Important elements of good complaint handling

Inquiry

The way you deal with a complaint should be tailored to the circumstances of the individual complainant

Listening to complainants’ concerns and expectations is fundamental to good complaints handling. Clarifying both the reasons for the complaint and the motivations behind it at the outset will help you to lay the groundwork for appropriate investigation and, hopefully, an outcome that satisfies the complainant.

The way you deal with a complaint should be tailored to the circumstances of the individual complainant. Arranging a face-to-face meeting will allow you to clarify the issues from the complainant’s point of view and to find out what outcome they want. You will then have an opportunity to discuss what the complaints process can and can’t deliver if the complainant seems to have unrealistic expectations.

You should also use this time together to agree an action plan for resolving the complaint and to commit to an appropriate schedule. Alternatively, depending on the nature of the complaint, it might be possible to resolve the issues there and then, especially if they arose from misunderstandings that can be sorted out by direct discussion.

Preparation is the key to a successful meeting of this nature. The very useful Complaints Toolkit, published by the Healthcare Commission (now part of the Care Quality Commission), suggests that you involve the complainant in the arrangements and ensure that they understand what will be discussed, who will be in attendance and that they are welcome to bring an advocate, friend or relative with them.⁷

You will also need to find out beforehand if the complainant is in need of any special support, such as an interpreter, and if there is anyone that they specifically don’t want to see at the meeting.

See Appendix 3 for some guidance on conducting the meeting. A word of advice: take notes and read these out before the meeting breaks up to ensure that they accurately reflect the discussion and that you are in agreement about the salient points. Follow up the meeting with a letter to the complainant confirming what has been agreed.

Even if a face-to-face meeting is not possible or appropriate, it is worth talking the matter over with the complainant on the telephone to clarify the issues, find out what outcome they want, explain the complaints process and tell them when they can expect an outcome.

Recording

Keep your complaints log simple

All complaints – minor and serious – should be recorded so that they can be fed into clinical governance, service improvements and your annual reports. Keep your complaints log simple; if it is too complicated and time-consuming to fill in, it is likely that staff will not bother to record minor, verbal complaints.

Good documentation is an essential component of good complaints handling. A complaint file should include all documents relevant to a complaint, including information gathered during an investigation, notes from interviews and telephone conversations, witness statements, copies of letters and actions taken or intended as a result of the investigation. They should be kept separate from the patient’s medical records.

Assessment

All feedback should be recorded and used to inform service improvements, but there is no legal obligation to do so unless the feedback comes in the form of a complaint. However, in the context of inviting feedback – comments, compliments, concerns and complaints – it’s not always easy to know whether a person is actually complaining or not.

Your practice complaints policy should include guidance for frontline staff on assessing the seriousness of verbal complaints

The Department of Health definition, “an expression of discontent requiring a response”, is very broad. You will therefore need to consider all negative comments and concerns and an appropriate response, unless the person concerned makes it clear that they do not require a written response.

Even if people do not consider their feedback to be a complaint, it is presumably given in the expectation that you will take their comments on board. It is only courteous to follow up with a letter, telling them that you’ve considered their comments (and possibly made improvements as a consequence) and thanking them for taking the trouble to share their views with you.

Your practice complaints policy should include guidance for frontline staff on assessing the seriousness of verbal complaints. While it is probably not appropriate to apply the Risk Assessment Matrix (RAM) (see Appendix 4) on each occasion, your staff will need a clear idea of the difference between a concern that they can resolve on the spot and an issue that they should refer to the complaints manager or a more senior member of the team.

Ideally, your staff will feel competent to deal with most minor concerns themselves by offering an appropriate apology and/or a solution to the problem. This aspect of complaints handling lies outside the scope of this booklet, however, which focuses on serious complaints that require a more formal approach.

For complaints that cannot be dealt with on the spot, carrying out a risk assessment will help you to decide their level of seriousness, which will then determine your plans for dealing with them. The amount of time and effort you invest in dealing with a complaint should be proportionate.

A high risk complaint, for example, is likely to warrant an extensive and detailed investigation, possibly carried out by an external investigator, and may also demand immediate remedial action. On the other hand, extensive in-depth investigation and analysis of a minor complaint is rarely justified.

Carrying out a risk assessment will also help you to decide whether you can handle a complaint alone or whether to bring in outside help – from MPS, your LMC Secretary or the health board or PCT, for example. We recommend that you contact MPS for assistance in dealing with all serious complaints, especially those that fall within the red zone of the RAM.

Investigation

Planning is key, not only to taking a systematic approach, but to ensuring consistency in the way you handle complaints

Investigation of a complaint should be thorough, impartial and proportionate. The extent of investigation should be determined by the seriousness of the complaint, the potential for a re-occurrence and the degree of injury or harm to the patient or others. It is a principle of good practice that the investigation should be carried out by someone other than the people involved in the complaint.

This is not always easy to achieve, however – especially in singlehanded practices – so we recommend that members in this situation contact us for advice if a complaint is made against them.

Planning is key, not only to taking a systematic approach, but to ensuring consistency in the way you handle complaints. The Department of Health’s leaflet, Investigating Complaints, would be very useful for organising your thoughts. It will help you to plan your investigation logically without being over-bureaucratic.

The first step in planning is to identify the issues and agree a timescale within which your investigation will be completed (wherever possible in consultation with the complainant). If you agree a clear plan and a realistic outcome with the complainant from the start the issues are more likely to be resolved satisfactorily, not forgetting to advise the complainant that they can obtain independent advice and support from an advocate such as the Independent Complaints Advocacy Service (ICAS).

The analysis should include not only your findings, but any actions that those findings should inspire, such as service improvements, patient safety issues or explanations or apologies

Your plan should include three key questions that define your investigation:

• What happened?
• What should have happened?
• What are the differences between those two things?

Then decide who you need to talk to and the kind of documentary information you will need to gather in order to investigate each issue. Documentary information might include medical records, witness statements, relevant policies and procedures, GMC guidance, clinical guidelines and standards.

Once all the information has been gathered, it must be analysed. The National Patient Safety Agency (NPSA) offers very useful advice about weighing the evidence in its online tutorial on conducting a Root Cause Analysis (see the Resources section at the end of this booklet for links). You may find that you need to call in colleagues to help with the analysis, depending on the complexity of the complaint.

The analysis should include not only your findings, but any actions that those findings should inspire, such as service improvements, patient safety issues or explanations or apologies to the complainant. You should also advise the complainant of their right to ask the PHSO to review their complaint if they remain unhappy with the outcome of local resolution.

Impartiality

“Complaints should be handled by someone who was not involved in the events giving rise to the complaint.”

(Health Service Ombusdman, Principles of Good Complaint Handling, p.11)

Signing off

The facts must be explained in clear language that can be easily understood by a non-medical person.

Once you have completed your investigation, you will need to draft a letter to the complainant outlining your investigation and your findings. This should include an explanation of the facts you are basing your conclusions on and a description of any actions you are taking as a result of your findings. The facts must be explained in clear language that can be easily understood by a non-medical person.

If the complainant is owed an apology, you should give one. If you have found that the complaint is not supported by the facts, it is still important to acknowledge the complainant’s feelings with an expression of empathy. You could say, for example, that you understand why he/she might have felt that a mistake had been made and sympathise with any anxiety or grief that this might have caused.

You must also advise the complainant of their right to ask for an independent review from the PHSO should they remain unhappy with the outcome of the investigation and its findings.

If the complainant is experiencing bereavement, a sensitive response is especially important. In a study of complaints referred to MPS in 2006, 9% had been referred on for further action after the local resolution stage. Of the complaints that were associated with bereavement, however, the figure was 20%.

Box 1: Bodies with inspection, monitoring or investigation responsibilities

England

• Care Quality Commission
• Primary Care Trusts
• Health Service Ombudsman

Scotland

• HNS Quality Improvement Scotland
• Health Boards
• Public Services Ombudsman

Wales

• Healthcare Inspectorate Wales
• Independent Review Secretariat
• Community Health Councils
• Public Services Ombudsman for Wales

Northern Ireland

• Health Boards
• Regulation and Quality Improvement Authority
• Northern Ireland Ombudsman.