With written complaints to the Medical Council on the rise, Kate Taylor, clinical risk and education manager at Medical Protection, looks at the common reasons for complaints – and how you can manage them 

In everyday life we are prone to complaining. We complain about the weather, the traffic, the news, our health…sometimes we even complain about healthcare provision, including our GPs. According to the Medical Council, written complaints from patients are on the rise – from 308 in 2015 to 369 in 2016. ¹

Why do patients complain?

When patients’ expectations are not met, they are more likely to voice a complaint. The most common reason for complaints is poor communication; however, patients often complain about their clinical treatment, staff attitude and the practice systems and processes, such as appointment availability, prescription issues, waiting times and delay in referral.

Complaints can be made in various ways:

• Practices could receive a verbal complaint directly to a member of practice staff
• A written complaint to the practice
• A formal complaint made directly to the Medical Council or Nursing and Midwifery Board of Ireland.

We know from the Medical Council that patients most commonly want the clinician to realise what they have done: they don’t want the same thing to happen to another patient and they want to understand why the event occurred in the first place. ²

The importance of an apology mustn’t be underestimated in the context of a complaint; over half of patients who complain to the Medical Council simply want an apology.

If we were to bump into a stranger in the supermarket or busy street, we would offer an apology: patients are far more understanding if they are kept informed, so offering an apology if you’re running late with your appointments or have to interrupt a patient to take an urgent phone call, or when something has gone wrong with the care of the patient, would go a long way to avoid a formal complaint.

Most people don’t find it easy to apologise: they don’t like to admit they were wrong. Another reason for not apologising is the fear of litigation. It is important to recognise that an apology is not acceptance of liability; however, it does acknowledge the thoughts and feelings of the patient, which can help in resolving the situation.

Complaints should also be viewed as a source of feedback, giving an opportunity to learn from what has not gone well, while also improving customer service.

How does a complaint impact on general practice teams?

Receiving a formal complaint can be extremely unpleasant for the clinician or practice team involved. Complaints can often be interpreted as an accusation of personal failure or a personal attack: we can feel that we have been personally criticised if someone complains about the care or treatment we have delivered. We mustn’t underestimate the impact that this can have on individuals, as often formal written complaints can take several months to be resolved.

We often get a subtle indication when patients are unhappy with the care or service that they have received. This is the ideal opportunity to try and deal with it promptly, de-escalating the situation and avoiding it from progressing to anything more formal. Complaints are a source of frustration for the patient and their families too, so an early resolution would be a preferred option.

Complaints protocol

Practices should have an in-house complaints procedure that clearly outlines their approach to managing complaints. Having a clear complaints procedure that patients are fully aware of will allow practices to take more ownership of complaints and, hopefully, negate the need for patients to go directly to the Medical Council or Nursing and Midwifery Board of Ireland. The practice should consider advertising this to patients via their website and practice leaflet, and in the patient waiting room.

The protocol should also outline timescales for investigation and formal response.

Complaints manager

Appoint a dedicated complaints manager. Having someone dedicated to take ownership and co-ordinate complaints is vital. This is normally the practice manager, supported by a senior GP partner. The role of the complaints manager is to co-ordinate the investigation, collate an appropriate response and feed back to the complainant.

Staff training

Practices must ensure that all staff has been trained in the complaints procedures; this could also be incorporated into the induction programme for new staff. This assists staff in managing any situations that could eventually result in a complaint, such as a verbal complaint at the front reception desk, which could be well managed by trained reception staff.

Patient involvement

Depending on the nature of the complaint, it may be appropriate to offer to meet with the patient face to face to discuss the complaint. This offers a commitment to taking the complaint seriously, and that a full investigation will be undertaken.

Investigating the complaint

Investigations should be undertaken in a timely manner, so the situation does not escalate. Even relatively minor complaints justify being investigated; asking important key questions can help establish the facts:

• What actually happened?
• How did it come to happen?
• What can be learned from the event to reduce the chances of it happening again?
• What should have happened?

Responding to complaints

Following the investigation, it is important that the practice feeds back to both the complainant and practice staff as appropriate. Providing the patient with a written apology, a summary of the main issues as well as any action taken as a result of the investigation findings, constitutes a good complaints response.

It is also crucial to inform all practice staff of any improvements/changes within the practice. It won’t always be appropriate to advise all staff of every complaint, but informing staff of any required changes will go some way to preventing a similar complaint being received.

Conclusion

Complaints are inevitable in general practice. However, how practices choose to respond and react to complaints can have an impact on early resolution – and can help to rebuild trust with patients and their families.

AND THERE’S MORE

Medical Protection is launching a complaints handling workshop in Ireland – more details coming to medicalprotection.org soon.