"My Own Anger Propelled Me" - Observations driven by a study of patients' complaints to a NHS hospital in London
II. How Much Money Would be Saved?
- My Own Anger Propelled Me
- How Much Money Would Be Saved?
- Complainant Expectations and Avoiding Escalation
- Understanding the Complete Picture
We were only asked by our client to gather complainant data so there was nothing on this in our survey. So we will construct an estimate.
The Health Services Ombudsman had in 2004/5 a case load of 2478 health service-related cases which cost £11,229,000 to handle - we will call this a cost per case of £4500.
That is of course just for starters. We do not know what Trusts spend (the Trust we worked with has no figures) for handling the case up to three times - once at the front line when the problem was first mentioned, the escalated complaints unit in the Trust, then again in that same unit when questions arrive from the Ombudsman. Actually make that up to 4 times because the Healthcare Commission is currently sending back 27% of cases because they feel more could be done at local level.
If we say charitably enough the Trusts' costs per case are half those of the Ombudsman and that the first opportunity to handle is costed as zero being part of the general costs of care, then the Trust may spend up to almost £7000. This is a low end costing.
How does £20,000+ per case grab you?
If the Trusts' costs are actually the same as the Ombudsman's (they could easily be higher in a fully escalated and investigated case involving the time of many senior clinicians and managers including the Chief Executive as opposed to the managed costs of an Ombudsman case team), then their cost to handle might be £13500 for a three time go around. Add back the Ombudsman cost and we are getting a cost per case of £18,000. Would you like to make that more? Easy - add in the costs of the Healthcare Commission and we are over £20,000 per case.
£1,000,000 Saved
Stop 50 cases @£20K going to the full process all the way to the Ombudsman and on this estimate, we have saved £1 million pounds of public money.
Any advance on that? Let us get back to the actual research.
Angry and Sad
Our second conclusion echoes the quote that forms the title of this piece. The health service does not recognise that complainants are driven by emotion. Another quote will give the flavour
"I sincerely hope that no member of my family or friends is ever admitted to this hospital). Your negligence killed my mother- and to have to watch for 3 months just how shoddy your hospital is run has opened my eyes to a world that I never thought existed. Disgraceful- is what I think ..."
The NHS complaint process is an adversarial, investigation-based, inquisitorial process that seeks to establish 'facts'. In doing so, it disguises and hides the emotional aspects by throwing the fire blanket of process over the blaze of feeling. This may dampen feelings down - it rarely extinguishes them; rather banks them up - so making things more comfortable for the managers and clinicians involved - the dispassionate path of process can reassure those whose conduct and judgements are being challenged. They feel safer if the process looks even-handed and 'fair'.
Excluded and Invisible
To the complainant of course, whose feelings are being ignored and tidied away in the interests of process, this looks like indifference, condescension or at worst total exclusion from an approach which is then seen as favouring the insiders. The dispassionate process disarms the consumer whose major weapon is emotion. The NHS is not of course alone in creating a process like this - organisations everywhere manage the emotions and feelings of their customers. The worst do this by ignoring them. More enlightened ones at least recognise and respond to the feelings.
Burnout?
Unrecognised emotional conflict burns out customer complaint managers - being the fire blanket involves stifling not just their customers' emotions but their own as well. If they get as worked up about service failure and poor quality as their customers, lips are pursed and careers ended - 'going native' in the customer cause is the ultimate sin - not very 'professional'. So much for all those management tomes and CEO pronouncements about passion for the customer - demonstrate it and you are seen as demented.
But things do change and improve as a result of complaints. The shame is that the complainant never gets to hear about this. Achievements are buried away in the hospital's monthly quality report. One example of an actual internal report will suffice to make this point.
"All A&E doctors are to receive training in response to new guidelines for patients presenting with back pain. Physiotherapists will also work alongside doctors in A&E. As a result of a complaint received in Urology, there is more flexibility in allowing relatives to interpret and translate for patients. One investigation in maternity highlighted a need to review the way care is provided to women who are admitted with intrauterine death and particularly, a designated area for women who are having a stillbirth"
Continued: Complainant Expectations and Avoiding Escalation