If the principal rule of medicine is ‘first do no harm’, then when it comes to complaints the first rule must be ‘do not make things worse’. Dealing with complaints is rarely easy or pleasant, but there are some ways to avoid making a bad situation worse.
Here’s a five-step plan for improving the way you respond to patients’ criticism.
1 Expect complaints
The number of written complaints against GPs in England rose by 8.2% between 2010/11 and 2011/12. Complaints are becoming ever more common as GPs see more patients and take on more of the NHS’s work in primary care. That, and an increasingly consumerist society, make complaints inevitable. The Government even encourages people to complain.
Although few of us would go that far, it is true that we often learn most when things go wrong – regardless of whether a complaint follows. I have seen numerous patients over the years who I have expected to complain but did not. One doctor in my area, who was so highly regarded that he was known as ‘the GPs’ GP’, said in his retirement speech that he had been sued five times for things he had not done, but that no-one had ever noticed the things that had kept him awake at night.
Some patients can amaze us by being offended by something that may appear to us to be utterly trivial. But we can often benefit from seeing ourselves as others see us.
Complaints can be made through any avenue but those submitted via NHS Choices can be the most difficult as correspondents are often anonymous. Complaints should be written down by someone, even if it is only the receptionist who takes a complaining call by phone. A distinction should be made in your practice policy between ‘grumbles’, ‘helpful suggestions’ and formal complaints.
2 Answer each and every formal complaint and do so promptly
An acknowledgement should be sent promptly, perhaps within two working days. A substantial response should be given within 28 days and if this is not possible the patient should be told why – for instance, if the clinician concerned was on leave. Even a rapid acknowledgement with a promise to look into the matter properly might satisfy some people – but delays can exacerbate already bruised feelings. Remember to take advice but, as with motor insurance, saying that you are sorry that something apparently went badly is not the same as admitting you have done something wrong or admitting liability.
The three keys are acknowledgement of the complaint (its importance to the patient), explanation (of the practice’s account of what happened) and agreement if possible.
3 Involve all the staff concerned in the matter
There is no excuse for not discussing a complaint with the staff members involved, even though there might be a natural inclination to avoid worrying others or protect colleagues who are considered fragile. A complaint might bring to light patients’ unmet needs or a doctor’s educational needs.
I knew of one small practice years ago where almost every complaint or significant event involved only one of the doctors. This was a cause for acute embarrassment for the rest of the team who used to scratch around for something else – anything else – to discuss at practice meetings.
Similarly, if sessional doctors or locums are involved, they must be informed at once and asked for their side of the story. I have come across examples in my LMC work when doctors doing locum sessions have only discovered they were named in a complaint after it was settled. One salaried doctor came back from extended leave abroad to find the practice had essentially agreed with a complainant in her absence that she had acted negligently and had not waited to give her a chance to make a defence. In fact, her actions were entirely defensible, as the subsequent and avoidable performance review eventually revealed. Contacting the doctor is a fundamental matter of natural justice and courtesy. It also makes it more likely that the complainant will get a proper hearing.
4 Know when to stop
It is vital to follow due process. When you have acknowledged the complaint, looked into it, collated statements from all those involved, written to the patient offering at least sympathy for their dissatisfaction, arranged a meeting and given the opportunity for the patient to accept the practice’s explanation or apology or to take things further – stop.
Unfortunately some patients are enthused by the process and want it to run and run. A practice of my acquaintance got involved in a protracted game of email ping-pong, which went on for weeks. Sometimes four emails would arrive and each was answered. Then a few days would pass and all would sigh with relief, only for an all-too-familiar address to appear in the inbox on Monday morning. The LMC became involved and went through the same depressing process and we noticed that some of the messages were being sent in the small hours. Eventually the practice had to send a firm but fair message informing the complainant that no more correspondence would be entered into.
5 Reflect on lessons learned
The maxim that lessons should be learned from complaints is not always easy to observe. But reflection on any complaint, how it arose, how it was dealt with, how it made you feel and perhaps how it changed your practice is always valuable. It is also a vital part of a meaningful appraisal and revalidation. Even complaints from patients who are regularly critical of the practice can yield important information.
One of my appraisers told me once that she always thought getting the odd complaint was a good thing because it confirmed she wasn’t making many inappropriate antibiotic prescriptions.
Finally, remember that even the slickest complaints process can be a bruising experience for those involved and that we have a duty of care to our colleagues as well as to our patients.
If a staff member is upset by a complaint, it could be appropriate to discusss it in an appraisal, allow them time off or give them relevant training or CPD. But my experience is that most people primarily need to understand that getting a complaint does not mean you are a bad person. Equally, those who are blasé about getting a complaint often need to be counselled in another direction – the person making a complaint has a point of view too and their view should be acknowledged.
Dr Barry Moyse is chair of Somerset LMC and a GP in Taunton
Complaints policies: the basics
• Every practice must have a complaints manager, and one partner (the ‘Responsible Person’) must ensure compliance with regulations.
• When a complaint is made, either orally or in writing, if it cannot be dealt with in 24 hours it needs to go through a formal complaints process.
• Record the complaint, acknowledge it within three days, and set up a meeting with the person investigating. Ask about preferred outcomes, assess how realistic these are and set an action plan, including a date for review.
• After investigating, reply to the complainant and offer to meet them again if this is appropriate. If the complainant is unsatisfied, refer them to the Health Ombudsman.
• Keep a record for 10 years.
• It is no longer a statutory requirement to copy complaints to your PCT, though some trusts still recommend this.
Source: BMA, England only