Managing complaints effectively

Doctors have expressed serious concerns about facing an increase in patient complaints following decisions they are making in good faith during these unprecedented times. Ms Diane Baylis, Clinical Risk Educator at Medical Protection, discusses how to handle complaints efficiently and learn from them

Doctors have been and continue to work in uniquely challenging circumstances during the Covid-19 pandemic – they are treating patients with what is still a new disease and making difficult clinical and triaging decisions.

Public support for doctors, and others working in healthcare, has been overwhelming, but it could be anticipated that the ‘goodwill’ and understanding that has been shown to the doctors over the last six months may become depleted.

In this context, there is a risk of patient dissatisfaction, and increased demands placed upon frontline healthcare workers. For some doctors, this may already be the case.

Handling an influx of complaints

A crucial part of a doctor’s job is working effectively with patients after they experience disappointment about their medical care and feel that they need to make a complaint. So, having a formal complaints procedure in the practice or hospital will help to effectively manage and respond to a complaint.

And of course, a doctor’s ethical responsibilities with respect to open disclosure and duty of candour must not be forgotten. Every complaint should be an opportunity to resolve patient dissatisfaction, learn from mistakes and improve services for patients. This will in turn not only
reduce risk but will also safeguard a doctor’s reputation.

It is also key to ensure that all staff know where to locate the complaints procedure and have undergone training

Imagine this scenario: It’s a typical busy Monday morning at a practice and the doctor has just finished the morning surgery. The doctor opens the post and, reading one letter, their heart sinks. The letter is from the Medical Council and reads:

Dear Dr Murphy
I am writing to inform you that the Medical Council has received a complaint against you.
Enclosed with the Medical Council letter is a photocopy of the patient’s
written complaint stating he had been kept waiting for 45 mins for his appointment with you, you didn’t apologise and then didn’t give him antibiotics for his sore throat. The consultation cost him €60 and he was unhappy with the service he received in return.

Ideally, everyone involved in a complaint like this should try to nip it in the bud earlier and deal with it ‘in-house’, to avoid the need for the Medical Council to become involved.

Complaints to the Medical Council about doctors are typically related to communication or systems issues, for example failure to actively listen, perceived lack of care, poor communication of diagnosis, tests and results. Other issues include perceived failure to diagnose or refer for a specialist opinion, medication issues, repeat prescriptions, breaches of confidentiality and improper examinations.

Various studies in several countries to understand what outcome patients are seeking from their complaint, have concluded that patients are trying to achieve similar outcomes.1 The vast majority wanted the doctor to realise what they had done wrong and wanted an explanation of why the incident had occurred. Interestingly, only a very small number of patients said that they wanted financial compensation.

Patients can either complain to their friends or relatives, or they can contact the HSE, but they often contact the Medical Council directly. Ideally, they should make a complaint directly to the practice or hospital as this would give the opportunity to discuss the issue with the patient and defuse the situation.

Encouraging feedback

Patients should be encouraged to give feedback, so doctors and the wider team know when they have done something well, and when they did not get things quite right.

An in-house complaints procedure is important in obtaining patient feedback, both positive and negative. While we may not wish to receive negative feedback, it can highlight areas of concern, and mean that any issues are addressed early. It can also enable patients’ concerns to be dealt with quickly and effectively, which may reduce the possibility of a Medical Council complaint or clinical negligence claim.

Firstly, it is important to ensure that practices and hospitals have a written complaints policy that all staff are familiar with. Details that should be included in the written complaints policy are:

• Key contact
Identify who is the responsible person for managing complaints. In a practice for example this may be a senior GP partner or the practice manager.

• Timeframe
On receiving a complaint it is important to acknowledge this with the patient. It would be ideal to acknowledge receipt of the complaint within three working days.

• Response time
It is also important to advise the complainant when they will receive a full response. Any acknowledgement with the patient should include a commitment to investigating what has gone wrong.

• Response
When handling and investigating the complaint, it is important to establish what actually happened; how did it come to happen; and what can be learned from the event to reduce the chances of it happening again. Investigations should be undertaken in a timely manner so as not to escalate the situation.

It is also important to apologise and acknowledge the distress that the situation has caused, no matter how difficult it may be. In some instances, the reason for not apologising is the fear of litigation but, in reality, an appropriately worded apology is not an acceptance of liability. Ensure that in the response to the patient, it details a summary of the main issues and the action plan.

Giving clear responses to each issue raised will provide the patient with a full understanding of what has happened. It may be appropriate to invite the patient to meet and to discuss their complaint further, noting that this may currently be via phone or video call.

The wider team should be familiar with the complaints procedure as all too often they may be the person to whom the patient complains in the first instance. It is also key to ensure that all staff know where to locate the complaints procedure and have undergone training.

It is also important that patients are informed how to complain or give feedback. This can be communicated via the practice or hospital website, leaflets or by displaying a poster in the reception/waiting areas.

And, of course, it is good practice to ensure that all complaints are kept confidential and recorded clearly and accurately, but stored separately from the patient’s medical record.

For further expert advice, it is advisable to contact Medical Protection, or your medical defence organisation, when a patient complaint is received. Medical Protection members can find more information on this topic by visiting our online learning platform www.prism.medical.org.

References

1. Bismark et al. Accountability sought by patients following adverse events from medical care: the New Zealand experience. CMAJ. 2006 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586070/