From Volume 41, Issue 5, June 2014 | Pages 423-427
Patient complaints invariably cause concern and distress. Whilst prevention should be the primary objective, this is not always possible. This final article in the series describes strategies for the management and resolution of complaints, as well as the advantages of good complaint handling.
The number of dental complaints continues to rise1 despite some recent decrease in National Health Service (NHS) complaints.2 Prevention of complaints is always more desirable but cannot always be achieved. Efficient complaint resolution is therefore a necessity. Here are some reasons why:
However, in addition to the obvious need, and obligation, to resolve complaints efficiently, there are also some clear advantages.
The reaction of anybody to a complaint is unlikely to be a positive one. Dentists and their teams are no exception. The first response may well be emotional;4 a mixture of fear, anger, frustration and worry, as well as concerns that the complaint could progress elsewhere. The overall view is essentially negative.
However, good complaint handling can actually provide clear and definite advantages as follows:
To resolve a complaint effectively means firstly finding out what the patient wants. Only then can a response be made. It is often assumed that patients who suffer clinical problems or adverse outcomes form the majority of complainants. However, as mentioned in the first article of this series,5 for both medical and dental treatment non-clinical issues appear to be a major reason for patient dissatisfaction, with approximately 70% of litigation related to poor communication and adverse perceptions.6
This does not necessarily explain what the patients want to achieve by making their complaints. It is often assumed that financial compensation is the major motivation, but evidence,7 as also previously cited in this series, shows this not necessarily to be the case. The main reasons why patients complain are:
Having identified what patients want, the question is then – what needs to be done to resolve the complaint and how does one go about it? How much engagement with the patient is appropriate and necessary? There are really only three options:
Consider this as a five-step process:
The GDC considers that patients should have access to a complaints procedure,8 so it is important to make that system as effective as possible. The following are recommended:
Empathy is a vital skill for the effective resolution of complaints and diffuses many situations that could otherwise deteriorate. It demonstrates a sincere and genuine attempt to understand the issue from the other person's point of view and is especially valuable at an early stage where discontent can often be verbally resolved without the need for a more formal, usually written, process being required.
Empathy is firstly conveyed by short summaries of fact, for example; ‘so the tooth has been tender to bite on and now you have severe pain’.
However, empathy also means using short summaries of emotions. The patient may say: ‘The pain has been terrible’ The reply could be: ‘We need to make an appointment to investigate the problem’. Whilst this response clearly describes the action needed, the patient may consider that his/her concerns are not really being engaged with. A more empathic response would be: ‘That must have been very difficult and upsetting for you. We need to make arrangements to sort things out’. The same solution is being proposed, but the patient reaction is likely to be much more favourable.
Empathy may greatly assist the resolution of the complaint, but clear action must also follow.
However, the patient may first want simply to ‘let off steam’ and needs to be listened to for a period of time. For example:
Listening to the patient's unhappiness, within reason, may not be pleasant but it is often a necessary first stage.
The second stage is then providing an explanation or, if applicable, an apology:
As can be seen, the wording of the apology is very significant.
Finally, it is reasonable to propose an appropriate course of action:
The above stages provide patients with opportunities to express their concerns, to discuss their problems and receive solutions or clear plans of action. It may then be that the action proposed is simply not to agree and that nothing more can be done. In most cases however, engagement with the process is invariably helpful, even in situations where both parties cannot finally agree a solution.
Complainants could just be looking for an apology to their complaint and this may or may not be justified. They may however be expecting some form of monetary reimbursement.
This can be a means of resolving a complaint, especially where the request is justified. Alternatively, reimbursement may be regarded as a pragmatic response to a situation where no particular fault is present but as a gesture of goodwill to resolve the matter, without any admission of liability or wrongdoing.
For example, a patient may be unhappy with his/her dentures. Despite there being no clear clinical fault, the patient remains unhappy. In these circumstances the fees could be reimbursed. The patient cannot then claim any financial disadvantage and the funds can be used to seek treatment elsewhere.
Of course the decision to reimburse is not always easy to reconcile. If there is no reason whatsoever to return fees then it should be resisted.
Finally, the patient may request compensation, rather than reimbursement. For example, loss of earnings, pain and suffering, etc. This is very different from reimbursement and requires proof that a fault occurred which resulted in some loss. When this happens it is always prudent to contact your indemnity provider.
All dental treatment must be fully documented, including complaints. However it is only necessary to confirm, in the patient records, that the complaint process has been initiated. All subsequent actions, if they are not clinical treatment, should be recorded and stored in a separate complaint file. This file should also contain relevant documentation such as copies of letters to and from a patient, as well as the notes of any telephone or face to face conversations.
Whilst a complaint may have been fully resolved, the final stage of the process is the follow up; contacting patients and asking if they are now satisfied and whether they require any more action. This is not always easy, or necessarily welcome, but it is potentially extremely rewarding and very much a part of complaint recovery, as mentioned earlier.
Whilst the generic protocol described can be considered suitable for all complaints, some modification will be necessary for the different routes of patient complaint.
Face to face complaints are less common when patients consider that their concerns are serious. These are usually put in writing. However, small problems which may of course develop further if not dealt with quickly, can often be concluded verbally.
Good communication, especially good listening, is a vital part of the process. Research by Carson9 demonstrates that non-verbal communication is a very significant factor in a patient consultation. Further medical evidence10 has shown that clinicians who are skilled at non-verbal communication receive higher satisfaction scores from their patients. So what makes a good non-verbal style?:
Appropriate words are of course then needed, but when discussing the complaint with a patient it is important to:
This is usually an unsatisfactory way to resolve a complaint as body language and eye contact are missing. What can sound unhappy or hostile may in fact be accompanied by a smile. Unfortunately, this cannot be seen and the wrong conclusions may be drawn. Arranging a face to face meeting is almost always a better way of resolving a verbal complaint, even though a telephone conversation may seem a tempting alternative option.
This is probably the most common route for discontent, certainly for more serious issues. The same general principles apply but ‘holding’ the complaint with an acknowledgement, so that the complainant will not go elsewhere, is essential. All that is needed is confirmation that the letter has been received and the matter being looked into. However a full response, as soon as possible, should then be promised. Again, contact with your indemnity provider is prudent in this situation.
The full reply, when all the facts have been investigated should:
Effective complaint handling is an essential skill and a GDC requirement. Whilst the prevention of a problem is always best, this cannot always be achieved. Good complaint handling can therefore hopefully produce a solution that is not only fair to all parties but also provides significant advantages to a surgery or practice. Most important of all it reduces substantially the stress and strain that complaints can cause for the dental team.
