Dealing with complaints as a doctorBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7007 (Published 26 November 2014) Cite this as: BMJ 2014;349:g7007
Abdelmageed Abdelrahman and Sarah Brown look at how doctors should deal with complaints and how they can use these interactions to improve their practice
The number of complaints from NHS patients is rising. Figures from the General Medical Council show that the number of complaints made about doctors from members of the public has risen sharply in recent years, increasing to a record high of over 6000 in 2012, the latest year for which figures are available.1
A rise in the number of complaints does not necessarily signify a fall in standards, but doctors are often extremely disappointed when someone complains about them. They may feel unsupported when dealing with complaints and be fearful of the consequences of doing so.
Complaints are important. They reflect the expectations of patients, and they offer the opportunity to investigate the quality of care that patients are receiving. A healthcare service that listens to patient complaints is able to detect any problems early on, and correct them, thus improving the quality of care provided and protecting future patients from harm. It is therefore essential that healthcare professionals work together with patients to deal constructively with complaints.
Patients need a complaints system that is uncomplicated and simple to understand. If the system is too complex, some patients may decide not to make a complaint, which could intensify their feelings of not being listened to.
There should be multiple access points through which patients can make a complaint. They should be able to voice a complaint directly to staff, send an email or letter to the hospital, or complete an online form. Leaflets and websites need to be widely available, and they should tell the patient or a relative what to include in a complaint.
Information on what will happen next should also be available to the patient. It is important to remember that this process should be able to accommodate those who may have language or learning difficulties. Crucial to patient satisfaction in this respect is transparency. The patient should be able to believe that the complaint will be heard, that his or her views will be respected, and that action will be taken as a result of the complaint.
Most importantly, patients should be confident that a complaint will never lead to substandard care. It is important to reassure the patient that complaints are an opportunity for healthcare professionals to improve care and that the patient will not be criticised for making a complaint.
When a complaint involves other organisations, it should be copied, with the patient’s consent and the acknowledgment letter, to the organisations involved. The agencies concerned should agree which organisation will take the lead in responding to the compliant and they should ensure that the complaint handling is on the right track.
An assessment of the complaint should be made to gauge the length of time needed to manage it. The sign-off letter should include all the issues raised, a full explanation in language free from medical jargon, an apology, and an explanation of what is being done to correct things. The complainant should be thanked for giving you the opportunity to look into the matter.
On receipt of the complaint, details should be logged and passed to the complaints lead. It is important to check whether any immediate action should be taken in relation to patient care. You may wish to consult your medical indemnity organisation for advice at this point.
Within three working days of the complaint being received, an oral or written acknowledgment should be given. This should include an apology for any trouble experienced and an invitation to discuss a way forward.
When you finalise a plan to investigate the complaint, the complainant’s reference number, name, contact number, and preferred means of contact should be included. Consent to proceed with the investigation should be sought. You should also include a summary of the complaint, the date or dates of the relevant incident or incidents, details of any issues that need to be explored and the outcome the patient is seeking, an agreed timescale for a response, and information about how the response will be provided.
The investigation should include taking statements from all involved, reviewing local policies and procedures, drawing conclusions from information obtained, discussing the conclusions within the team, and drawing up an action plan.
The response to the patient should begin with a sincere apology and acknowledgment of any distress caused. This reinforces the fact that you have listened to the complaint, and that you understand why the patient was angry or upset. A summary of the main points raised in their letter, and what has been done to resolve these, should be discussed. An invitation to meet or contact you again should also be offered.
Consequences of poor complaint handling
It is important to deal with a complaint in a prompt manner, but being too brisk so that the case is closed does not result in improved service provision. Care should therefore be taken when drafting the letter of response, to ensure that the response is not generic. Inadequate management of the complaint may lead to further work, damage to your reputation, escalation of the complaint, General Medical Council referral, and litigation. Most importantly, the trust that members of the public have in the healthcare service could be jeopardised.
Complaints provide an opportunity for self-reflection. Consider why the patient is complaining, what you did wrong, what you could have done differently, and what you can do to ensure that the same issue does not arise again.
It is important to consider that the complaint may represent views shared by others, and as such, this may not be the first time that certain behaviours or actions have resulted in unsatisfactory patient care. It is important that the person being complained about is able to learn from any mistakes that may have been made.
Complaints should also help drive learning at an organisational level, and it is important that complaints affect practice. For this to occur, there must be a culture within your organisation of learning, accountability, and continual improvement. Those in a role of leadership and governance must focus critically on the narrative of each complaint. They ensure that the organisation is able to implement appropriate changes for service improvement, which ensures that the public has trust in the healthcare service.
Complaints should be investigated and a formal response should be recorded and used to inform service improvement. There should also be a culture of support and encouragement to anyone involved, facilitating their development in a non-hostile environment.
Teams should review their complaints log periodically to look for recurring themes and to ensure that any changes that have been agreed with the patient have been put into practice. It is important to review the situation to determine whether it is beneficial to disseminate lessons learnt.
We have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.