How to Deal with Complaints in Healthcare

Complaints are an integral part of ensuring quality healthcare provision.

Knowing how to deal with complaints is crucial for professional growth, but handling the complaints of patients or their visitors can often be complicated and hard to navigate.

All aged care service providers are required to have internal complaints resolution processes under the Aged Care Act 1997 (ACSQC 2019).

This article addresses the best way to manage common complaints in healthcare settings. A common complaint is one that can be mitigated at a local level (i.e. the unit).

Note: The following advice is not applicable for complaints alleging criminal behaviour nor complaints that relate to breaches in code of conduct.

What is an Effective Complaint Handling System?

An effective complaint handling system should:

• Ensure issues are addressed adequately and in a timely manner;
• Strengthen the relationship between the service provider, care recipient and care recipient’s family and representatives; and
• Enable continuous service improvement.

(ACQSC 2019)

Note: The Royal Commission into Aged Care Quality and Safety (2020) has recently published a research paper outlining 50 new quality indicators related to a variety of topics, including complaint handling. This research can be viewed on the Royal Commission’s website.

Complaint-Handling Processes

The way in which a practice handles a complaint determines whether or not the practice can claim to be safe and responsive. Providers with efficient complaint-handling processes are best positioned to manage complaints quickly and with ease (HCC 2020).

An early resolution has the following benefits:

• Feelings of dissatisfaction with the service are less likely to intensify if the process is short;
• It may be less likely that the subject of the complaint will be discussed in the community;
• A quicker beginning of the complaints process usually means a quicker resolution; and
• The service and staff are demonstrating they take the complaint seriously.

An effective complaint-handling process creates opportunities to restore confidence in your services, increases quality as a result of feedback and prevents minor issues from escalating into bigger problems (HCC 2020).

Keep in Mind:

• Complaints are inevitable - everybody has a right to make a complaint;
• Complaints are not necessarily bad - in some cases, the complaint may reflect more on the processes than the staff. Support for staff in the event of a complaint is crucial. This support may even build trust in the team;
• Complaints are an important aspect of quality improvement - they can be useful in the aim of feedback for improvement; and
• Complaints give individuals a voice.

(Cusack 2019)

Complaints in Healthcare Settings

While blame and complaints occur in most workplaces, healthcare settings are particularly fraught with emotion and fear, and often high expectations on the part of the consumer (Suter 2017).

Your job isn’t to put consumers in their place, but rather, to learn from and reach closure on the complaint as quickly as possible.

Put yourself in their shoes: attending hospital (or another healthcare setting) is a significant emotional event for both patients and their visitors. People who are unwell are particularly vulnerable, and visitors and relatives may be anxious and overly protective.

All people will consider their own complaint issues to be serious, therefore, all issues should be dealt with accordingly.

Managing the Complaints of a Visitor

Relatives, friends and visitors need to know how to make complaints. The less time they spend trying to identify how to lodge the complaint and with whom, the less likely the issue is to be embellished or blown out of proportion.

When managing complaints from a relative, friend or another visitor of a patient, try to be as approachable as possible.

Consider holding a meeting away from the noise and bustle of the ward somewhere that is conducive to a confidential conversation. Assess whether it is necessary for the patient to also be present in the room.

In case the situation escalates, ensure that other staff members know where you are holding the meeting. Consider whether it may be worth having another staff member (or security) present and position yourself safely, between the complainant and the door.

Turn off pagers and mobile phones if possible, sit at the same level as the complainant and ensure you maintain a calm and even voice.

Making Complaints Accessible

Anyone who wishes to complain should be able to easily do so. Accessibility is a key component of an effective complaint management system (ACQSC 2019).

Accessibility can be achieved through:

• Providing information sheets to care recipients and their representatives explaining how to complain;
• Publicising your organisation’s complaints policy and contact details;
• Actively seeking feedback;
• Encouraging care recipients and their representatives to raise concerns;
• Gathering feedback in a variety of formal and informal ways (e.g. suggestions boxes, forms, conferences); and
• Providing access to advocates and language services.

(ACQSC 2019)

The Complaint Management Process

1. Acknowledging the Complaint

Complaints should be acknowledged in a timely manner. It is important to:

• Outline the complaint process to the complainant;
• Encourage the complainant (and their representative if applicable) to participate in the resolution process;
• Provide the complainant with the name and contact details of relevant personnel;
• Assure the complainant that you will maintain confidentiality; and
• Provide the complainant with an estimated duration for the complaint resolution process and inform them about when they will next be contacted.

(ACQSC 2019)

In some cases, a written acknowledgement may be appropriate. If the complaint was received via mail and can be addressed quickly, it may even be possible to provide the complainant with an acknowledgement and resolution simultaneously (ACQSC 2019).

2. Assessing the Complaint

This step involves:

• Clarifying the specific issue that has been raised by the complainant;
• Assessing the level of risk to the wellbeing, safety and health of those involved in the complaint;
• Determining whether any specific aspects of the complaint need to be prioritised;
• Communicating with the complainant to determine how they would prefer the issue to be resolved (e.g. apology, change in services, raising awareness of the issue); and
• Determining whether any legal representatives need to be consulted.

(ACQSC 2019)

Depending on the specific problem and the complainant’s preferences, some issues may be easier to resolve than others. However, if the complainant’s desired outcome is unachievable, you will need to explain why this is the case and offer them alternatives (ACQSC 2019).

Part of the assessment process is planning, i.e. determining how exactly the complaint will be managed. A plan might identify:

• The issues that need to be addressed;
• The complainant’s desired resolution and whether it is achievable;
• Any information that needs to be gathered and legal representatives that need to be consulted;
• An estimate of the time it will take to resolve the issue; and
• Any special considerations e.g. sensitive or confidential information.

(ACQSC 2019)

The care recipient, complainant and staff should be included in the planning process to ensure that a mutually agreed resolution is determined (ACQSC 2019).

Some complaints may also require investigation, i.e. the gathering of relevant information to help inform an appropriate resolution. Remember to uphold the principles of fair investigation: impartiality, confidentiality, transparency and timeliness (ACQSC 2019).

3. Responding to the Complaint

Once an appropriate resolution has been determined, the next step is to formally communicate this to the complainant and other parties involved. Depending on the situation, this could be through a conversation or written explanation (ACQSC 2019).

At this stage, you may consider offering an apology to the complainant. Apologising demonstrates empathy and may contribute to a more positive outcome, even if you are not completely at fault. An apology may also lead to an improved relationship between the service provider and complainant (ACQSC 2019).

4. Following Up the Complaint

Ask the complainant for feedback in regards to how their complaint was managed. If the complainant is unsatisfied, you may consider internal reviews, mediation or other options (ACQSC 2019).

5. Considering the Complaint

When finalising a complaint, always remember that the issue could occur again in the future. It may be beneficial to review policies and procedures or initiate systemic improvements (ACQSC 2019).

Recording Complaints

Record all complaints, detailing at a minimum:

• The date it arrived;
• Who sent it;
• What the complaint was about;
• Who did what about it (investigation-wise);
• How it was actioned;
• The outcomes of those actions; and
• A closure date.

(Suter 2017)

Communication is Key

Generally speaking, handling complaints well is underpinned by engaging with consumers about their concerns and working to understand the resolutions they are seeking.

Communication issues are responsible for the majority of complaints, and in many cases, complainants are simply looking for either an explanation or apology (HCC 2020).

Another common motivation behind complaints is to prevent the same thing from happening to others. This is why it is crucial to acknowledge complaints promptly and let people know what is being done to prevent it from happening again (HCC 2020).

When engaging with complainants, you should:

• Welcome the complaint, thank the complainant for raising the issue and show eagerness to resolve the problem.
• Be positive, professional and polite.
• Be empathetic.
• Offer information that may help the complainant gain a better understanding.
• Take notes to better clarify the situation and demonstrate that you are taking the complaint seriously.
• Always respect the complainant’s privacy and dignity.
• Be honest and avoid making promises that can not be upheld.
• Know how to apologise properly. Keep in mind that under Victorian legislation, ‘sorry’ is not an admission of guilt. By saying sorry, you are simply acknowledging that the complainant is upset and that their grievance/issue matters to you.
• Recognise the mistake and the harm it caused; when apologising, refrain from using cliched phrases.
• Outline clearly to the complainant what is being done to address the complaint in order to be proactive and assure them that their feedback is being taken seriously.
• Clarify and be firm in your explanation about what happened and why.
• Practice active listening.
• Be aware of the body language you are displaying; utilise non-verbal cues such as expressions, movement, gestures and eye contact.
• Recognise and respond to signs of stress from complainants.
• Validate the complainant’s concerns and commit to resolving the issue in a timely manner.
• Be patient; avoid rushing or interrupting the complainant.
• Escalate the complaint if required.

(ACQSC 2019; Cusack 2019; LIV 2017)

Conclusion

Remember that complaints handling is often targeted by accreditation assessors and concise records will be very useful in this situation, especially when an outcome can show an improved process along the way.

For managers or supervisors, it is vital that the staff trust that you will treat them respectfully and with discretion when questioning their actions, and that you and the staff member plan a suitable improvement plan together. Remind staff of the ratio of complaints to compliments, as in most cases, the compliments outweigh the complaints.

Remember that complaints are to be expected in all healthcare settings, it is not whether you receive complaints, but how you handle them that reflects your practice. Know that there are ample support and resources available to you in the event of receiving a complaint.

Additional Resources

• Aged Care Quality and Safety Commission, Better Practice Guide to Complaint Handling in Aged Care Services
• Health Complaints Commissioner
• Royal Commission into Aged Care Quality and Safety, Research Paper 15 - Residential Care Quality Indicator Profile

References

• Aged Care Quality and Safety Commission 2019, Better Practice Guide to Complaint Handling in Aged Care Services, ACQSC, viewed 30 November 2020, https://www.agedcarequality.gov.au/sites/default/files/media/better_practice_guide_to_complaint_handling_in_aged_care_services_-_2019.pdf
• Cusack, K 2019, 'Healthcare Complaints and Investigations', Ausmed, 28 February, viewed 7 August 2019, https://www.ausmed.com.au/cpd/lecture/healthcare-complaints-and-investigations
• Health Complaints Commissioner 2020, Complaint Handling Standards, HCC, viewed 30 November 2020, https://hcc.vic.gov.au/providers/complaint-handling-standards
• Law Institute Victoria 2019, Why Apologise?, LIV, viewed 6 August 2019, https://www.liv.asn.au/Staying-Informed/LIJ/LIJ/December-2017/Why-apologise-
• Royal College of Nursing, Patient Family Complaints, RCNi, viewed 5 August 2019, https://rcni.com/hosted-content/rcn/first-steps/patient-family-complaints
• Royal Commission into Aged Care Quality and Safety 2020, Australian Residential Aged Care Quality Indicators, Royal Commission, viewed 30 November 2020, https://agedcare.royalcommission.gov.au/news-and-media/australian-residential-aged-care-quality-indicators
• Suter, C 2017, 'Receiving Complaints from a Patient, Relative or Visitor', Ausmed, 6 March, viewed 7 August 2019.