Dealing with complaints

Dealing with complaints or serious incidents can be a challenging and distressing part of consultant life. With the right mind set however it can be a positive experience and improve patient care through personal and institutional learning and reflection.

Sometimes complaints can be dealt with through an early discussion, perhaps even on a relatively informal setting such as on the ward. A record of ‘early resolution’ of complaints is kept. It is therefore crucial to ensure that there is accurate contemporaneous documentation. Some complaints may require a written response to try and resolve the issues. Some complaints require a formal complaint meeting, this may be the next step when a written response has failed to provide a sufficient answer to the complainant. The complaints team in your organisation will be able to guide you through the process and make it clear to you what level of response is required. Each trust will have a localised protocol on how to handle with complaints and serious incidents and it is important to follow the processes, both to ensure it is handled correctly and to ensure that you, and other doctors are provided the correct support

It is important to remain objective when dealing with a complaint. When clinical errors occur it is rarely due to one individual’s clinical error and frequently due to wider or systemic organisational issues. Involvement in a complaint does not signify that you are a ‘bad’ doctor. This can represent an opportunity to change practice through clinical policy change and ultimately improve patient care – for example automatic provision of enhanced / extra care or clear admission policies for at risk patient groups.

Supporting colleagues and yourself

A serious incident investigation process should be a no – blame process that is calibrated to improve clinical care, maximise learning and prevent future harm. It should never feel like a ‘witch hunt’. It is important to seek help from an experienced colleague or even independent support from personal indemnity society if you feel you are being victimized. It is equally important to speak up if you feel that another team member (particularly a resident doctor) is being subjected to this.

Complaints often arise due to perceptions of clinical care and communication issues – the clinical care provided may in fact have been excellent. Discussing the case with an experienced colleague can often not only be helpful, but also re-assuring – you may find that they wouldn’t have done anything different to you.

Planning a complaint meeting

Dealing with complaints will often involve meeting with family members. This can be a good opportunity to clarify the issue and explain things in more detail. It can be allow a ‘reset’ of the relationship and allow you to impart a clear narrative of the care provided. This can be an incredibly satisfying process if handled well and it may even be the case that all parties leave the meeting feeling satisfied.

It is worth taking the time to consider how you will approach a meeting.

Is there a complaints team / patient liaison service who should organise and facilitate the meeting
Are there any other team members, or teams who need to attend
Is there a meeting room in a non-clinical area that you can use to host the meeting
Establish the details and nature of the complaint / question
Establish what they know of the case
Provide an accurate overarching narrative
Keep it factual and objective
Take care to use non-medical, plain language. Avoid jargon, or explain medical terms if they are central to the issues raised
Check understanding
Ensure contemporaneous note keeping of such meetings
Ensure you set aside sufficient time and that you will not be disturbed – these meetings can be focussed on perceptions of ‘not being listened to’
Don’t be afraid to ‘say sorry’ if you feel it is appropriate
If this episode has led to institutional learning then it is likely appropriate to share this

Approaching this as an opportunity to ‘have the conversation you wish you had’ and re-set the narrative can make a daunting task incredibly satisfying. As ever, discuss the case with a colleague beforehand and plan something nice to do afterward.

Planning a written response

Often complaints can be addressed via a written response. This may be how your organization requests you to respond to the complaint.

It is important that you read the complaint and also take the opportunity to read through the notes of the care episode in question and particularly your input into this. Check that you feel able to actually respond to the issues raised. It is not uncommon that complaints centre on things out of our control such as aspects of nursing and domestic care. It may be more appropriate for other members of the team such as the clinical matron to answer questions such as this. It is also double checking that you were actually involved in the care episode – sometimes coding issues can lead to miss-attribution of consultants.

Your complaints team or a colleague may be able to guide you through this, or may even have a template that you can follow. You may wish to:

Break down the issues and respond to each in turn
Keep it factual
Avoid jargon where possible and carefully explain complex medical terms where necessary
Provide an overarching narrative – this can be useful to help the complainant see the issues in context and perhaps appreciate the aims and objectives of care and why certain actions were necessary
Defer some questions to other more appropriate respondents. Issues such as nursing care cannot really be addressed by the medical team and should be answered by a senior member of the nursing team.
Feel free to ‘say sorry’ if you think it is appropriate
If this episode has led to institutional learning then it is likely appropriate to share this

Self-care

Sometimes these issues can be upsetting, especially if they are unexpected or feel unwarranted. It is important to recognise that is ok to feel frustrated or upset. It is always worth taking the time to talk through complaints with a colleague. It is very likely they will have had a similar experience at some point and can talk you through how you may wish to handle things and what to expect.