Healthcare organisations' responses to concerns and complaints often fall short of the expectations of patients and staff who raise them, and substandard responses to concerns and complaints have been implicated in organisational failures. Informed by Habermas's systems theory, we offer new insights into the features of organisations' responses to concerns and complaints that give rise to these problems. We draw on a large qualitative dataset, comprising 88 predominantly narrative interviews with people raising and responding to concerns and complaints in six English NHS organisations. In common with past studies, many participants described frustrations with systems and processes that seemed ill-equipped to deal with concerns of the kinds they raised. Departing from existing analyses, we identify the influence of functional rationality, as conceptualised by Habermas, and embodied in procedures, pathways and scripts for response, in producing this dissatisfaction. Functionally rational processes were well equipped to deal with simple, readily categorised concerns and complaints. They were less well placed to respond adequately to concerns and complaints that were complex, cross-cutting, or irreducible to predetermined criteria for redress and resolution. Drawing on empirical examples and on Habermas's theory of communicative action, we offer suggestions for alternative and supplementary approaches to responding to concerns and complaints that might better address both the expectations of complainants and the improvement of services.

医疗机构对担忧和投诉的反应往往达不到提出这些问题的患者和工作人员的期望，对担忧和投诉的不合标准的反应与组织失败有关。在哈贝马斯的系统理论的指导下，我们对组织对引起这些问题的担忧和抱怨的反应特征提供了新的见解。我们利用了一个大型定性数据集，其中包括对六个英国 NHS 组织中提出和回应关切和投诉的人进行的 88 次主要叙述式访谈。与过去的研究一样，许多参与者描述了对系统和流程的挫败感，这些系统和流程似乎没有能力处理他们提出的类型的担忧。从现有的分析出发，我们确定了功能理性的影响，正如哈贝马斯所概念化的，并体现在反应的程序、途径和脚本中，在产生这种不满时。功能合理的流程能够很好地处理简单、易于分类的问题和投诉。他们不太适合对复杂的、跨领域的或无法简化为预定的补救和解决标准的关切和投诉作出充分回应。借鉴经验实例和哈贝马斯的交往行为理论，我们提供了一些替代和补充方法的建议，以应对可能更好地满足投诉者的期望和服务改进的关注和投诉。产生这种不满的途径和应对脚本。功能合理的流程能够很好地处理简单、易于分类的问题和投诉。他们不太适合对复杂的、跨领域的或无法简化为预定的补救和解决标准的关切和投诉作出充分回应。借鉴经验实例和哈贝马斯的交往行为理论，我们提供了一些替代和补充方法的建议，以应对可能更好地满足投诉者的期望和服务改进的关注和投诉。产生这种不满的途径和应对脚本。功能合理的流程能够很好地处理简单、易于分类的问题和投诉。他们不太适合对复杂的、跨领域的或无法简化为预定的补救和解决标准的关切和投诉作出充分回应。借鉴经验实例和哈贝马斯的交往行为理论，我们提供了一些替代和补充方法的建议，以应对可能更好地满足投诉者的期望和服务改进的关注和投诉。他们不太适合对复杂的、跨领域的或无法简化为预定的补救和解决标准的关切和投诉作出充分回应。借鉴经验实例和哈贝马斯的交往行为理论，我们提供了一些替代和补充方法的建议，以应对可能更好地满足投诉者的期望和服务改进的关注和投诉。他们不太适合对复杂的、跨领域的或无法简化为预定的补救和解决标准的关切和投诉作出充分回应。借鉴经验实例和哈贝马斯的交往行为理论，我们提供了一些替代和补充方法的建议，以应对可能更好地满足投诉者的期望和服务改进的关注和投诉。