Handling patient complaints and dispute resolution

Patient feedback and complaints are vital business tools used for addressing identified risks, near misses, and improving business processes. Such information can assist the business to identify strengths and weaknesses and opportunities to improve their services and facility. These services can be continually improved through a systematic analysis and response to customer complaints, which may also be the best source of market-based information available to the provider.

All feedback from patients, including their families, and staff should be encouraged at all times. All complaints, both formal and informal should be managed appropriately, fairly and promptly.

People usually complain because something has gone wrong, but they may also complain because of unmet expectations or because there has been a breakdown in communication.

People may also complain about the practice itself: being kept waiting too long without explanation, breaches of privacy, abrupt staff, confusing messages etc. (often this is due to “inconsistency of message” – different information from different people about the same topic).

How you deal with complaints may have an influence on whether the matter will go further (e.g. to the medical registration body, to a complaints handling body or to the patient's lawyer). The following is a simple guide on what to do and what not to do if you receive a complaint about you, your doctors or your staff.

• You should ensure the complaint is being made by the patient themself. If being made by a relative, next of kin or other you need to be aware of the need to respect and maintain the patient’s confidentiality.
• There are staff designated to deal with complaints. If patients perceive that their complaint is being taken seriously and is being handled by someone with sufficient authority to address and resolve their concerns, they are generally more likely to accept the outcome.
• Allow staff the authority to deal with difficult situations where they are able to cope with those situations. Alternatively, you must be available or have systems in place to allow staff to seek assistance if a situation escalates and they require assistance.
• In the first instance, it is a good idea to deal with complaints of a clinical nature yourself; you can then involve the doctor as necessary.
• Do not ignore complaints. It is good practice to deal with complaints as quickly as possible with an emphasis on resolving the concerns.
• Listen to the concerns raised: you may not agree that there was anything to complain about, but that is not the view of the person who made the complaint. Encourage the patient to tell you what has happened in their own words:
  - What is the complaint about?
  - Who is it about?
  - What outcome does the patient expect from making a complaint?
  - What aspects of their care or service provided would they like to see done
  differently?

The scope of the complaint is very important to establish at the outset as you may assume the worst but the patient’s concern may be very limited. For instance, they want to see a copy of a report and have it explained, or to receive an apology for being kept waiting for an extended period.

Acknowledge the complaint and the patient's feelings: “I can see that you're upset, it must have been frustrating for you” etc. If you are upset about an outcome, tell the patient. There is nothing wrong with empathy. If you are sorry about what happened, tell them.

Care about the patient. Be available if something has gone wrong, be prepared to meet with them, more than once if necessary, to address and resolve their concerns.

• Speak directly with the patient if they have made a complaint – preferably face to face if practicable.
• If the patient complaint is from a healthcare complaints body, the Medical Board of Australia or AHPRA, or is a claim for negligence initiated by the service of a Statement of Claim or other court document from the patient’s lawyers, contact Avant for advice.
• For all other complaints - once received in writing or verbally - acknowledge in writing that you have received the complaint, and follow up with a phone call.
• Suggest a meeting to discuss the concerns. Encourage the patient to bring a friend or partner to accompany them, or suggest an interpreter if language is a barrier.
• Gather the facts: medical notes, copies of reports, records of phone calls, discuss with relevant staff, checking local protocols. Check what happened on that day: was it especially busy? Was that the day you were running very late and were rushed? The day a casual had to be called in to replace a staff member on leave?
• Provide information. Most people who complain wish to obtain information about what happened, and what it means for them.
• Consider the factors that led to the complaint: are there changes that can be made to prevent a recurrence? If so, communicate this to the patient as they will wish to see you take the complaint seriously and that it will make a difference,

Keep parties informed. If there will be delays while you seek out facts or in your being available, say so, as uncertainty or “no response” will add to the grievance.

Provide a summary of what has been covered, what has been achieved and ascertain if the patient is satisfied that their concerns have been addressed. Clarify what will happen next. If follow-up is required, make sure it happens. If further information, treatment or a referral has been promised, make sure this happens. You should ensure that both parties agree to an acceptable timeframe around resolution. Be prepared to be reasonable about fees. The aim is to resolve an issue and preserve the therapeutic relationship.

If, however, you feel that the relationship can no longer be sustained because of the complaint, there are ways of managing this.

When informing the patient that the practice intends to terminate the relationship, do not blame the patient but rather the relationship. Follow up this discussion with a letter to the patient repeating the doctor’s decision and highlighting the importance of any ongoing care they require. Advise that you are happy to provide a copy of their medical records (without cost to the patient even if this is your usual record transfer policy), and offer assistance finding a new doctor if necessary. Practice managers should advise practice staff to make no further appointments for the patient.

However, it is not appropriate to end the relationship if the doctor is currently treating the patient for a serious health problem or they are the only practitioner offering a particular service. Be careful not to terminate a relationship with a patient solely on the basis of gender, sexual preference, race, disability, age, HIV status or other factors covered by anti-discrimination legislation.

It is a confronting experience to receive a complaint. It is difficult not to become defensive. The temptation is to deny the issues, to blame the patient for being difficult, non-compliant, hostile etc. However, it does not help resolve the situation by fighting back, ignoring the problem or being ‘petulant’.

Talk to a colleague, the practice principal, your professional organisation, or Avant’s Medico-legal Advisory Service, seek advice and seek support.

Further reading

Nash, L., Curtis, B., Walton, M., Willcock, S. and Tennant, C. The response of doctors to a formal complaint. Australasian Psychiatry 2006; Vol 14 (3): 246 – 250.

Mulcahy, L. 2003, Disputing Doctors: The Socio-legal Dynamics of Complaints about Medical Care, Open University Press, Buckingham, UK.