COMPLAINTS

HANDLING

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Complaints Handling
1 Rev 01 16-Feb-2017


 “Good complaint handling should be led from the top, focused on outcomes, fair and proportionate, and sensitive to
complainants’ needs. The process should be clear and straightforward, and readily accessible to customers. It should be
well managed throughout so that decisions are taken quickly, things put right where necessary and lessons learnt for
service improvement” (Parliamentary and Health Service Ombudsman, 2008)


AIMS:

The purpose of this module is to provide the learner with the skills in how to recognise a complaint and how to effectively
manage complaints within the workplace.

LEARNING OUTCOMES:

Following the completion of this module, you should be able to:

• Recognise a complaint
• Demonstrate empathy whilst maintaining control of the conversation
• Accurately record, investigate and provide an outcome following a complaint
• Identify and describe the key steps in the complaints process
• Recognised the key skills and qualities needed to handle complaints effectively including empathy, building rapport
and engaging with the service user/customer






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Complaints Handling
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INTRODUCTION:

Good quality complaint handling is vital to maintain the continuous improvement in the quality and delivery of care within
any health and social care organisation. It provides a tangible and measurable reflection of the organisation’s commitment
to an open and responsive safety culture. All NHS, private sector and other health and social care organisations will have
written policies and procedures on how to effectively manage and handle complaints, irrespective of their nature or
severity. As an employee, it is important to ensure that you are aware of the internal policies and procedures applicable to
your current place of work and how to access them.

WHAT IS A COMPLAINT:

The Patients Association defines a complaint as:

“An expression of dissatisfaction made to an organisation, either written or spoken, and whether justified or not, which
requires a response. There is no difference between a ‘formal’ and an ‘informal’ complaint. Both are expressions of
dissatisfaction”

In 2003, the Government released a report - NHS Complaints Reform: Making Things Right, whereby its findings into the
complaints procedure within the NHS had shown:

! The process on how to raise complaints and concerns was unclear and too difficult
! There is often a delay in responding to complaints and concerns
! Too often complainants received a negative response
! Complainants do not seem to get a fair hearing
! Patients did not get the support they needed when they wanted to complain
! The Independent Review stage does not have the credibility it needs


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 ! The process did not provide the re-dress patients want
! There did not seem to be any effective way of learning from complaints to bring about improvements


WHY DO CUSTOMERS/ SERVICE USERS COMPLAIN?

Here are some reasons why people may feel the need to complain in a healthcare setting:

! Patients who were in pain or discomfort
! Delays in getting appointments for medical review due to extensive waiting lists
! Negative attitudes from staff
! Complications following medical and surgical interventions.
! Patient expectations not being met
! Poor delivery of quality care
! To claim compensation for damages or losses following medical negligence or substandard care
! To raise concerns regarding a health care provider who may lack skills/competency in the provisions of delivering a
safe and effective service, suggesting further training is required.
! Lack of information – patients feeling that they had little or no contribution towards their care
! Compassion – patients said they felt they had not been treated with the compassion they deserve.
! Dignity and care – patients said they felt neglected and not listened to.
! Resources – patients said there was a lack of basic supplies like extra blankets and pillows.







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The Shipman Inquiry:

Dame Janet Smith, the judge who prepared The Shipman Inquiry, reviewed the complaints procedure within the NHS and
concluded her findings in the ‘Fifth Report of the Shipman Inquiry’, which was published in 2004. Her findings concluded
that service providers had shown:

! A lack of fair procedures
! Failure to investigate complaints properly
! Failure to give adequate explanations
! Failure to take account of the inherent imbalance of power between healthcare professionals and patients,
including the patient’s fear of retribution
! Lack of impartiality in organisations investigating their own conduct
! Absence of accountability to an external body
! Complaints handlers lack of necessary skills
! High levels of dissatisfaction among complainants with all levels of the system

Annual figures from the Health and Social Care Information Centre state that there were over 162,000 complaints made
against NHS care in 2012/13. This amounts on average to 3,000 received per week. Over several years, there have been
many official reports that explored what was wrong with the complaints system and made recommendations for change.
Unfortunately, many of these recommendations have not been fully implemented and subsequently there was an
increase of 1,000 complaints reported during the period 2014/15.







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Complaints Handling
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IDENTIFYING A COMPLAINT:

A complaint is ‘an expression of dissatisfaction on a consumer's behalf to a responsible party’ and should be considered as
a free, direct communication from service users/customers. It gives you an opportunity to reflect and make changes to
services or processes that are faulty or failing. It is also useful in retaining the customer’s trust and building rapport should
the outcome following a complaint meet their needs and engaging them as advocates for others.

Most individuals who raise a complaint are simply looking for:

• An apology
• An explanation as to what happened and why
• Improvement to current services provided
• Reassurance that it won’t happen again to anyone else
• Their customer needs to be met

Customers have two separate needs when they raise a complaint:

1. Needs relating to the complaint:
- The expectation that their complaint will be dealt with promptly, fairly and following the correct process
- To be given what was denied and in some instances followed with a formal written apology
- Appropriate action to implement changes to prevent further complaints being made and improve service
delivery
2. Individual needs:
- Want to be heard
- To be understood and respected
- To be treated with care and compassion (empathy)


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COMPLAINTS PROCEDURE IN THE NHS AND HEALTH/SOCIAL CARE SETTING:

Individuals are encouraged to complain directly to the care provider or manager of the practice/care home/hospital who
arrange the services with which they are unhappy or have concerns. This gives the service provider the opportunity to try
and put things right for them, should it be justifiable and reasonable. Should an individual requires assistance with the
process in escalating a complaint, information should be readily available for them to source local advocacy services.

Complaints can be made against any the following:

- The healthcare provider- this is the organisation where you have received the service from. For example, GP
surgery, private clinic, hospital, dentist, nursing or residential home.

- The commissioner - commissioners are responsible for the making payments for care and services provided to said
organisation.

Should a patient/carer wish to complain directly to the commissioner they can do so. However the commissioner cannot
re- investigate claims that were initially reported to the health care provider. Where a complainant remains dissatisfied
with the initial response, they should be provided information and advice on how to escalate complaints to the
Parliamentary and Health Service Ombudsman (if government or NHS funded treatment/services), Independent
Healthcare Advisory Services (IHAS) or the professional organisation that regulates that area of practice.

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Complaints Handling
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HANDLING COMPLAINTS:

An effective complaint handling system provides three key benefits to an organisation:
• It resolves issues raised by a person who is dissatisfied in a timely and cost-effective way;
• It provides information that can lead to improvements in service delivery; and
• Where complaints are handled properly, a good system can improve the reputation of an organisation and
strengthen public confidence in an organisation’s administrative processes.

Trying to understand why some people complain can be very challenging, especially when you feel that the complaint is
not justifiable. The complaints process is not about apportioning blame; the aim is to learn from any concerns addressed
and any mistakes highlighted to assess and consider alternative measures/processes that can be put in place to avoid
similar issues in the future.

When managing a complaint, all those involved (the complainant, staff members etc.) should be treated with respect, tact,
compassion and concern for their wellbeing. It is important to listen carefully to what people say and to conduct the
investigation in a fair and objective manner. All organisations should be able to demonstrate to all stakeholders that the
investigation and the decision-making process has been:

• Open and transparent
• Evidence based
• Logical and rational
• Comprehensive and with a level of detail appropriate to the seriousness of the complaint
• Timely and expeditious
• Proportionate to the seriousness of the complaint(s) raised
• Be honest and the investigation will find the truth of the matter


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To effectively handle complaints, it is vital that you remain empathetic and always treat the complainant with the upmost
respect.

Good communication skills to remember:

- Acknowledge the complaint and apologise for the fact that the complainant feels the need to do so
- Listen to the complainant and reiterate the points to address to ensure you have all the correct information
- Explain what action will be taken and the processes that are required to do so
- Thank the complainant for addressing their issues and/ or concerns
- Remain calm and professional
- Focus on the complaint, not the individual
- Remember that the complaint is evidence that, in the customer’s perspective, services provided or staff
professionalism does not meet their expectations

COMPLAINTS PROCEDURE

The Complainant should be allocated a single point of contact within the Organisation with whom they directly liaise.
The nature of their complaint and the outcome they are seeking is established at the outset. There is equality of access
for all complainants, with consideration for those people who may find it more difficult to use the process.

• The complainant is given contact details for a named person with whom they can liaise with throughout the process
- Acknowledge receipt of the complaint and where possible, provide a complaint reference number and point of
contact for further correspondence or communication.





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Complaints Handling
9 Rev 01 16-Feb-2017


• The complainant’s preferred method of communication should be established at the earliest opportunity
- Legislation requires that the complainants preferred method of communication be established. Complaints may
be made orally, in writing or electronically. The method of communication should be addressed and documented
as soon as the complaint has been raised.

• An explanation of how the complaints process at the organisation works should be provided
- Explaining how the complaints process works is the first step in ensuring the complainant is well informed about
what to expect and how typically complaints are handled

• Third party consent should be obtained, where the complaint was made on behalf of the patient.
- Consent is required when communicating to the complainant about the details of a third party and the Trust
should have a written record from the third party giving their consent.

• Accurately record complaint information and make it accessible.
- Make sure that your version of the complaint matches exactly what the service user/complainant has said. Your
documentation should be accessible by any branch of the organisation should the individual intend to make
contact in future.

• A written acknowledgement is sent to the complainant in the three-day time frame
- Where a complaint has been received in writing, a written acknowledgement should be sent within three days of
receipt and should be a hard letter copy sent directly back to the complainant.

• Provide the complainant with anticipated time frame for resolution of the complaint
- The organisation needs to discuss the timeframe for handling a complaint.

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Complaints Handling
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• Ensure that service users/complainants are notified should there be any delays in resolving complaints.
- After setting a timeframe, the organisation should try its up most to stick to it. Where this proves difficult, the
complainant should be informed in good time

In exceptional circumstances, the issues raised in a complaint may warrant communication to an external organisation.
For example, the police may be contacted when a criminal offence is suspected.

• Where serious misconduct is suspected, the individual(s) is suspended, pending further investigation
- Suspension is warranted when the content of a complaint suggests an individual(s) poses a significant risk to
others at the time the complaint is made. Suspending that individual reduces that risk while the organisation
investigates further.

RELEVANT DOCUMENTATION THAT SHOULD BE RECORDED AND FILED:

The file should include all relevant documentation including:

• The initial complaint correspondence
• The initial assessment of the complaint severity and the details of the person making the assessment
• Dates, identities and positions of all parties involved in the investigation
• Copies of all correspondence (patients, staff and other opinions sought)
• Interview notes and emails in relation to the investigation
• Extracts from the patient record where appropriate
• Records of oral communications – face to face and telephone conversations
• Photographic evidence where appropriate. A hard copy should be available which is signed on the back “as taken
and not modified”. A copy of the original digital photograph should be stored on CD
• Copies of organisation policies or protocols that have been referred to or at least a reference made to it in the file


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• Cleaning schedules if there are infection control concerns
• Staffing rotas may be included to determine interviewees or possible staff shortages
• Any previous complaints about the same persons or situation or process
• Any previous complaints from the complainant, where appropriate
• Other supporting information obtained to help formulate a judgement
• The final investigation report should be included, detailing the author, the decision making process, conclusions and
recommendations i.e. a summary of the key facts relied upon in reaching the final decision
• The response letter to the complainant
• Evidence of support offered to staff involved in the complaint
• A chronology of the investigation process

25-28 days has been the historical target for delivering responses and for some Clinical Commissioning Groups, remains
a contractual requirement. This should be used as a starting point but complex complaints will reasonably take longer.
Also, some simpler complaints could be answered much more quickly. You should consider the urgency of the issues
raised, the complexity of the case and the reasonable expectations of the complainant.

Good record keeping assists in improving accountability and provides for transparent decision-making. Care Quality
Commission (CQC) Essential Standards of Quality and Safety also require that “A documented audit trail of the steps taken
and the decisions reached are retained.”

SERVICE RECOVERY:

Service recovery is how you can revert patient/ service user dissatisfaction to a point of satisfaction - the positive result
following a failed service encounter with your service user.

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Complaints Handling
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There are a few ways to achieve service recovery:
• A simple apology is all that the service user may be wanting and to recognise that you or the organisation were
indeed at fault or failed to provide a specific service.
• Providing a solution to the problem identified
• Compensating the service user/customer with something that is of value to them.


IMPROVING THE QUALITY OF CARE AND REDUCING INCIDENCE OF COMPLAINTS

If standards of care were better or patients felt they could raise concerns on the ward and see them dealt with at the time,
many would not feel the need to complain at all. Below are a few recommendations that could reduce the number of
complaints received with the Health Care sector:

! Staff providing basic care should be adequately trained, deemed competent or where appropriate, supervised by a
senior member of staff
! Annual appraisals to include a linked process to medical and clinical revalidation, which focuses on communication
skills and on appropriate dealing with patient concerns in a positive manner.
! Trusts should ensure that there are a range of basic information and support available on the ward for patients,
such as a description of who is who on the ward and their role and those who oversee the care provisions currently
in place. Consideration for suitable resources to accommodate where there may be language barriers, cultural
beliefs and for those who have learning disabilities or considered vulnerable allocated advocate/responsible person.
! Patients should be able to contribute and understand the care and treatment they are receiving. Whilst written
information can be helpful, it is always important to discuss diagnoses, treatments and care with a patient. Patients
frequently need to revisit topics already addressed.

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Complaints Handling
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 ! Trusts should provide patients with a feedback survey to address any aspects of their care whether positive or
negative to allow the organisation/commissioner to review current process and where possible, implement
changes.


IMPROVEMENTS IN THE WAY COMPLAINTS ARE HANDLED

There needs to be a change in the way hospital staff approach dealing with complaints. All feedback, including complaints,
offers valuable information, which can lead to improvements. But there must be the right organisational ethos to enable
this to happen, so that both the service user and the provider feel supported.

RECOMMENDATIONS

! Attention needs to be given to the development of appropriate professional behaviour in the handling of
complaints. This includes honesty and openness and a willingness to listen to the complainant, and to understand
and work with the patient to rectify the problem.
! Staff need to record complaints and the action that has been taken and check with the patient that it meets with
their expectation.
! Complaints are sometimes dealt with by junior staff or those with less training. Staff need to be adequately trained,
supervised and supported to deal with complaints effectively.
! Every Chief Executive should take personal responsibility for the complaints procedure, including signing off letters
responding to complaints, particularly when they relate to serious care failings.
! There should be Board-led scrutiny of complaints. All Boards and Chief Executives should receive monthly reports
on complaints and the action taken, including an evaluation of the effectiveness of the action.

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 ! There should be a new duty on all Trusts to publicise an annual complaints report, in plain English, which should
state what complaints have been made and what changes have taken place.
! Every Trust/ organisation has a legislative duty to offer complainants the option of a conversation at the start of the
complaints process. This conversation is to agree on the way in which the complaint is to be handled and the
timescales involved
! Where complaints span organisational boundaries, the Trusts involved should adhere to their statutory duty to
cooperate so they can handle the complaint effectively.
! Commissioners and regulators should establish clear standards for hospitals for complaints handling. These should
rank highly in the audit and assessment of the performance of all hospitals and those in the health and social care
setting.
! Implement a portal/system for sharing good practice on complaints handling between hospitals, including examples
of service improvements that result from action taken in response to complaints.

CONCLUSION:

Service users/relatives who complain are offering an organisation a chance to identify and resolve problems, demonstrate
excellent service, and uphold high level of standards and provisions for delivery of care. In essence, they are providing you
with a gift…

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Complaints Handling
15 Rev 01 16-Feb-2017