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Responding to complaints

Mastering your response to a complaint is key to ensuring a positive outcome for all involved. Dr Andrew Stacey, MPS medical adviser, talks you through the process

Despite their best efforts, many health professionals will receive a complaint about the care they provide. Receiving a complaint is always a stressful experience and clinicians react in different ways.

It is advisable to discuss the clinical aspects of complaints with peers, both for educational purposes, as well as for collegial support. The Medical Assurance Society (MAS) and MPS also support access to a counselling service, which aims to provide immediate psychological support to members and assist in identifying useful resources for them in the longer term.

Right 10 of The Code of Health and Disability Services Consumers’ Rights1 (the Code of Rights) covers the right for a consumer to complain about a provider, and the duties that providers have in assisting with such complaints. Every provider, unless an employee of a provider, must have a complaints procedure and follow this when responding to a complaint.

Complaints can be raised verbally or in writing. If received verbally the discussion should be recorded in writing and agreed with the complainant. Check who is making the complaint – if it is not the patient, make sure you have consent to contain the patient’s health information in your response, or determine that consent is not required in the circumstances (such as a complaint from the spouse of a patient that you were rude to them).

What to do 

It is a requirement of the Code of Rights that the complaint is acknowledged within five working days. It is also beneficial to offer to discuss with the complainant how their complaint will be handled.

Written responses not only enable you to carefully construct your reply, but also form the basis of any meetings you subsequently have with the complainant

You should then undertake your investigation into the complaint and draw up a written response. Written responses not only enable you to carefully construct your reply, but also form the basis of any meetings you subsequently have with the complainant.

You should respond as soon as practicable. At ten working days following acknowledgement of the complaint, you should either have responded, or considered how much more time you will require. If the additional time required is 20 working days or more, then you must notify the complainant of the reasons for this.

Where the complaint concerns a number of clinicians, aim for a coordinated response, with input from all the clinicians involved. Unfortunately it is not uncommon for members to come to MPS with a complaint that they have just been made aware of, and to which others had previously responded on their behalf. Often, input from the individual at the start would have avoided misunderstandings that resulted in escalation of the complaint.

It is important to engage with the patient and attempt to resolve the complaint at an early stage. Not doing so risks the complaint being escalated, for example to the office of the Health and Disability Commissioner (HDC). Members have been criticised by the HDC for not attending to complaints in a timely fashion. This runs the risk of referral to a professional regulator such as the Medical Council or Psychologists Board for investigation of concerns arising from the professional’s conduct.

Structure of the response

Because complaints vary so much it is advisable to contact MPS at an early stage. On a number of occasions, MPS’s ability to assist members has been limited by prior responses submitted without our assistance. Be mindful when preparing your response that it may be read by more than the complainant, for example passed on to authorities such as the HDC.

Read the complaint and identify the issues raised. Often it is helpful to jot down a few words or a short phrase in the margin each time a new concern is mentioned.

Include a sympathetic opening paragraph, placing the complaint in context. This may include an apology and acknowledgement of distress (condolences) if appropriate. Explain how the matter has been investigated and summarise the issues raised in the complaint.

Include a sympathetic opening paragraph, placing the complaint in context

Where responses are to an external authority such as the HDC, Medical Council, or Psychologists Board, it is useful to include a paragraph that paints a picture of you as a health professional. You should include details of your qualifications (where you graduated from and when), vocational registration, and current worksite and role.

Make sure you include a clear chronological account of the events in question, with an explanation of what happened and why. Many complaints arise from a consultation or series of consultations. A clear account of each consultation in terms of the history given by the patient, the examination findings, the results of investigations, the working diagnosis and differential diagnosis, and the management plan, goes a long way to addressing concerns about the clinical care provided.

Answer all the questions raised in the complaint or explain why you cannot answer a point. Some complaints can be lengthy, containing a large number of concerns. In this circumstance it may be more appropriate to group the concerns into themes and deal with them on this basis.

Draw conclusions and advise of any improvements or changes in practice that have been made as a result. The motivating factor for many patient complaints is a desire to stop the same thing happening to someone else. Being able to demonstrate that you have taken the complaint seriously and have made any appropriate changes in your practice may stop it going further.

Finish by providing details of the Office of the Health and Disability Commissioner and contact details of local advocacy services that can provide any further assistance desired by the complainant. It is often useful to offer an invitation to meet or to provide further information.

Responses are better posted out than emailed, as emails tend to be sent with less consideration than conventional correspondence, and run the risk of ‘ping-ponging’ of emails back and forwards. The issue of whether to store correspondence relating to a complaint in a patient’s file or separately depends on the nature of the complaint and should be considered on a case-bycase basis.2

Responses are better posted out than emailed, as emails tend to be sent with less consideration than conventional correspondence

How can MPS help?

Complaints are unpleasant for all concerned and can be very time-consuming. MPS assists members in responding appropriately to a complaint, with the aim of resolving the matter quickly, effectively and at the lowest level possible. If you would like further MPS assistance, it would speed up our advice to you if you can forward the following information to us by email to advice@mps.org.nz or fax to 0800 677 329: 

  • Copies of all the relevant complaint documentation to date
  • Any relevant background information, including the dates on which you interacted with the patient/s (if relevant). Please make sure all patient/complainant details are made anonymous
  • A draft of your response to the current complaint
  • Details of where and how you would like us to reply (including telephone/ fax numbers, email addresses etc)
  • Whether or not the complaint can be discussed with anyone in your absence. A factsheet containing this information is also available on our website.3

References

  1. The HDC, Code of Health and Disability Services Consumers’ Rights Regulation 1996
  2. MPS Factsheet, Storage of patient complaints 
  3. MPS Factsheet, A quick guide to complaints
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