- Email: [email protected]
How to deal with a complaint
PERSONAL PRACTICE
How to deal with a complaint
communication about care; insufficient communication about medical interpretation of results or future care plans. Complaints can arise from perceived rudeness or dismissiveness of staff; delays in assessment and treatment; adverse outcomes of healthcare; and disappointed expectations. Some complaints focus on ‘the system’; some express the carer’s general frustrations at being in an alien environment when anxious about a child’s health and well-being.
Alistair Thomson
Abstract What do Complainant’s want?
Complaints about clinical and non-clinical care are becoming more common. Resolving complaints constructively can help improve care of the complainant and others. Poor responses to complaints can be counterproductive and ultimately more time-consuming. Paediatricians receive a moderate number of written complaints with a variety of motivations. A collaborative approach to addressing the issues is most likely to lead to a balanced response. Defensible documentation is the basis of a successful analysis of the complaint. A careful, detailed written account of the clinical facts should be prepared. Opinions and management decisions can thereby be more easily explained. Complaints often highlight the lack of clinical reasoning recorded in the medical notes. Discussions about complaints in departmental education sessions can disseminate learning effectively.
Most complainants want a proper acknowledgement of their complaint and a sincere apology. An apology is not an admission of liability (although some complainants may claim they view it as such). Beyond that there may be a variety of reasons for a complaint. A common phrase to read is that complainants wish ‘to make sure the same mistake never happens again’. Most doctors view this as unrealistic, but this has some reasonable components, which include the need to understand matters better; to highlight mistakes in care; and to improve patient care overall.
Complainant’s motivation
Keywords Complaint; formal complaint; patient complaint; patient
Many complaints arise out of understandable concerns about a child’s health. Some reflect a desire to return the child’s health to the time before the illness: this is not always possible. In such instances, adjustment to the child’s new status may involve the parents going through a grief process. The normal stages of grief e denial, anger, bargaining, depression and adjustment e can all be subverted into a complaint. The risk of pathological grief reactions under such circumstances is high. A grief reaction may be continuously restarted and augmented as new complications of an illness emerge. Parents may seek to blame the healthcare professionals involved, so as to lighten the (often unjustified) burden of their own guilt for the child’s predicament. A few complaints are from people who are perpetually unsatisfied; some view a complaint as the best way of getting special treatment; and a few wish to gain information for a major complaint or litigation. Recognising these can be helpful in responding appropriately to the complaint.
liaison; response to complaint; written complaint
Introduction Few people receive complaints with equanimity; but if we wish to improve the care we give, receiving a complaint positively can be the first step. A well-answered complaint can satisfy the complainant, address care of the patient in question and thereby improve the service for others; a poorly handled complaint can cause more problems.1,2 This article focuses on written complaints. Paediatricians are in a moderateerisk profile for Trust-level complaints. Complaints about a child’s care may be made by anyone. Most often they come from family members, including grandparents and more distant relatives. It may initially feel reassuring to have a complaint made by one family member that is not supported (or opposed) by others, but the need to properly address the complaint is not diminished. In general complaints about paediatricians arrive via the Trust’s complaints department. They represent a fraction of the total number, most of which are about adult patients and adult problems. Thus complaints about paediatric care may be unfamiliar to the Trust in a number of ways and a paediatrician’s response to the complaint should carefully set out the paediatric perspective.
Receiving the complaint Written complaints can arise by letter or via email. Most come via the Trust’s complaints department. Read it carefully; once read you can start ‘slow thinking’ about it.
Informing others Generally the complaint will be known to others already. The department’s clinical lead will be informed by the Trust’s complaints department. Therefore, inform the clinical lead that you are responding. If the complaint is serious, the divisional lead, the medical director, or the legal department need to be informed. Occasionally your defence organisations or other bodies (GMC, BMA, or Head of School, Training Programme Director and Educational Supervisor for trainees) may need to know. Inform others who contributed to care - e.g. those healthcare staff who looked after the child during an admission, or through
What are complaints about? A theme to emerge from analyses is that complaints are commonly about communication. This could mean incomplete communication of results, diagnoses or management plans; poor
Alistair Thomson MA MD BChir FRCPCH FRCP DCH DRCOG Consultant Paediatrician, Leighton Hospital, Crewe, UK. Conflict of interest: none declared.
PAEDIATRICS AND CHILD HEALTH 29:1
38
Ó 2018 Elsevier Ltd. All rights reserved.
PERSONAL PRACTICE
a series of outpatient visits related to the complaint - that they may be approached by the complaints department. Be sensitive doing so: although their involvement may have been slight, they may be upset to hear of a possible complaint against them. Discuss the complaint with anyone likely to be involved in the response. If others need to respond separately, avoid collusion. It will be important to allow them to form their own response. However, it is unhelpful for a response to a complaint by separate parties to contain contradictory chronology or viewpoints. Divergence of views should be resolved before submitting the response to a complainant. This may need to be brokered through a third party.
Answer all the elements of a written complaint. It may be useful to do so in the order that they occur in the letter of complaint. However, complaints letters tend to have several inter-mixed components. Consider organising them in different ways: for example, matters of factual accuracy, clinical issues, allegations about behaviour, etc. Once organised in the best way for the circumstances, respond to each e either singly or bracketed together. Complex responses with lengthy words and sentences, complicated reasons, or a defensive or arrogant tone are unhelpful. A comprehensive and detailed response couched in simple but clear lay language is best and can obviate supplementary questions.
Getting advice
Contacting and meeting the complainant
It is helpful to discuss some complaints with the clinical lead, whose advice and experience may prove valuable. Talk to colleagues, locally or further afield, to gain advice. Although this can seem difficult, an external view often provides perspective. If the complaint is serious, discussion with the divisional lead, the medical director, or the legal department is advisable. The complaints department response to a complainant is likely to be apologetic by default, while advancing a Trust viewpoint. Ensure that your view is represented.
It may be useful to meet the complainant before finalising the response to a complaint. If so, ask the complaints department to arrange an appointment. Before meeting, prepare a final draft of your written response, so that your views on the issues are clear. Be prepared to modify these as you hear more at the meeting. Rehearse your response to the components of a complaint beforehand: this will help you to stay coherent and calm. (Perhaps rehearse responses into a tape recorder and play them back, with a colleague, critical friend or the complaints manager). Invite a friend for them and a witness for you (Trust manager, or a colleague). It can be helpful for someone else to keep a record of the meeting as it proceeds. If the complaint involves a colleague, consider whether to include them in a joint meeting. This may be appropriate if there is a medical complaint around, for example, the transfer of a sick child to a tertiary centre, or the birth and resuscitation of a baby; it may not be appropriate if the complaint is about clinical care in one part and secretarial department responses on another. Before the meeting, prepare the environment: ensure privacy, comfortable seats, water and glasses, writing paper and pens, tissues, the medical notes and all supplementary information. Thank the complainant for coming and introduce everyone. Listen to the complaint(s), stay calm and make a list of the issues to discuss. Refer to the contemporaneous medical records to respond. Show the relevant notes to the complainant if appropriate (e.g. to demonstrate times when actions were taken or results returned), but explain them carefully. Generally do not share copies of notes at this stage since it diverts attention away from the conversation. Respond to queries if you know answers; or commit to further enquiries; do not give commitments that cannot be kept. Summarise, checking that all the issues have been dealt with and outline what will happen next e further enquiries, a letter, another meeting. End by thanking the complainant.
Gathering the information Avoid responding to a complaint without first consulting all the information available. Besides medical records this may include correspondence, emails about the patient’s care, notes by other healthcare staff, secretaries, customer care/patient advice and liaison services, etc. Accurate recall of events is important: this is often at variance with contemporaneous records. Misinterpretation of medical events by lay persons is common. Mis-statement of the sequence of events by those present is usually not deliberate, but can be the result of shocking and unusual events being subject to memory distortion and recall bias. While some recall is sometimes more detailed than medical notes have recorded, contemporaneous notes and records are the best source for accurate and detailed chronology. If medical records are not immediately available, set down a private note of your account of events; update this as you recall more, but be prepared to modify this when the medical notes become available.
Responding to a complaint There is usually a deadline for response. Do not ignore this. As soon as you have the information, begin a response. A good response may need to go through several drafts; the sooner the first draft is attempted the better. After reading the complaint and all the information, set aside some time, while the matter is fresh in your mind. Some general principles are useful for the written response. Firstly, a clear chronology is often the best way to set out how and why events unfolded. Remember to differentiate between what was recorded in the medical and nursing records and the observation charts (the facts) and what can be recalled (it is often instructive how little clinical reasoning is recorded). Use clear language and explain medical terms.
PAEDIATRICS AND CHILD HEALTH 29:1
Finalising the written response - more is more? Provide a full initial response to a complaint, aiming at brevity and succinctness. Spell- and grammar-check it. Even if not all used in the Trust’s response it can provide a record of the issues, your practice and your initial response in case matters escalate into a further complaint or litigation. The target standard is a well-constructed, accurate and objective account, which could be used as the template for a court document if necessary.
39
Ó 2018 Elsevier Ltd. All rights reserved.
PERSONAL PRACTICE
Share your final draft with the complaints department and, if necessary, the Trust’s legal department and solicitors. Your written response to the Trust’s complaints department will help to construct their final response letter. You should insist on seeing the final response, checking what is said on your behalf. If you are not happy, explain why.
Key Learning Points in Coping with Complaints Aim to treat complaints positively Put yourself in the complainant’s position Listen carefully to the complaint Respond to all components of the complaint Meet and send a summary to the complainant Write (and discuss) a reflection
Prevention of complaints
Do not: Delay answering a complaint Fail to gather and use the facts Flout the Duty of Candour Submit an incomplete, ill-constructed or unprofessional response Forget to support trainees and other staff Keep it all to yourself
Dealing successfully with complaints should foster a culture which improves the general care given to patients, not just those with the issue relevant to the complaint. Primary prevention of complaints requires keeping up-to-date with current practice and new developments (q.v. GMC’s Good Medical Practice). Write your own notes, and check those made on your behalf. Ensure contemporaneous, comprehensive records, which are legible, timed, dated and signed. Dictate letters and discharge summaries promptly: keep them brief, structured and relevant. Leaders in the department set an example by their conduct, behaviour and standard of medical care. Treat patients and colleagues with courtesy and respect; remain even-tempered and equable; and be approachable by all staff and relatives. All these will reduce the risk and incidence of complaints. Be ready to acknowledge your mistakes, demonstrating that it is acceptable and the norm to do so. Show that you are able to learn from the errors of yourself and/or other staff. The GMC’s Duty of Candour principle is sound in practice but needs care. Talking about even a minor medical error is quite different to discussing a new development or deterioration in the course of an evolving illness. Breaking the news of a medical error to a patient or parent - together with its implications and possible remedies - requires experience and excellent communication skills exercised tandem with tact, sensitivity and empathy. Timing and pacing and a follow-up meeting may be required. Senior team members are often best discussing such matters. Members of the healthcare team should be ready to support those who have received complaints with a non-judgemental approach. Discussion can be helpful. It is an Educational Supervisor’s duty to ensure that trainees report errors and complaints and to support them through the process. Most juniors and newly appointed consultants have not been the subject of a direct complaint and should be guided through the steps. Help them to avoid submitting incomplete, introspective, unnecessarily or unjustly self-incriminatory or subjective responses. Documents remain in the records so those which skimp on chronology, are poorly expressed, badly spelt or punctuated can create an unprofessional impression.
Vignette no. 1 A mother complained about a delay in establishing her child’s diagnosis. Several senior doctors had seen the patient but investigations for her expected diagnosis were negative. The mother wanted treatment started; the assessing consultant offered a further subspecialist opinion. A detailed written response addressed all elements of the many-headed complaint. A lengthy timescale was acknowledged, but investigation and referral waits had made up the most part. The sub-specialist referral was subsequently accepted and a rare hereditary diagnosis was confirmed and treated. The child stayed under the care of the original consultant. The consultant’s comprehensive written response to the complaint was commended by the complaints department.
Vignette no. 2 A complaint was made about a consultation on a toddler who had been brought by mother and grandmother. It alleged that the consultation had been brief, that no examination had been conducted, that concerns had not been addressed and no diagnosis had been offered. With reference to the medical records, a written response was constructed confirming the duration of the consultation, the examination undertaken and the assessment arranged to clarify the parents’ suggested diagnosis and inform management. An apology was offered for any deficit of explanation during the consultation. The mother and father attended the next booked consultation where a further apology was offered with a brief discussion recapping the written response. After investigation a rare condition e but not the parents’ original suspected diagnosis - was diagnosed.
Learning from complaints Complaints should be reported to the Clinical Incident system. They may be discussed in morbidity and mortality meetings. Some complaints will involve a full root cause analysis (RCA) process, - which clinicians should attend. A reflective note about every complaint should be recorded in your (e-)portfolio for discussion at appraisal: anonymise clinical details and preserve confidentiality. If a complaint has led to a change in your (or others’) practice or has learning points of
PAEDIATRICS AND CHILD HEALTH 29:1
general relevance it could be presented at a Quality Improvement (QI) or Continuing Professional Development (CPD) meeting. Presentation may identify patients and staff: inform others who have been involved so that they can contribute. Discussion can set an example and facilitate feedback on how the complaints process was followed.
40
Ó 2018 Elsevier Ltd. All rights reserved.
PERSONAL PRACTICE
dealt with, but its use needs prior thought, sensitivity and skilful communication. Ultimately complaints can stimulate and enhance both personal and professional development. A
Aftermath of complaints The best outcome of a complaint would be resolution to the mutual satisfaction of complainant and doctor, re-establishment of trust and improvement of the therapeutic relationship with lessons incorporated into service or practice. This is the commonest result of complaints; and it can be made more likely by adherence to the principles and good practice outlined so far.
REFERENCES 1 GMC. Good medical practice. 2013. London: GMC, https://www. gmc-uk.org/guidance/good_medical_practice.asp (accessed 30 March 2018). 2 Medical Defence Union. MDU Guide to the new NHS and social care complaints procedure. At: https://www.themdu.com/get-mdusupport/ive-had-a-complaint (accessed 30 March 2018).
Conclusion Written complaints are increasing in frequency. Many can lead to improved care. The Duty of Candour informs how complaints are
PAEDIATRICS AND CHILD HEALTH 29:1
41
Ó 2018 Elsevier Ltd. All rights reserved.
How to deal with a complaint
communication about care; insufficient communication about medical interpretation of results or future care plans. Complaints can arise from perceived rudeness or dismissiveness of staff; delays in assessment and treatment; adverse outcomes of healthcare; and disappointed expectations. Some complaints focus on ‘the system’; some express the carer’s general frustrations at being in an alien environment when anxious about a child’s health and well-being.
Alistair Thomson
Abstract What do Complainant’s want?
Complaints about clinical and non-clinical care are becoming more common. Resolving complaints constructively can help improve care of the complainant and others. Poor responses to complaints can be counterproductive and ultimately more time-consuming. Paediatricians receive a moderate number of written complaints with a variety of motivations. A collaborative approach to addressing the issues is most likely to lead to a balanced response. Defensible documentation is the basis of a successful analysis of the complaint. A careful, detailed written account of the clinical facts should be prepared. Opinions and management decisions can thereby be more easily explained. Complaints often highlight the lack of clinical reasoning recorded in the medical notes. Discussions about complaints in departmental education sessions can disseminate learning effectively.
Most complainants want a proper acknowledgement of their complaint and a sincere apology. An apology is not an admission of liability (although some complainants may claim they view it as such). Beyond that there may be a variety of reasons for a complaint. A common phrase to read is that complainants wish ‘to make sure the same mistake never happens again’. Most doctors view this as unrealistic, but this has some reasonable components, which include the need to understand matters better; to highlight mistakes in care; and to improve patient care overall.
Complainant’s motivation
Keywords Complaint; formal complaint; patient complaint; patient
Many complaints arise out of understandable concerns about a child’s health. Some reflect a desire to return the child’s health to the time before the illness: this is not always possible. In such instances, adjustment to the child’s new status may involve the parents going through a grief process. The normal stages of grief e denial, anger, bargaining, depression and adjustment e can all be subverted into a complaint. The risk of pathological grief reactions under such circumstances is high. A grief reaction may be continuously restarted and augmented as new complications of an illness emerge. Parents may seek to blame the healthcare professionals involved, so as to lighten the (often unjustified) burden of their own guilt for the child’s predicament. A few complaints are from people who are perpetually unsatisfied; some view a complaint as the best way of getting special treatment; and a few wish to gain information for a major complaint or litigation. Recognising these can be helpful in responding appropriately to the complaint.
liaison; response to complaint; written complaint
Introduction Few people receive complaints with equanimity; but if we wish to improve the care we give, receiving a complaint positively can be the first step. A well-answered complaint can satisfy the complainant, address care of the patient in question and thereby improve the service for others; a poorly handled complaint can cause more problems.1,2 This article focuses on written complaints. Paediatricians are in a moderateerisk profile for Trust-level complaints. Complaints about a child’s care may be made by anyone. Most often they come from family members, including grandparents and more distant relatives. It may initially feel reassuring to have a complaint made by one family member that is not supported (or opposed) by others, but the need to properly address the complaint is not diminished. In general complaints about paediatricians arrive via the Trust’s complaints department. They represent a fraction of the total number, most of which are about adult patients and adult problems. Thus complaints about paediatric care may be unfamiliar to the Trust in a number of ways and a paediatrician’s response to the complaint should carefully set out the paediatric perspective.
Receiving the complaint Written complaints can arise by letter or via email. Most come via the Trust’s complaints department. Read it carefully; once read you can start ‘slow thinking’ about it.
Informing others Generally the complaint will be known to others already. The department’s clinical lead will be informed by the Trust’s complaints department. Therefore, inform the clinical lead that you are responding. If the complaint is serious, the divisional lead, the medical director, or the legal department need to be informed. Occasionally your defence organisations or other bodies (GMC, BMA, or Head of School, Training Programme Director and Educational Supervisor for trainees) may need to know. Inform others who contributed to care - e.g. those healthcare staff who looked after the child during an admission, or through
What are complaints about? A theme to emerge from analyses is that complaints are commonly about communication. This could mean incomplete communication of results, diagnoses or management plans; poor
Alistair Thomson MA MD BChir FRCPCH FRCP DCH DRCOG Consultant Paediatrician, Leighton Hospital, Crewe, UK. Conflict of interest: none declared.
PAEDIATRICS AND CHILD HEALTH 29:1
38
Ó 2018 Elsevier Ltd. All rights reserved.
PERSONAL PRACTICE
a series of outpatient visits related to the complaint - that they may be approached by the complaints department. Be sensitive doing so: although their involvement may have been slight, they may be upset to hear of a possible complaint against them. Discuss the complaint with anyone likely to be involved in the response. If others need to respond separately, avoid collusion. It will be important to allow them to form their own response. However, it is unhelpful for a response to a complaint by separate parties to contain contradictory chronology or viewpoints. Divergence of views should be resolved before submitting the response to a complainant. This may need to be brokered through a third party.
Answer all the elements of a written complaint. It may be useful to do so in the order that they occur in the letter of complaint. However, complaints letters tend to have several inter-mixed components. Consider organising them in different ways: for example, matters of factual accuracy, clinical issues, allegations about behaviour, etc. Once organised in the best way for the circumstances, respond to each e either singly or bracketed together. Complex responses with lengthy words and sentences, complicated reasons, or a defensive or arrogant tone are unhelpful. A comprehensive and detailed response couched in simple but clear lay language is best and can obviate supplementary questions.
Getting advice
Contacting and meeting the complainant
It is helpful to discuss some complaints with the clinical lead, whose advice and experience may prove valuable. Talk to colleagues, locally or further afield, to gain advice. Although this can seem difficult, an external view often provides perspective. If the complaint is serious, discussion with the divisional lead, the medical director, or the legal department is advisable. The complaints department response to a complainant is likely to be apologetic by default, while advancing a Trust viewpoint. Ensure that your view is represented.
It may be useful to meet the complainant before finalising the response to a complaint. If so, ask the complaints department to arrange an appointment. Before meeting, prepare a final draft of your written response, so that your views on the issues are clear. Be prepared to modify these as you hear more at the meeting. Rehearse your response to the components of a complaint beforehand: this will help you to stay coherent and calm. (Perhaps rehearse responses into a tape recorder and play them back, with a colleague, critical friend or the complaints manager). Invite a friend for them and a witness for you (Trust manager, or a colleague). It can be helpful for someone else to keep a record of the meeting as it proceeds. If the complaint involves a colleague, consider whether to include them in a joint meeting. This may be appropriate if there is a medical complaint around, for example, the transfer of a sick child to a tertiary centre, or the birth and resuscitation of a baby; it may not be appropriate if the complaint is about clinical care in one part and secretarial department responses on another. Before the meeting, prepare the environment: ensure privacy, comfortable seats, water and glasses, writing paper and pens, tissues, the medical notes and all supplementary information. Thank the complainant for coming and introduce everyone. Listen to the complaint(s), stay calm and make a list of the issues to discuss. Refer to the contemporaneous medical records to respond. Show the relevant notes to the complainant if appropriate (e.g. to demonstrate times when actions were taken or results returned), but explain them carefully. Generally do not share copies of notes at this stage since it diverts attention away from the conversation. Respond to queries if you know answers; or commit to further enquiries; do not give commitments that cannot be kept. Summarise, checking that all the issues have been dealt with and outline what will happen next e further enquiries, a letter, another meeting. End by thanking the complainant.
Gathering the information Avoid responding to a complaint without first consulting all the information available. Besides medical records this may include correspondence, emails about the patient’s care, notes by other healthcare staff, secretaries, customer care/patient advice and liaison services, etc. Accurate recall of events is important: this is often at variance with contemporaneous records. Misinterpretation of medical events by lay persons is common. Mis-statement of the sequence of events by those present is usually not deliberate, but can be the result of shocking and unusual events being subject to memory distortion and recall bias. While some recall is sometimes more detailed than medical notes have recorded, contemporaneous notes and records are the best source for accurate and detailed chronology. If medical records are not immediately available, set down a private note of your account of events; update this as you recall more, but be prepared to modify this when the medical notes become available.
Responding to a complaint There is usually a deadline for response. Do not ignore this. As soon as you have the information, begin a response. A good response may need to go through several drafts; the sooner the first draft is attempted the better. After reading the complaint and all the information, set aside some time, while the matter is fresh in your mind. Some general principles are useful for the written response. Firstly, a clear chronology is often the best way to set out how and why events unfolded. Remember to differentiate between what was recorded in the medical and nursing records and the observation charts (the facts) and what can be recalled (it is often instructive how little clinical reasoning is recorded). Use clear language and explain medical terms.
PAEDIATRICS AND CHILD HEALTH 29:1
Finalising the written response - more is more? Provide a full initial response to a complaint, aiming at brevity and succinctness. Spell- and grammar-check it. Even if not all used in the Trust’s response it can provide a record of the issues, your practice and your initial response in case matters escalate into a further complaint or litigation. The target standard is a well-constructed, accurate and objective account, which could be used as the template for a court document if necessary.
39
Ó 2018 Elsevier Ltd. All rights reserved.
PERSONAL PRACTICE
Share your final draft with the complaints department and, if necessary, the Trust’s legal department and solicitors. Your written response to the Trust’s complaints department will help to construct their final response letter. You should insist on seeing the final response, checking what is said on your behalf. If you are not happy, explain why.
Key Learning Points in Coping with Complaints Aim to treat complaints positively Put yourself in the complainant’s position Listen carefully to the complaint Respond to all components of the complaint Meet and send a summary to the complainant Write (and discuss) a reflection
Prevention of complaints
Do not: Delay answering a complaint Fail to gather and use the facts Flout the Duty of Candour Submit an incomplete, ill-constructed or unprofessional response Forget to support trainees and other staff Keep it all to yourself
Dealing successfully with complaints should foster a culture which improves the general care given to patients, not just those with the issue relevant to the complaint. Primary prevention of complaints requires keeping up-to-date with current practice and new developments (q.v. GMC’s Good Medical Practice). Write your own notes, and check those made on your behalf. Ensure contemporaneous, comprehensive records, which are legible, timed, dated and signed. Dictate letters and discharge summaries promptly: keep them brief, structured and relevant. Leaders in the department set an example by their conduct, behaviour and standard of medical care. Treat patients and colleagues with courtesy and respect; remain even-tempered and equable; and be approachable by all staff and relatives. All these will reduce the risk and incidence of complaints. Be ready to acknowledge your mistakes, demonstrating that it is acceptable and the norm to do so. Show that you are able to learn from the errors of yourself and/or other staff. The GMC’s Duty of Candour principle is sound in practice but needs care. Talking about even a minor medical error is quite different to discussing a new development or deterioration in the course of an evolving illness. Breaking the news of a medical error to a patient or parent - together with its implications and possible remedies - requires experience and excellent communication skills exercised tandem with tact, sensitivity and empathy. Timing and pacing and a follow-up meeting may be required. Senior team members are often best discussing such matters. Members of the healthcare team should be ready to support those who have received complaints with a non-judgemental approach. Discussion can be helpful. It is an Educational Supervisor’s duty to ensure that trainees report errors and complaints and to support them through the process. Most juniors and newly appointed consultants have not been the subject of a direct complaint and should be guided through the steps. Help them to avoid submitting incomplete, introspective, unnecessarily or unjustly self-incriminatory or subjective responses. Documents remain in the records so those which skimp on chronology, are poorly expressed, badly spelt or punctuated can create an unprofessional impression.
Vignette no. 1 A mother complained about a delay in establishing her child’s diagnosis. Several senior doctors had seen the patient but investigations for her expected diagnosis were negative. The mother wanted treatment started; the assessing consultant offered a further subspecialist opinion. A detailed written response addressed all elements of the many-headed complaint. A lengthy timescale was acknowledged, but investigation and referral waits had made up the most part. The sub-specialist referral was subsequently accepted and a rare hereditary diagnosis was confirmed and treated. The child stayed under the care of the original consultant. The consultant’s comprehensive written response to the complaint was commended by the complaints department.
Vignette no. 2 A complaint was made about a consultation on a toddler who had been brought by mother and grandmother. It alleged that the consultation had been brief, that no examination had been conducted, that concerns had not been addressed and no diagnosis had been offered. With reference to the medical records, a written response was constructed confirming the duration of the consultation, the examination undertaken and the assessment arranged to clarify the parents’ suggested diagnosis and inform management. An apology was offered for any deficit of explanation during the consultation. The mother and father attended the next booked consultation where a further apology was offered with a brief discussion recapping the written response. After investigation a rare condition e but not the parents’ original suspected diagnosis - was diagnosed.
Learning from complaints Complaints should be reported to the Clinical Incident system. They may be discussed in morbidity and mortality meetings. Some complaints will involve a full root cause analysis (RCA) process, - which clinicians should attend. A reflective note about every complaint should be recorded in your (e-)portfolio for discussion at appraisal: anonymise clinical details and preserve confidentiality. If a complaint has led to a change in your (or others’) practice or has learning points of
PAEDIATRICS AND CHILD HEALTH 29:1
general relevance it could be presented at a Quality Improvement (QI) or Continuing Professional Development (CPD) meeting. Presentation may identify patients and staff: inform others who have been involved so that they can contribute. Discussion can set an example and facilitate feedback on how the complaints process was followed.
40
Ó 2018 Elsevier Ltd. All rights reserved.
PERSONAL PRACTICE
dealt with, but its use needs prior thought, sensitivity and skilful communication. Ultimately complaints can stimulate and enhance both personal and professional development. A
Aftermath of complaints The best outcome of a complaint would be resolution to the mutual satisfaction of complainant and doctor, re-establishment of trust and improvement of the therapeutic relationship with lessons incorporated into service or practice. This is the commonest result of complaints; and it can be made more likely by adherence to the principles and good practice outlined so far.
REFERENCES 1 GMC. Good medical practice. 2013. London: GMC, https://www. gmc-uk.org/guidance/good_medical_practice.asp (accessed 30 March 2018). 2 Medical Defence Union. MDU Guide to the new NHS and social care complaints procedure. At: https://www.themdu.com/get-mdusupport/ive-had-a-complaint (accessed 30 March 2018).
Conclusion Written complaints are increasing in frequency. Many can lead to improved care. The Duty of Candour informs how complaints are
PAEDIATRICS AND CHILD HEALTH 29:1
41
Ó 2018 Elsevier Ltd. All rights reserved.