Dr Katherine Grant, Medicolegal Adviser at Medical Protection, provides a series of practical tips to help you manage the complaints process
Many doctors will receive a complaint at some time in their career. At Medical Protection we understand how stressful such matters can be.
Unfortunately occasionally things do go wrong in healthcare and it is inevitable that sometimes patients are dissatisfied, disappointed or upset with the care that they have received.
Good complaints handling is key in resolving matters at an early stage. If you provide an open, honest and conciliatory response it may prevent the patient from
pursuing other avenues such as a Medical Council complaint or financial compensation. It could also potentially reduce the workload involved in responding to the complaint and minimise any damage to your reputation.
Whether you work in a large specialist hospital or a small clinic, it is useful to have a local complaints procedure in place. An effective complaints handling
process should be flexible and responsive, allowing both doctor and patient to be clear on how a complaint will be dealt with, and in what approximate timescale.
Ideally, the complaints process should provide you with the opportunity to explore the issues raised, identify any specific learning points and put things right where necessary. Reflection and learning from complaints is a valuable skill for all doctors, and adopting a positive manner and attitude when responding to a complaint can be a sign of true professionalism.
Steps for effective complaints handling
1) Receiving the complaint
• The complaint should be logged or passed to the appropriate colleague as necessary.
• Check whether any immediate action is necessary in relation to the patient’s care.
• Ensure appropriate consent is sought from the patient if a third party has complained on their behalf.
2) Acknowledge the complaint and inform your MDO
• Include an initial apology at this stage as appropriate and outline the complaints policy if available.
• Outline the plan for investigation, likely timescale and how the response will be shared.
3) The investigation
• Examine the concerns raised by reviewing records and obtaining statements. Draw up conclusions and an action plan as required.
• Include the finding of the investigation.
• See below for detailed advice on drafting a response letter.
5) Monitoring and review
• Is there opportunity for audit or further teaching or training sessions, or focused CPD?
• Can any lessons learnt be shared more widely?
How to write a response
Sometimes complaints can feel personal, particularly if a patient questions your skills or decision-making as their doctor. Even if you feel upset after receiving a complaint it is essential, when drafting a written response, that you remain objective and write in a conciliatory tone.
The purpose of a complaint response is to try and resolve matters, not perpetuate further correspondence. Responses which blame the complainant or lack reflection may lead to escalation such as a further complaint to the Medical Council, or a negligence claim. An empathetic and conciliatory tone can help to bring matters to a swift conclusion.
The elements of a good response letter are:
• An opening paragraph which sets the response in context; contains an apology or sentiment of regret and acknowledges the patient’s feelings of distress as a result of what happened. This is recommended whether the complaint is justified or not.
• A summary of the main issues the patient has raised in their letter. This will also help you focus your response.
• An account of what action has been taken to investigate the complaint.
• A clear explanation in response to each of the issues raised, identifying any failings and apologising as necessary.
• Details of any changes that have been made to reduce the risk of the issue happening again, and any reflections or learning points drawn from the matter.
• An invitation to meet or contact you again if they have any further questions.
• A reiteration of your apology for what occurred.
• Your account should be typed and free of jargon with any clinical terms or concepts explained.
An apology, expressing regret about the patient’s experience or emotions, is not an admission of liability and is appropriate when a patient has suffered harm from their healthcare or experienced disappointment. An apology is an acknowledgement that something has gone wrong and a way of expressing empathy. Contrary to popular belief, apologies tend to prevent formal complaints rather than the reverse.
Meetings and mediation
Mediation through meeting with complainants can be valuable in resolving complaints at an early stage. A face-to-face discussion of issues should be considered
and offered as part of effective complaints handling.
Pre-meeting preparation is essential in setting boundaries and expectations, as well as making the most of everyone’s time:
• Ensure that the time and place are convenient for all concerned.
• Set a timeframe for the meeting.
• Clarify beforehand the particular issues that the complainant would like to discuss.
• Agree who will be present and their role. You should invite the complainant to bring a friend and/or advocate. You may want to have someone else present to take some notes.
• Have any relevant notes, letters, procedures, clinical guidelines or protocols etc. available in case they need to be referred to.
• Agree in advance that all parties to the meeting will be treated with respect and courtesy. If this does not occur then the meeting may need to be curtailed.
• Consider if the complainant has any particular needs – for example, an interpreter or access issues.
At the meeting:
• Make sure phones are switched off or diverted.
• Begin with introductions and confirm if notes are being taken and by whom. This can often avoid disagreements later over exactly what was said and agreed.
• It is usually helpful at the beginning of a meeting to offer an apology and the hope that matters can be resolved.
• Give the complainant the opportunity to outline their outstanding concerns in order that you can then provide a response.
• Do not feel under pressure to answer any questions to which you do not have an immediate answer. You can offer to check on a point and get back to the complainant with a response.
• If notes are taken it is good practice to share these in draft form with the complainant to ensure that everyone agrees that they are an accurate record of the meeting.
• At the end of the meeting make sure everyone is clear what the next steps are and provide details of the next step in the complaints.
At Medical Protection we understand that dealing with complaints can be stressful and time-consuming. If handled well, complaints can be a valuable source of feedback. However, poor handling can lead to an escalation of concerns. If you receive a complaint or are asked to provide a response by your employer, contact your MBO for advice.
This article first appeared in Casebook Asia, and is the property of Medical Protection
Many thanks for permission to reproduce.