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Advice for health-care institutions on how to manage patient complaints

When patients complain, health-care facilities must avoid three common mistakes in how they respond, Toronto health lawyer Kate Dewhirst tells AdvocateDaily.com.

“I advise health-care organizations across Ontario, and one of the things I help them do is respond to patient complaints,” says Dewhirst, founder and principal of Kate Dewhirst Health Law. “It’s always hard receiving a critique, hearing that you haven’t met somebody’s expectations. It’s especially hard when the complaint is delivered loudly, rudely and mean-spiritedly.”

But whether a complaint is about clinical care, professionalism, civility, fees or parking, she coaches her clients to avoid three major pitfalls in dealing with it: 

Not recognizing an opportunity for improvement

In order to receive and make use of constructive criticism, institutions must create an environment where feedback is explicitly encouraged, Dewhirst says.

“My first comment to health-care teams is that it’s really hard to get people to tell you what’s going wrong. Even if a team receives complaints, it’s not necessarily that we’re encouraging the right kind of feedback," she says.

"If we have an engaged and responsive individual who’s received a service and noticed problems, that is the best evidence we could have that something is not working.”

Organizations must convey the message that if people come forward with complaints somebody will do something about their concerns, Dewhirst adds.

“We must show that we want to do better and that we need their input to meet our goal.”

That could mean putting up waiting-room posters requesting feedback and training front-line staff on how to listen, and informing employees where to direct particular types of complaint, she suggests.

“In any service, we do things because that’s the way we’ve always done them,” Dewhirst says. “If we don’t hear differently, we just continue to do it the way we thought was appropriate in the first place.”

One reason people don’t come forward with helpful criticism is the power imbalance between staff and patients, she says.

“Patients and caregivers are fundamentally in a vulnerable position," Dewhirst says.

“Most of the time there is uncertainty and vulnerability. Almost always there is pain. This isn’t a situation where you can go it alone if you don’t like what’s happening. If people feel like they will receive bad care because they’ve raised an issue of concern, they just won’t.”

Not recognizing a complaint

Patients and caregivers often air their displeasure to the "wrong" staff person and don’t use the language that an organization uses to raise a complaint, she says.

“People don’t say tap tap tap on the shoulder, 'Excuse me, I would like to make a complaint today.' Instead, they complain to the coffee clerk,  or a front-line administrative person and make casual statements of frustration or problems," Dewhirst says.

"Complaints come to folks who aren’t complaint managers. If the vocalization goes to the wrong person, organizationally we may never know.“

 When patients’ concerns do not receive a response “in the moment,” the issue tends to escalate, she warns.

“When we don’t recognize there’s a complaint, there can be a bad outcome because no one got back to that person. That message didn’t get conveyed to the right staff person, no one followed up, and so that person sits and seethes. When that happens there can be negative patient impact and serious reputational damage,” Dewhirst says.

Front-line staff should be trained to recognize actual complaints and respond in the moment. She suggests having the person write down the complaint and letting that person know an administrator or patient relations team member will call them.

Not putting four walls around a complaint

Another thing health-care organizations sometimes fail to do when someone complains is to clarify the totality of the person’s issues, Dewhirst says.

“Somebody comes forward and makes a complaint, but we make a mistake if we don’t say ‘and is there anything else?'"

The complaint may then go on for months, in a cloud of issues, because the first thing the person mentions is not the main thing they are worried about, Dewhirst says.

“They were actually worried more about part 2, and they didn’t tell you that after part 2 they were really worried about parts three, four and five.”

It’s important to ask the “what else” question, she says. “I call it putting four walls around the complaint.”

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