulence on the skin plate at different local openings is investigated, which is the basic dynamic load acting on the gate. The Fast Fourier Transform (FFT) algorithm is used to convert a digital signal in the time-domain into a set of points in the frequency-domain. Finite Element Method (FEM) is also used to analyze the free vibration characteristics of the gate at different openings. The paper presents a numerical procedure based on the finite element discretization that treats vibration analysis of the service gate. The natural frequencies obtained by FEM are compared with the frequencies of pressure fluctuations measured in the hydraulic model test of the outlet to investigate the avoidance of resonance phenomena at the gates. The mode shapes of the gate are also presented.