Article Text

Original research
How do National Health Service (NHS) organisations respond to patient concerns? A qualitative interview study of the Patient Advice and Liaison Service (PALS)
  1. Keegan Shepard,
  2. Ruta Buivydaite,
  3. Charles Vincent
  1. Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Ruta Buivydaite; ruta.buivydaite{at}


Objectives To describe the current work of the Patient Advice and Liaison Service (PALS) and assess the service’s potential to resolve concerns and contribute to organisational learning.

Design A qualitative study using semistructured interviews.

Setting Four mental health trusts and four acute trusts in the English National Health Service, a total of eight PALS across different trusts.

Participants Twenty-four participants comprising of PALS staff and clinicians working with PALS teams.

Methods Semistructured interviews were undertaken with participants using video conferencing software. The framework method was used for the analysis of the large qualitative dataset, which is a conventional method of analysis, similar to thematic or qualitative content analysis.

Results PALS teams fulfil their core responsibilities by acting as point of contact for patients, providing information and resolving a variety of recurrent problems, including PALS staff communication, staff attitudes and waiting times. The remit and responsibilities of each PALS has often broadened over time. Barriers to resolving concerns included a lack of awareness of PALS, limited to no policies informing how staff resolve concerns, an emphasis on complaints and the attitude of clinical staff. Senior management had widely differing views on how the PALS should operate and the management of complaints is a much higher priority. Few PALS teams carried out any analysis of the data or shared data within their organisations.

Conclusions PALS teams fulfil their core responsibilities by acting as point of contact for patients, providing information and resolving concerns. PALS staff also act as navigators of services, mediators between families and staff and, occasionally, patient advocates in supporting them to raise concerns. PALS has the potential to reduce complaints, increase patient satisfaction and provide rapid organisational feedback. Achieving this potential will require more awareness and support within organisations together with updated national policy guidance.

  • health & safety
  • risk management
  • health policy

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • Contributors KS and CV conceived the service evaluation and all authors contributed to its design. KS carried out all of the data collection. RB and KS carried analysis, while CV extensively supervised and provided support during the process. KS and RB drafted the manuscript and all of the authors reviewed and agreed on the current version.CV is acting as guarantor of this study

  • Funding This study was funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Quality, Safety and Outcomes Policy Research Unit, PR-PRU-1217-20702. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.