Authors: Charlotte Davies, Steve Walters, Eimear Jones / Editor: Elizabeth Herrieven / Codes: SLO12 / Published: 30/07/2019

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Answering complaints is an important role of the Emergency Department Consultant and it’s now part of the RCEM management portfolio. We’ve made a few suggestions about how to answer complaints but everyone will have their own tips, so feel free to leave a comment or two.

Complaints procedures vary by Trust so read your local policy and speak to the people who answer complaints regularly. Here, however, are a few tips and tricks that we’ve picked up along the way.

Front Line Response

Often complaints can be halted on the shop floor just by listening, apologising and trying to offer a solution -even if you don’t think their complaint is justified. Listen to what the complainant is actually saying – not what you think they are saying! Stay calm and give them chance to express their concerns. If you can’t solve the problem maybe someone else can – often the senior nurse will be the most experienced person in the department at de-escalating complaints. Never say that something is “nothing to do with you” or “not your department”. Say that you will try to help and put the patient in contact with the appropriate person. Only when you have done everything possible to resolve the concern, or if the patient is adamant they wish to complain, should you direct the patient to Complaints or PALS.

PALS

All Trusts have a Patient Advice and Liaison Service, who can be contacted by email, telephone or in person. The PALS team manage to resolve many complaints before they get to the formal stages. PALS will “triage” the patient’s complaint and, depending on the nature of the concern and wishes of the patient, may attempt to agree an informal resolution, or register the issue as a formal complaint (which may be through passing the case to a separate Complaints Department, who can also be contacted directly rather than via PALS). The content of the complaint will be reviewed and even if the patient agrees an informal resolution, it may be appropriate to complete an incident form. PALS have a non biased view on the complaint and the complainant. They will be able to easily link into other departmental resources. Remember complaints should be seen as a positive thing – they are able to stimulate us to improve, and sometimes give us the “clout” that we need.

By triaging the complaint, PALS are able to identify the key issues and the preferred action of the patient – if all the patient wants is another appointment it’s easier for everyone if they can make that happen rather than going through a full investigation and a formal written response. PALS are also able to see if the complainant has raised similar concerns before and offer advice on how to proceed. Patients who persistently complain may need a specific “code of conduct” plan – your trust will have advice on who needs this, and how to create it.

If the person writing the complaint is not the person affected (eg. daughter of a mother with dementia who was the patient), the Complaints or PALS department will make sure appropriate consent from the patient has been sought. If the patient is deceased and the complainant has “sufficient interest” the complaint will proceed. Children can complain, although they are encouraged to involve an adult in their complaint. Complaints should be accepted in any language. Sometimes MPs complain on the behalf of their constituents – it is assumed by most trusts that the MP has gained consent to do so.

PALS or the Complaints Department will also liaise if more than one department has to answer the complaint. They will help form an agreement as to who should lead the response and will review the final response letter to check the language is appropriate. They will also help co-ordinate a meeting to discuss the complaint should it be agreed that this will aid resolution of the concern.

The process around answering complaints is regulated by:

  • Best practice guidance from the Department of Health
  • The Parliamentary and Health Service Ombudsman‘s Principles of Good Complaint Handling 2009
  • Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, introduced 1st April 2009
  • Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 16: Receiving and acting on complaints

Ongoing Care

Making a complaint should not alter the quality of care the patient receives. It is recognised that making a complaint sometimes causes the relationship between the doctor and patient to break down and continuing treatment would not be in either party’s best interest. If possible, the patient’s care should be transferred to another clinician, including in another NHS trust if appropriate. Because care should not alter, details of complaints should not be documented in the patient’s file.

Timelines

Making a complaint: A complaint should be made within 12 months of the incident that is the subject of the complaint or 12 months from the date the complainant became aware of the matter that is the subject of the complaint. If it would have been unreasonable for the complaint to be made earlier and where it is still possible to investigate the facts of the case effectively, then discretion may be used.

Responding to a complaint: All complaints should be triaged and acknowledged within three working days.
The regulations require that an appropriate timescale to receive a written response is agreed with the patient and the patient should be kept informed of any delays. Some Trusts have general timescales which they aim to achieve all responses by – often this is within 25 working days but check your local complaints procedures.

Concluding Complaints

Once a response has been sent, if the patient is still not satisfied they can approach the Trust for further resolution. If the patient is still not satisfied or if the Trust is not able to offer any further resolution the complainant has the right to approach the Parliamentary and Health Service Ombudsman (PHSO).

Answering a Formal Complaint – Procedure

  • Check the complaint has been through the appropriate channels (Complaints or PALS teams)
  • Inform Caldicott Guardian if relates to breach of confidentiality
  • Inform other departments if complaint is not just about yours, if this has not already been done
  • Check confidentiality / consent
  • Send a response letter. This will normally be written to the complaints coordinator, who will then send a united trust response.
  • Learn from the complaint
  • Trainees involved should reflect (in writing or orally)
  • If complaint is complicated consider legal / MPS / MDU review of your response.

Answering a Complaint – Structure

Each complaint will be different in terms of what you need to say. The tone of your letter should be professional, measured and sympathetic and you should try to avoid jargon and medical abbreviations. It is easier to write in the first person if you were involved in the complaint.

The response should be typed on headed paper, with the date written, and the complaint number documented. Each trust will be different, but you are likely to be writing your response letter to the complaints coordinator. This person will generally then pull all responses together into a formal response to the patient from the Chief Executive.

It will be difficult to start – a useful phrase is “thank you for asking me to respond to the concerns raised by…”. Specify what your account is based on – is it memory, contemporaneous notes, statements or usual working practice – the key phrase is likely to be “I have made this report based on the contemporaneous notes made at the time, and statements made by the doctors who looked after…”.

Do not assume the person reading your response has any background knowledge of the case, so your next paragraph should start with a factual account of what happened. This should be objective but contain relevant information to the complaint – e.g. “There had been 12 emergency calls, instead of our expected 5” rather than “we had too many blue calls, and we couldn’t cope”. In ED, it is often useful to highlight the timeline eg. “you were booked in at 1959, triaged at 2010, and seen by a doctor at 2059 – an hour after arrival”.

After this factual account offer an apology where appropriate. Some people find it easier to structure this using “The 3Rs”:
Regret – acknowledge that something has gone wrong, even if you are not at fault.
Reason – provide a reason for the mistake, if there is one.
Remedy – ask the complainant what they would like to happen, or highlight the steps you have already taken.

You could say “In response to the concerns raised by… firstly, on behalf of the department, I would like to apologise, and hope that this report will answer some of the questions and concerns raised”.

You should never, however, apologise that a patient “felt the need to complain” or that they “felt you were rude”. This is seen as a ‘non-apology’ as it is not apologising for the specific event, just for bad feeling. Instead, you could say that you “understand their concerns”. You can of course say you are “sorry to hear about your poor experience” or that you are “sorry for the sad outcome” without saying the complaint was justified.

You can then explain what has happened, identifying any causes.  Comment only on the performance of your own department, though, and let other departments respond regarding their own issues.

Finish off with a repeated apology and a summary of the bottom line, together with suggested learning outcomes.

Summary

  • An explanation
  • An apology
  • A response to the individual concerns raised by the complainant
  • An account of action taken or planned to improve the care of or service to the individual and/or to reduce the risk of a re-occurrence, where appropriate
  • An account of the conclusions drawn and a copy of the risk investigation, if applicable
  • Who to contact if the complainant remains unhappy with the response so that further efforts to resolve the matter can be made locally.

We hope this has provided you with some useful tips for answering complaints. We’d love to hear your suggestions and if you have any “stock” phrases or complaint templates. Managing a complaint is a mandatory component of the RCEM management portfolio – so is something you, or your supervisees, will have to do.

For further reviewing, this is a great review of the Complaints System – Putting Patients Back in the Picture.

There are lots of brilliant comments on twitter around answering complaints.

 

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