Developing the right mindset to manage complaints

Dr Michael Devlin, Head of Professional Standards and Liaison, Medical Defence Union, provides advice on how to respond to complaints during the Covid-19 pandemic.

With the second anniversary of the pandemic now looming, the effort of battling Covid-19 continues to
exert a relentless toll on hospital staff and their patients. The impact of the pandemic on waiting times has been particularly significant, according to the latest Health in Ireland Key Trends report from the Department of
Health. It stated: “As of October 2021, there were 28,383 adults waiting six months or more for an elective procedure, an increase of over 25 per cent on March 2020.”

And in December, the IHCA warned that there were 897,153 people on waiting lists to be treated or assessed by a consultant, an increase of 58,478 people (7 per cent) since the start of 2021. Such delays are hugely frustrating for doctors who are unable to provide the optimum level of care and for patients facing a long wait to see a specialist about a chronic health condition or worrying symptoms. As a result, it’s important to consider how to communicate with patients about waiting times, delayed treatment or a delayed diagnosis and how best to handle complaints that may arise.

Based on the Medical Defence Union’s experience of advising members, here are our suggestions to help you to minimise matters from escalating.

Pre-empt problems with good communication

Many complaints arise because patients feel they haven’t received care in a way they expected or within an expected timescale. Clear and honest communication at the outset is therefore key to managing expectations and pre-empting problems, as well as underpinning patient care, according to Medical Council guidelines. Ensure patients appreciate the potential timescale for test results or referral appointments – be realistic rather than over-promise. Give them a clear plan of what to do should their condition not improve or worsen; or if they do not hear from another service within a certain timeframe.

Bear in mind that anxious patients may not take in everything you say so check their understanding and ask if they have any questions during a consultation, rather than as they are going out the door. This will give you an opportunity to identify and clarify any misunderstandings before they become a cause for dissatisfaction.

Prioritise record-keeping

Longer waiting times make it more likely that patients will present to another member of the team if symptoms do not resolve or their condition worsens. Effective record-keeping should help your colleagues ensure continuity of care so patients do not feel they are starting all over again and help reduce the risk of things slipping through the net.

After each patient interaction, document what has taken place, including relevant findings on examination (including what you looked for, but didn’t find), tests, the safety netting advice given, details of any referral made, and any discussion relating to advice given or obtaining consent. In the event of a complaint, clear records, which are made at the time, can also be invaluable in understanding what happened and in responding to concerns.

Approach complaints in good faith

It’s natural to feel dispirited when receiving a complaint, especially if the circumstances are beyond your control. However, research shows that patients’ motivations are often straightforward – such as the need for answers about their care and the desire to prevent someone else having the same experience. If someone is critical of the care they have received, your response could make the difference between resolving the matter quickly and seeing it escalate. By understanding and addressing the cause of dissatisfaction, you have a better chance of resolving the complaint at an early stage. Reacting defensively is likely to make matters worse.

Recognise and respond quickly to concerns where possible

Any patient can say they are not happy with the service they receive, but at what point should this trigger an organisation’s complaints procedure? The simplest approach is to ask the patient. If frontline staff are trained to respond to all expressions of unhappiness with an apology and questions (such as “How has this affected you?” and “What can I do to put this right?”), many verbal complaints may be dealt with quickly and informally.

While this may not always be possible, it is clearly better to try and settle complaints at an early stage by responding professionally to the concerns raised by the patient. The HSE’s complaints handling policy calls this approach ‘point of contact resolution’ and requires it to be completed within two working days. The HSE says staff should “provide an apology/explanation where possible and avoid apportioning blame, being argumentative or defensive”. If you are unable to deal with the issue, you will need to escalate it to your line manager, while reassuring the complainant that their complaint has been “listened to, understood, and [outlining] how this complaint will be handled beyond this point”.

Cooperate with your organisation’s complaints officer

If a complaint is made in writing it will fall to your organisation’s complaints officer to contact the complainant within two working days with an offer to meet with them, along with the clinical director or another senior member of staff. If the matter is resolved, a letter summarising what happened is sent to the complainant and the doctors involved may be sent a summary of the concerns raised.

When a complaint is not settled after a meeting, or if the complainant declines this offer, a formal complaint investigation begins and you may be asked to help your organisation put together a full written response. It is important to respond promptly as organisations are expected to issue a full response to the complainant within 30 working days or, if this is not possible, to update the complainant every 20 days regarding progress.

Although many complaints should be resolved either at the point of contact or after a written response, some may proceed to either an HSE internal complaint review or an external, independent review (eg, by the Ombudsman). Complaints that escalate in this way may signal an increased risk that the matter could be reported to the Medical Council. Therefore, it is important to seek advice at an early stage from your medical defence organisation if you are involved in an escalating complaint.

Getting a complaint response right first time is the best way to settle patients’ concerns and to reduce the risk that a complaint will escalate. Set aside adequate time and discuss the concerns raised with other team members, seeking advice if required. If you have been asked for an account of your clinical care, this should be a factual, chronological statement written with close reference to the clinical records and any relevant guidelines you followed. It is perfectly reasonable to refer to your recollection of events or your usual practice, even if not detailed specifically in the records, if this helps you to explain what you did and why.

Be sure to address all the questions that relate to your involvement. Even when the concerns don’t match your own recollection or if you believe a complaint has no merit, acknowledging the patient’s experience shows empathy and can help heal the doctor-patient relationship. Equally, it can be helpful to show that you have reflected on the issues raised in a complaint, including the learning points you have identified and addressed and how you will change your practice as a result. As mentioned earlier, complainants often want to know that something has changed and evidence of reflective practice, in line with Medical Council guidance, is one method of doing this.

Apologies are not an admission of liability

To maximise the chance of resolving the complaint, the hospital’s response is likely to be conciliatory in tone and perhaps include an apology. Contrary to the fears of many doctors, this should not be seen as an admission of wrongdoing, but recognition that things could have been done differently, even in cases where the overall
care was reasonable.

Seek advice

Finally, being involved in complaints is upsetting for patients and colleagues alike. Seek support from your peers or your medical defence organisation if you are facing a complaint – don’t try to go it alone.

MDU membership is open to consultants and hospital doctors not currently in training posts working in public hospitals. To find out more information, visit www.themdu.com/ireland or follow us on Twitter @the_md