"My Own Anger Propelled Me" - Observations driven by a study of patients complaints to a NHS hospital in London
IV. Understanding the Complete Picture
- My Own Anger Propelled Me
- How Much Money Would Be Saved?
- Complainant Expectations and Avoiding Escalation
- Understanding the Complete Picture
Beyond Satisfaction - Other measures of the result
So what about satisfaction? We in fact think that the satisfaction rating in the context of the escalated complaint is not in itself a particularly informative indicator of what is going on. The output from a survey of this sort has to be action - and I do not mean ritual disembowelment of the complaint manager. More positively, managers need to have data (it may need supplementing) that will lead to process or attitudinal improvements to the work of the hospital or the complaint office itself. Secondly they need a measure or as I will argue a group of measures to see if improvements in the system have worked.
So we use a set of measures looking at 'confidence' and 'readiness to recommend' to complement the single satisfaction question. We also like to know about the impact of this experience as reflected in the complainant's conversations about it to others - the word of mouth phenomenon.
Almost half of the people we surveyed will tell between 6 and 15 people about their experience. Most reported that their confidence in the hospital had gone down. The experience had not raised the confidence of any complainant. It dissatisfied almost two thirds of the complainants and a minority were taking it further. Others while not satisfied, were letting the matter drop quoting reasons such as
"I did not take the matter any further as i waited weeks and weeks for a reply and when it came it was full of medical jargon"
The 20% level of satisfaction with the response that we recorded, while not unexpected since we are dealing with a formal escalated process, is still disappointing. However it must be seen against another finding - that whatever the low level of satisfaction and the drop in confidence in the institution, well over half of the sample surveyed would recommend others to take their complaint to the hospital. Part of this of course is because they have no choice - if they do want complain, there is no one else to take it to. Another clue may lie in what we discussed at the beginning of the article - the sheer emotional charge that led to the complaint in the first place. The complainant will tell others not to be put off by the system but to have their say.
Understanding the Complete Picture
Escalated complaint processes are usually marked low for satisfaction. This may depress managers but more importantly, put them off doing more surveys. They are not masochists - why do a survey when you know people are pissed off? The solution to this is to get data that tells the story of all users - the satisfied and the dissatisfied.
When trying to understand how well an organisation is dealing with its customers, we need to have information on all of them, namely
- % of users who had no problems with their experience of the hospital
- % of users with problems who did not mention them to anyone
- % of users who mentioned a problem to someone and were satisfied
- % of users who mentioned a problem and were dissatisfied but did not escalate it beyond the front line
In addition, a survey of all staff involved in complaints to compare is very informative and one way to use the data is to contrast the two views - internal and external (i.e. the complainant) - of the system. A workshop on closing that perception gap is always a lively debate and switches the emphasis from contemplating problems which appear intractable to deepening understanding and focussing on solutions.
This holistic approach moves the emphasis from the performance of one small part of the system - where the problem has been congealed and frozen into the shape of a formal complaint - to a fuller understanding of what happens to the individual.
At this point, we have an approach which can be demonstrated as essential management information where there are no victims and villains but only winners.
The M-A-C Call for Action
We say - don't be scared of dissatisfaction research. Look behind the 'satisfaction/ dissatisfaction' measure at the full range of problems that may spark dissatisfaction as well the whole process and all the people potentially involved. Discover the smaller wins that will over time change attitudes and address the hardy annuals. This learning is not punitive but restorative both to staff and patient alike. Understanding the emotions on both sides of the house will help avoid burn-out and increase co-operation and participation amongst all. In this way we can begin to work with those general criteria mentioned by the Ombudsman - openness and learning: monitoring and performance - well connected with clinical governance and quality improvement activity.
Tell us of any surveys you have done – were the results useful? What improvements did they inspire? ( in confidence of course)
The M-A-C Offer
We will design, field and analyse/report a similar survey for you.
We can field a self-completion survey of complainants who have had their complaints considered formally by the complaints department for £10,000 excluding the costs of print and postage and VAT. If you want to add in a survey of those who have contacted your PALS department with a query or problem - something we very much recommend for reasons we state in the article - we will do both for £15,000.
These surveys will be considered as hard evidence backing up any assurances given to the Healthcare Commission in the relevant areas such as:
C14a - "Healthcare organisations have systems in place to ensure that patients, their relatives and carers have suitable and accessible information about, and clear access to, procedures to register formal complaints and feedback on the quality of services"
C14b - "Healthcare organisations have systems in place to ensure that patients, their relatives and carers are not discriminated against when complaints are made"
C14c - "Healthcare organisations have systems in place to ensure that patients, their relatives and carers are assured that organisations act appropriately on any concerns and, where appropriate, make changes to ensure improvement sin service delivery"
Such a survey also will feed into the NHS Litigation Authority assessment framework.
Contact Colin Adamson for all enquiries.
EARLY BIRD OFFER - sign up and save
Start work with us on a survey before December 15th 2005 and you will qualify for a special price of £9,000 for the complaints survey alone and £13,500 for the combined survey.