"My Own Anger Propelled Me" - Observations driven by a study of patients' complaints to a NHS hospital in London
- My Own Anger Propelled Me
- How Much Money Would Be Saved?
- Complainant Expectations and Avoiding Escalation
- Understanding the Complete Picture
"Anger propelled me" - these are the words of a complainant about a healthcare experience - her anger and emotion was shared by many who participated in a recent study of complainants at a London hospital. Bad experiences with the health service can create deep and lasting feelings and emotions which complainants then bring to a complaint handling system that does little or nothing to calm and address those feelings - just the opposite.
The Roots of Obsession
I have done lots of complaint handling surveys and have got used to reading and recording the views of angry and upset users. But what I read in the returned questionnaires moved and saddened me in a way that I had not expected - recollections of events that had happened in some cases over a year ago were still so sharp and painful in complainants' minds. Emotion drives persistence and determination - which in a minority shades into obsession - creating expense and disruption for NHS people whose energies and time could better be directed at their primary duty of care. Of course, they too have emotions and feelings. We must avoid complaints creating a toxic cocktail of disappointment and despair gulped down by complainant and health worker alike. The hangover is crippling and made worse by the gloomy prospect of a stern telling-off from teacher - the Ombudsman. Or even worse perhaps - having to do it all over again because the Healthcare Commission says so and it still goes to the Ombudsman.
Lots of Advice - Not Many Facts
A lot is written about NHS complaint handling. Much advice is given and guidance written. We plead guilty to having contributed to this process ourselves writing guidelines for the NHS in Wales and for the Healthcare Commission.
This abundance of advice is not matched by data on what actually happens at the front line. What emerges eventually into the public view comes from fully 'super-escalated' complaints that an Ombudsman has considered and decided.
The Ombudsman then adds to the volume of suggestion and recommendation. Ann Abraham has written about what she would want to see in her report 'Making Things Better?' (love the question mark) . Again here, the suggestions were visionary and broad identifying elements such as 'leadership, culture and governance' and 'customer focus, accessibility, flexibility and transparency'. The Ombudsman to be fair does go on to offer descriptions of what she means. For example:
Leadership, culture and governance
102. This will involve the Boards and Chief Executives of NHS bodies creating a
culture of openness and learning. There should be clear standards of behaviour set
and followed by the leadership of each local organisation, and the monitoring of performance
on complaints by managers and by the Board. Managers need to ensure that arrangements for complaint handling are
well connected with clinical governance and quality improvement activity.
How can we begin to translate these exhortatory generalisations into action on the ground without some closer understanding of what has to change to achieve these goals? Are there measures that will help to demonstrate that the goals have in fact been achieved? The survey we did demonstrates that such measures do exist and that they provide actionable data (going well beyond the simple and rather uninformative 'satisfaction' measure) that can form the basis for improved quality and satisfaction.
We have never seen or heard of what we would consider comparable studies about complaint handling at local hospital level. By 'good', we mean rather a piece of research that takes complainants back through the experience of having had a complaint and what it was that happened to them. How did they feel about that? How satisfied were they and would they say to their friends that it was worth complaining? Complainants have a very important role to play in improving the way problems are identified and sorted out.
Small Sample, Big Conclusions
One research study conducted by us for a Foundation Hospital Trust in London cannot answer all the questions. The data are based on a small sample of cases that had been managed by the complaints office in the previous 17 months. We make no claims that it is representative of all complainants who escalated their complaints in all hospitals and the small numbers means we must treat the data with caution. However we have been in the complaints business for a while and can with confidence draw some general conclusions that should help others even when those conclusions are based on only a few responses.
Our first conclusion is that the findings do help managers look beyond satisfaction and understand better the complainants' perception of other parts of the process. A low satisfaction rating is always depressing but if you can understand what parts of a process affect it and if changed, can push it up, there is a basis for action.
We need to know more about the origins of dissatisfaction and help avoid that expensive and prolonged process of the escalated and super-escalated complaint. If more problems were dealt with earlier and fewer escalated complaints generated, the money saved would be enormous and the satisfaction of users greatly increased. In our survey, 1 in 4 of the complainants said they were contemplating or actually had taken their case on.
Continued: How Much Money Would be Saved?