Are you confident in your complaints procedures?

This may be the policy you hope you will never need to use but I would argue that it is a policy that you need to be using regularly.   It is a requirement of Practice Standards that you have a procedure for responding to complaints.  With good procedures in place you will be able to resolve most complaints to your patient’s satisfaction and avoid any escalation to a formal complaint to your regulator.  On a positive note a complaint is an opportunity to learn and develop your practice.  If you are recently qualified you need to be equipped to handle complaints from day one of clinic work.  If you have been in practice for any length of time you may have experienced complaints, bear these in mind and consider whether you could have improved how you handled these situations.  When you look at the list of things that can be considered a potential complaint you will realise you are handling these situations regularly.

Recognising Complaints

Using your complaints procedures regularly will help you to recognise a complaint and respond efficiently and effectively to any matters arising.  Maybe you may think it is obvious to be able to recognise a complaint – surely it is just someone expressing dissatisfaction or concern.  Sometimes complaints can be veiled and you need to be aware of these situations so you can respond appropriately and also know when you need to involve your insurers.  Your insurers should be your first port of call when there is any situation which indicates a complaint is being raised.  If you try to handle the matter yourself and the complaint escalates you may find that you will not be covered by your insurers.

Balens, one of the insurers for osteopaths, have identified 5 warning signs of complaints which you need to be aware of, if you receive any of these you need to respond in collaboration with your insurers:

  • A verbal complaint of dissatisfaction, with a threat of taking things further
  • A letter of complaint alleging dissatisfaction, neglect, error or omission
  • Patient not attending for treatment without explanation or further contact
  • Patient refusing to settle or delaying payment of fees for an unreasonable period
  • A request for a refund of fees because treatment has not met expectations or has caused some harm

There are some complaints that should always be referred to the GOsC including dishonest, indecent or violent acts, abuse of alcohol or drugs, relationships with patients and incompetence.

Patients may raise complaints about a variety of things including lack of response to treatment, misdiagnosis, inappropriate referral to another practitioner or investigation, treatment making symptoms worse, treatment reactions, not enough time spent with them, long treatment courses etc. etc.  These are situations you will be responding to regularly and probably without any issues but be aware that any dissatisfaction has the potential to escalate if poorly handled.  Most practitioners are excellent at satisfactorarily responding to patients which maybe why the osteopathic profession has such a low number of complaints.

Complaints Procedures

Your clinic should have procedures in place for handling complaints.  You need a complaints procedure in place with all staff trained in the procedures.  Staff should be able to explain to a patient how you will proceed with handling their complaint.

This an example of how your complaints procedure should operate:

A patient comes in to the reception and makes a complaint to the receptionist and asks for a refund for their last treatment.  The receptionist tells your patient that you are currently busy in clinic but will be available to discuss the matter at 1pm.  She explains that you will take the matter seriously and investigate fully and offers the patient a copy of your clinic procedure for handling the complaint.  The receptionist makes an arrangement with the patient that you will telephone them at 1pm and you will not leave a message if the patient is unavailable but will try calling again until 2pm.  The patient is happy with this arrangement and leaves.

As agreed, at 1pm you phone and speak to the patient.  You explain that you will need to take details of their issue and then will investigate and get back to them with a response before the end of the week.  You listen carefully to the patient and make notes of their complaint.  You identify the resolution that they are seeking – which is a refund for the treatment and a referral letter back to the GP.  You repeat back to the patient your understanding of their issues and they agree that you have understood.  You agree with the patient to contact them again by telephone at 1pm on Friday to discuss the outcome or progress of your investigation and again, not to leave a message if they are unavailable.

You telephone your insurers and explain the situation.  They ask you to send by email an account of what has happened and your proposed response as soon as possible.  You review your notes and the treatment you gave and write a summary followed by the record of the patient’s complaint.  You explain to the insurers that whilst you think that the patients expectations of treatment were unrealistic and you do not believe you have caused any harm to the patient you are willing to give a refund to the patient as a gesture of goodwill and will write to the GP giving an account of your findings and treatment and recommending further investigations into the patient’s complaint.  Your insurers help you to write a response to the patient and agree to the gesture of goodwill refund.

You call the patient back on Friday at 1pm as agreed and say that you have investigated the complaint and read them the details agreed in the letter.  The patient is happy with this response.  You tell the patient you will write to the GP that day and that you will also post a copy of the GP letter, and your written response to their complaint with their refund today.  The patient thanks you very much for your understanding.

As a response to the complaint you complete a significant event analysis which enables you to reflect, learn and develop your practice.  You identify that you need to improve your communication of treatment expectations with patients.  This leads you to take some online learning about managing expectations.  You also alter your case history to add a box to encourage you to identify patient expectations from treatment so you know whether these are realistic and then make this part of the initial consultation dialogue.

From this simple example you can see that receiving a complaint can help you to learn and develop and handling a complaint well can prevent the complaint from escalating.  In your practice you need to have a complaints procedure and train your staff in the procedure you also need a simple leaflet explaining the process to patients.  Your patients should know that they can raise complaints, make comments and compliments and know how to do this.  This should be advertised in your practice and on your website.

There are a few risk factors for complaints that you should be aware of.  High risk groups include new patients, vulnerable patients – due to pain or life circumstances, patients that are new to you, adverse reactions to treatment, lack of improvement and prolonged treatment.  Be careful with these patients to make sure you are clearly explaining treatment, what you are doing and why and that you are agreeing with the patient how to proceed.

Your clinic situation

In multi-practitioner practices it is very important everyone knows and understands the lines of communication for handling complaints so that the patient is not given conflicting information and complaints are not miss-handled.  There is potentially some vulnerability if other practitioners are responding to your patients you need to be happy with the practice arrangements or make sure you can be contacted directly if you want to deal with your own patients.

If you work alone there are several options.  First of all you need to be prepared to handle complaints yourself and have a policy in place.  It is a good idea to make reciprocal arrangements with another practitioner or practice so there is an alternative person to approach if the patient does not feel happy speaking directly to you, otherwise the complaint could potentially escalate quickly because they don’t know who else to turn to apart from the regulator.

These are just some tips for recognising and handling complaints you will find more details in the Mint Folder or download the Handling Complaints module.

If you have good procedures in place for communication and obtaining consent you will have a much more robust foundation from which to handle a complaint.

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