Chapter 9

Handling Complaints

Research suggests that satisfied customers will tell four or five others about a pleasant experience, but deliver a poor experience and expect seven to 13 others to hear about it.

In the UK, the 2000 National Complaints Culture survey demonstrated that the number of complaints is rising. What is worse is that over 40% of complainants were dissatisfied with the first response. Research also shows that if a complaint is handled well, there is every opportunity of retaining the customer (patient) and their loyalty increases. This results in a reduced risk of a complaint in the future.

A complaint can be defined as “an expression of dissatisfaction with the practice’s procedures, charges, personnel, or quality of service”. Of the many patients who may feel that they have experienced a less than satisfactory outcome, it is estimated that only 10% will actually complain. The reasons that have been identified for this are:

• feel uncomfortable

• do not know how to

• do not have time

• not going to return to the surgery anyway

• do not see any benefit from the complaints process

• a fear of retribution

• do not want to.

Opportunity or Threat

It will not come as a surprise to readers that anecdotal evidence suggests that healthcare professionals do not welcome complaints – no professional relishes the prospect of having to appease a dissatisfied client. But we need to change our perception of such events and turn the threats to opportunities for positive change, not reasons for defensiveness.

Why Do Patients Complain?

There is a great tendency to believe that people will complain for the same reasons that they sue (Chapter 8) but that is not necessarily correct. Patients complain for a variety of reasons. These include:

• quality of service received

• quality of the outcome

• the quality of care

• the patient’s expectations have not been met

• the patient is a crusader (i.e., believes that you should know if they are unhappy)

• the patient does not perceive that they have had value for money

• the patient may be a difficult patient or a professional complainant

• the patient may actively be trying to help improve things

• the patient may be driven to complain by someone else.

Seeking Feedback

No one likes to listen to a complaint, but it is important to try and find out why someone is unhappy before they tell someone else. The opportunity to deal with complaints in-house should not be missed – feedback from patients helps to identify the blindspots of service provision. Most recipients perceive complaints as negative and best avoided. Character building they may be, but welcome they are not.

One way of identifying dissatisfaction is to survey patients as part of a normal feedback mechanism. It is easy to ask patients to complete a post-treatment questionnaire – many will welcome the opportunity and be pleased to learn that their views are being sought. The benefit is that much of the feedback is likely to be positive and pleasurable to read.

The negative feedback provides an opportunity to address patient concerns. Addressing these concerns before they manifest as a formal complaint is an example of proactive risk management.

It is important to have an easily accessible and publicised complaints pathway for patients. Patients will tend to access the path of least resistance when it comes to making complaints and what better mechanism from a risk management perspective than an in-house process.

Outcomes

What patients are seeking when they complain is a swift, meaningful and satisfactory response and outcome. If there is no proper complaints pathway then there is the prospect that the patient will go elsewhere – perhaps to a lawyer or the regulatory body.

An Outlet

Many patients simply want to let you know that in their opinion you, or a member of your dental team, got it wrong. It is important that patients are allowed to vent their complaint which may relate to a single incident or to multiple events going back in the past. Complaints may arise out of a very minor incident that was “the last straw” as far as the patient was concerned.

An Explanation, an Apology or Reassurance

Most patients will accept that things can go wrong. If something adverse happens then the purpose of many patients complaining is to get a full explanation for what has gone wrong and why. An apology should always be offered where appropriate.

Many practitioners fear providing an apology on the basis that it will be perceived as an admission of fault or liability. There are many situations where the dentist has not been negligent, but the patient was not properly prepared for the outcome. There is nothing wrong whatsoever with apologising to the patient for a failure to explain, or a breakdown in communication if that is what has happened. Similarly, if a patient has suffered avoidable harm (e.g. a handpiece injury to the patient’s soft tissues) then an early apology can make a significant difference to the outcome.

Carole Durbin is a barrister and partner at Simpson Grierson in Auckland, New Zealand. In one of her seminars on complaints handling to the New Zealand Dental Association, she referred to an analysis which categorised the different types of “apologies” and offered a wide spectrum of different kinds of statements (see Box 9-1).

Box 9-1

The Meaning of Sorry

Refusal and explanation	In my position I can’t give an apology, but I want you to understand…
Time to consider	I need some time to think about what you are asking.
More information	Why? What will you do with any statements I make?
Conditional apology	I will apologise for …. If you also apologise about …
Sorry for an event	I am sorry that this has happened, I wish it hadn’t.
Sorry for hurt	I am sorry that this has caused you so much distress.
No admissions of fault	I don’t say that I was wrong, but if I have caused you offence, I apologise.
Apology plus explanation	I apologise, but my intentions were good. I was under a lot of pressure. I acted on the best information I had at the time. The event occurred in these circumstances.
I would do differently	If I had another chance, I would do it differently. I would consult you first. I would use different language.
Apology for fault	I am sorry… it was my fault… there is no excuse for that kind of behaviour.
Future remedial action	I apologise and will try to make sure it does not happen again. I have changed our systems already.
Apology plus forgiveness	I am dreadfully sorry, please forgive me.

A lack of apology is likely to have a significant impact on the patient’s perception of the complaints process.

Appropriate Remedial Action or an Intention to Do So

It is important to provide appropriate remedial action as a matter of urgency. If this is not possible then an intention to do so at the earliest opportunity is important.

A patient who is unhappy with the shade of a crown will not be placated with an offer for an appointment 4–5 months down the road. They want it rectified as soon as possible. Patients do accept that not all treatment is successful, but will be far less forgiving if there is any unjustified delay in putting things right.

Empathy

Chip Bell and Ron Zemke are amongst the world’s leading consultants on customer care and building loyalty. Through experience and research, they have identified “empathy” as a key factor in the recovery process following a complaint. Those charged with the responsibility for handling complaints should be trained with this perspective in mind. Many patients will find it difficult to complain given empathy. An uncaring response is likely to result in the complaint being directed to an outside agency, where it may escalate. The principle of risk containment should apply here.

Redress/Recompense or Symbolic Atonement

For some patients there is no doubt that the purpose of complaining is to obtain compensation. This may be a genuine wish for some form of atonement or a deliberate exercise in order to obtain money. Many patients complain out of a wish for symbolic atonement. This varies from a desire to have the dentist acknowledge fault and to demonstrate that he/she has learned from the process to the other extreme of having the dentist publicly humiliated before his/her regulatory body. Patients seeking revenge or a degree of retribution are unlikely to be satisfied by a complaints process – however, patients may be driven to this stage by poor complaints handling, in particular if they feel that they have been patronised or ignored.

Many patients seeking symbolic atonement do so because they want to be sure that the same adverse outcome does not happen to other patients, and can see no other way of ensuring this.

Follow-up

The hardest action for the recipient of a complaint is to follow up the patient after attempts have been made to address the complaint and resolve the patient’s dissatisfaction. This follow-up allows the practice and patient to />

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