Complainants

Why people complain

From the complainant’s perspective, there are two interlinked aspects to a decision to complain:

• The nature of the event or experience giving rise to the complaint (the reason).
• Their emotional response to the event and expectations about what the complaint will achieve (the motivation).

Reasons

Most [complaints] are resolved at local level – many of them informally – and national statistics are patchy at best

There is little published literature on the reasons for the 43,000 or so complaints received in primary care each year. Most of these are resolved at local level – many of them informally – and national statistics are patchy at best.

Judging by MPS’s own experience and the available data from national bodies and various surveys of complainants, the top three reasons people give for making a formal complaint are:

• A perception of clinical inadequacy – delayed diagnosis, delayed referral, inappropriate management and treatment, inappropriate or inadequate advice.
• Access problems – difficulties in making timely appointments.
• Difficulties with interpersonal relations – all staff attitudes, including health professionals (rudeness, indifference, etc), and failure to communicate effectively.

Motivations

Numerous studies and anecdotal evidence have shown that the motivations behind complaints, though complex, are relatively consistent: complainants say that they want an explanation and they want an apology.

Complainants want to feel that they have been listened to and that their concerns are being taken seriously

A few of them want financial compensation and a very small minority want to see someone sacked or punished. Altruistic considerations seem to figure prominently, however; one of the most often-cited motivations for making a complaint is a wish to see service improvements and prevent the same thing happening to someone else.

In a study of 424 complainants in the Netherlands, researchers found that altruistic aspirations and a sense of natural justice were important motivators.¹ In response to a questionnaire, 94% of the respondents said that wanting to prevent the incident happening to others was either very important or the most important reason for making the complaint. Face-to-face interviews with respondents shed a little more light on this altruistic tendency, indicating that complainants share “general feelings of injustice and wrongness” and feel that they have a duty to complain.

These motives of the complainants illustrate that many patients seem to be driven by strong feelings of justice and duty. Their motives also reflect concern for other patients (altruism), but the complainants’ motives seem to express a more general feeling that “something must change”.²

On an emotional level, complainants want to feel that they have been listened to and that their concerns are being taken seriously. If they are upset, they want their feelings to be acknowledged and validated. It is important to understand a complainant’s underlying motivations for the complaint if the outcome is to meet their expectations. A complainant who wants to see improvements in the service as a result of their complaint, for example, will need to see evidence that lessons have been learned and changes implemented.

De-motivators, or why people don’t complain

Research published by the National Audit Office (NAO) towards the end of 2008 indicates that, although 13% of people are dissatisfied with some aspect of NHS services, only 5% of them bother to make a formal complaint.³

The main reason people gave for not bothering to complain was a belief that nothing would be done about it

A further 16% will make an informal complaint, and the remaining 79% keep their dissatisfaction to themselves.

The reasons non-complainants give for feeling dissatisfied reflect those given by actual complainants, though no data were recorded in this study about the seriousness of the clinical causes for dissatisfaction. The main reason people gave for not bothering to complain was a belief that nothing would be done about it if they did (32%); the second most common reason was that the issue wasn’t serious enough to warrant a complaint. Worries were also expressed that complaining might compromise patients’ ongoing relationships with their doctors or that they would be seen as troublemakers.

The 32% of respondents in the NAO’s survey who thought complaining would not be worthwhile are supported by a separate survey undertaken by the Patients Association.⁴ Almost half the respondents who had complained about some aspect of NHS services said of the experience that it was pointless or totally pointless. A further 18.7% thought it was slightly pointless.

The results of this research show that the old complaints system has created a lot of cynicism in the minds of NHS service users. A significant number of people expect the process to be onerous and the outcome disappointing. The new system is designed to overcome these two problems, but it will be some time before the perception of a pointless and cumbersome process is replaced in the minds of the public.

Complainants’ views on poor complaints handling

According to an omnibus survey commissioned by the NAO in 2007, 70% of complainants interviewed were satisfied with the way their complaint was handled in terms of being kept up to date with progress and being informed about how to take their case further.⁵ Only a third (34%), however, said that the organisation concerned had demonstrated that it had learned from the complaint by making changes to its systems and procedures.

In 2008, the Healthcare Commission reported that complainants who referred cases to them because they were not happy with the local procedure often felt that their case had not been investigated thoroughly or objectively enough, or that the explanation was couched in medical jargon that was hard to understand.⁶

In addition to the above criticisms, dissatisfied complainants often say that they felt no-one was prepared to listen to them properly, or to offer an apology (when due).