Notes from the field of public involvement

Thursday, 15 February 2007

Spotlight on Complaints and Preparing for a complaint audit

The Healthcare Commission is going to do an audit of complaint handling to cover all NHS organisations and its findings will feed into the annual health check in 2006/2007.

The Commission's recent report Spotlight on complaints (links to PDF) offers some solid clues as to what they will looking for.

The first point worth noting is that the Chief Executive is obviously a big fan of our approach to complaint handling. The title of our study of NHS complaint handling in an acute Foundation Trust was 'My Own Anger Propelled Me'.

We wrote then "Bad experiences with the health service can create deep and lasting feelings and emotions which complainants then bring to a complaint handling system that does little or nothing to calm and address those feelings - just the opposite". The emotions generated but ignored become powerful enough to drive people on through a lengthy and wearing process right up to the Ombudsman. The cost is huge both in terms of the personal and the financial.

So it was good to see Anna Walker quoted in the press release as saying "Complaints represent the raw feelings of patients and the NHS must listen and learn from them". Agreed. The learning is particularly important for the 10 Trusts named and shamed in the report for having the highest percentage of cases returned for further local resolution. Take a look also at our article about whether emotions are a help or a hindrance when making decisions.

So what should those in charge of complaint handling do first to make sure they perform well in any audit?

Are there any easy wins where you can avoid getting bogged down in the muddy shell holes of that war of inter-professional attrition called 'and whose fault was that?'. Look for some easier wins. Amongst the Commission's top 10 issues, we see

"poor communication and not enough information for patients" as number 2,
"poor handling of complaints" is 4th and
"poor attitudes of staff" is 7th.

This is a sign of a process which while ostensibly dedicated to the resolution of problems and the creation of satisfaction, creates more problems and more dissatisfaction. But the communication issue is one that the Complaints Manager can do something about. Also if there are complaints about process, what are they and what particular parts of the process are creating the problems? Poor attitudes of staff - well how long have you got? You will need help and time to address this. It is definitely not an easy win. Our creative thought on this is to use the communications work (see above) to 'train' the complainants in problem solving and see if more relaxed complainants - relaxed because they know how to get a resolution and are more certain of being heard and respected - create more relaxed staff. Just a thought based on our definition of a complaint as an unresolved problem or question.

What else to do?

The first thing to do is a survey of complainants. 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. 

In terms of the Healthcare Commission's feedback, the priorities in terms of the systems are 

(There is another Commission suggestion about taking into account what other people do which makes no sense - please revise Ed.)

Our emphases are clear - listen and listen for the solution they want and give it to them. We are not fans of long investigations. Investigations can be a very long-winded way of saying 'Go Away'.

Take a look at

Summary of Complaints Process:CAAFI

CAAFI process - Connection, Assessment, Action, Follow-Up, Improvement

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 that will fit the proposed new core standard.

  • A survey and process review will help you meet the first provision about meeting the needs of complainants
  • If you have a process which you understand and have confidence in, integrating with others and keeping it simple for the complainant becomes easier
  • You will be helping your people to arrive at outcomes that create higher satisfaction sooner.
  • Your system will produce decent data to drive action and improvement.

Contact Colin Adamson (tel. 020 8670 0595)

Colin Adamson | (Problem occured connecting to database: The server requested authentication method unknown to the client