"My Own Anger Propelled Me" - Observations driven by a study of patients' complaints to a NHS hospital in London
III. Complainant Expectations and Avoiding Escalation
- My Own Anger Propelled Me
- How Much Money Would Be Saved?
- Complainant Expectations and Avoiding Escalation
- Understanding the Complete Picture
Complainant Expectations
We recommended that complainants be told. Involve them in the solution - do not just characterise them as being part of the problem. When things improve, dish out the praise to all involved including the users, patients and carers. 45% of the complainants surveyed recorded themselves as being 'very dissatisfied' with the aspect of the final letter that 'described how things would be improved'. Yet all the guidelines about complaint handling acknowledge as a complainant motivation, the wish to avoid others having to go through the poor experience. Complainants who have seen a leaflet or listened to the news have been 'trained' to expect this as an output and they do not see it.
The users' eye view
Their observations and inputs can be acute and detailed
"in this year (2005) you have had the following continuing problems. your disabled toilet facilities for outpatient are excellent but those for inpatients are largely of an unacceptable standard. There are still not bath (bathing) facilities for disabled inpatients. 50% of the inpatient toilet/bathrooms are of poor standard + some frankly unhygienic. The refurbished ones are lovely. in February your kitchen ran out of kosher food. Your healthcare assistants do not care enough about whether a patient is fed; can eat unaided; can open food package; have fresh water or other fluids if recommended by dr. There are shortages of pillows. linen comes back from laundry with old dressings and excrement still on it."
So it is disappointing when a complainant writes
"Although promises were made that care and services would improve directly resulting from our complaint there has been no follow-up and no way of my knowing whether the promises made were in fact put in place. Since my complaint, another incident of neglect was experienced by another member of my family. However a complaint was not made because we felt it would not make any difference at all. I would avoid using (this hospital) in future."
The complaint system has to plug into the quality improvement system and the positive results of this have to be made clear to all. Customer quotes and anecdotes are very useful to dramatise and sharpen the statistics.
This is a recipe for action that leads us away from the cynicism that says that the causes of complaints are known and will never change. The hardy annuals driving complaints in this hospital were the same as everywhere else "medical care; nursing care; staff attitude and communication with the patient" (hospital complaint report). Some of this is clinical stuff and our survey steered well clear of exploring this. We were interested in process and only needed to know about these clinical matters in the context of what prompted the complaint.
Identifying the Wins
However behind those big broad headings lie lots of little actions that may have contributed to failure. If people complained about 'hospital appointments staff gave wrong information', what is going on here? What is happening to make those people who said they had a problem with 'getting sent home too early?' What is the connection of this problem to those who mentioned 'arrangements for leaving hospital were poorly handled'. There is a lot to unpack, define and act upon.
Good Letter - Poor Outcome
Hearing about what has happened as a result of the complaint will help to reassure the complainant. Of course the news will often come some time after the complaint. What may help more at the time is to make the actual process of complaint investigation more visible to the complainant. What happens after a complaint is escalated to the complaints department and is taken into the formal system is invisible and unknown to the complainant. Even if the quality of the letter is acknowledged as high - "prompt and clear", it may not be enough to retrieve the situation
"Although the response to my letter of complaint was prompt and clear and also apologetic about the substandard care I received, my confidence (in the hospital) remains much lower than it was prior to the incident that led to my complaint. I suppose that I am not certain that another patient might not experience similarly poor care despite the assurances given in the response letter. However I cannot really fault this final letter."
At the time of the survey, the complaints department was called the complaints and legal services department. As one user commented
"In addition I find it very annoying that when you ring the complaints + legal services department (couldn't the dealing of complaints have a more user friendly title or separate the two titles it comes across as very intimidating + believe me I'm not easily intimidated)! You're told quite curtly to write a letter. What if you have difficulty writing for various reasons. Surely complainants could be facilitated to use other means . P.S. The food .. is still in my opinion absolutely despicable - when is going to be better?"
Rich and detailed communications
The PS gives the authentic flavour of the complainant communication - the sheer generosity and variety of its insights, veering from corporate nomenclature to the nature of the complaints process and then straight on to the quality of food. It is a reminder of the richness of this seam as well as the difficulties in analysing and transposing this information which never arrives in neatly packaged bytes of data.
Early Solutions and Avoiding Escalation
We have discussed the costs of escalation and the survey showed up an aspect of complainants' behaviour that offers a chance to avoid the escalated complaint. The survey shows that there are many opportunities to intervene and discuss matters at the front line. When asked whether they had talked to anyone about their most serious problem before coming to the Complaints Department, over three quarters said they had. A few had gone to sources outside the hospital such as a solicitor or the Minister of Health and their MP but for the most part, they went to someone in the hospital. The hospital has a chance of pulling the complainant back from the formal procedure. Most of the people who answered this question said they had contacted someone at least twice and a few, up to three times. How can these opportunities be better used?
Early Complainant Connection
Even if that opportunity is missed and a complaint is subsequently received by the complaints office, we recommended an early meeting which would give the respective parties an opportunity to voice and to hear the feelings and connect with the experience and the person bringing the complaint - relative, carer, patient. This 'complainant connection' meeting would reveal and explain process, would manage expectation and might even resolve the issue. By contrast, the meeting offered at the end of the process may appear to the complainant as an over-whelming, quasi-judicial environment where a verdict is pronounced.
Continued: Understanding the Complete Picture