Handling Complaints, Meetings, and Presentations

National interest
Effective Leadership [1]
Organisation structure (independent personnel and committee
Record maintenance, complaint database and electronic information systems
Standardisation of complaint handling strategies
Quality improvement surveys
Training on communication and information dissemination
Patients should be informed how to make a complaint, and to whom. Written, verbal, telephonic complaints should be accepted.
Details of complaint management process should be available in hospital handbooks, websites and posters. All hospital staff are required to register the complaint if approached. Sixty five percent of all complaints are first reported to front line staff [11].

Steps in Complaint Management


Acknowledge the complainant; Update the complainant about the process and time frames.

Document time, date, hospital no, provider no, relevant addresses, witnesses name -maintain for records.

Register the complaint with the institutional database and clinical governance unit . Complaint notification form and clinical incident form to be filled as appropriate (written or electronic).

Assess the severity of the complaint for appropriate management strategy and referral.

Ensure fairness of procedure, communication, and outcome.

Investigation of the complaint.

Outcome- explanation/apology, health care policy changes, training and monitoring of health staff, fee exemption, disciplinary action, no action .

Complaint Handling- Organisational Structure

Who Registers Complaints?

Complaints from patients can be accepted by the front line staff (doctors, nurses , technicians, pharmacists) and assessed by the complaint committee or complaint manager. Complaint from an employee is notified to the immediate supervisor, line manager, human resources or the occupational safety and health representative

How to Handle Complaints?

The informal procedure: The complaint manager will not investigate or refer, but mediate or assist the employee in the resolution . To avoid the time and money spent on legal course, Alternate dispute resolution (ADR) systems have emerged to address patient complaints in an informal way [12]. The various ADR strategies are enumerated in Table 4.2.
Table 4.2

Alternate dispute resolution strategies
Negotiation : Both complainant and accused mutually decide on resolving dispute
Conciliation : Complainant and accused resolve the dispute in presence of a facilitator
Mediation : Facilitator actively influences resolution of dispute
Arbitrarisation : The facilitator makes the decision
Mini trial : Jury of senior officers, representing both the disputing parties, decide on the dispute
Summary jury trial : Jury of lawyers representing both the disputed parties, argue in the ­presence of an independent jury. The decision here is nonbinding
A formal process is used if the issue cannot be resolved informally or if the employee chooses it. Here, manager will investigate, interrogate and resolve the dispute .

Who Handles Complaints?


Health Care Personnel: In a survey of literature from US, UK, Australia, NZ and Singapore, patient complaints in most hospitals were initially handled by social workers [13]. Complaints regarding staff behaviour were handled by the public relations unit (PRU). However, the priority for PRU was organisation reputation over complainant satisfaction. Complaints about clinical incidents involving doctors or nurses were handled by the Line Manager. Complaints involving medical malpractice were referred to Medical disputes team.

Complaints committee : This is a committee formed by independent professionals in a hospital or region and occasionally board members and designed to address non legal complaints from patients [14]. The committee acts a mediator between the patient and the professional. It advises the patient about the outcome of the complaint and the corrective measures taken. The primary goal is to restore patient satisfaction and trust in the health care system . The committee lacks discretionary powers and can only advice the professionals. If the complaint is unresolved , serious, complex, involving multiple staff or departments, the committee refers it to the line manager and senior complaints officer and then to the board of executives.

Statutory disciplinary system or Registration board: This addresses patient’s complaints that require legal proceedings. The primary purpose of the board is to inspect and regulate quality of clinical care and professional conduct in hospitals . The board is empowered to issue warnings, suspension, work prohibition and cancellation of licenses of the professional.

External agencies: For unresolved patient complaints at the level of the hospital Board or serious complaints (criminal, corruption charges against medical practitioner), liaison with the Medical council or Registration Board, Civil Court, Police, Coroner is required. Government Ombudsman services are available in many countries for dispute resolution of general public. In UK, Australia and New Zealand, the State Health Service Commissioner specifically addresses complaints of patients and hospital employees. [15, 16] In New Zealand, The Health and Disability Commissioner is responsible in upholding the rights of a patient-right to respect, right to information, right to complain [17]. Fairwork Ombudsman is an independent agency of Australian Government to investigate complaints of all commonwealth employees including health care staff.
In summary, complaints in health care settings are very common. Poor communication by the staff is the most common cause for complaints. Every health care organisation should have a strategy and team to manage complaints. Prevention of complaints by open disclosure , effective communication and transparency in delivering health care services should be the primary goal.

Handling Meetings

Health care organisations today strive for quality improvement in clinical care. Besides, clinical skills, the professional needs managerial skills to coordinate with medical and management staff , ensure safety of patients and employees, manage complaints, allocate resources, organise research activities, network with professionals, and educate staff and students. Meetings are usually the starting point for all these processes. The Oxford Dictionary defines meeting as ‘An assembly of people for a particular purpose, especially for formal discussion’. The importance of ­planning and conduct of meetings in the context of health care organisation is discussed and few tips are provided to make them effective.
1) Is the meeting needed?
The first step is to question if a meeting is really needed. Most meetings are poorly planned, time consuming, and are organised in short notice. It is a collaboration of heterogeneous group of thinkers or planners. Face to face meetings are becoming less popular, given the various modalities of information exchange. However, for taking major decisions and disseminating information quickly and confidentially, face to face meetings will be indispensable.
2 Type of meetings
Meetings are generally classified into 3 types—(1) Information meetings (2) Problem solving or decision making meetings (3) Education meetings .
Lectures and conferences are examples of education meetings. Most of the departmental or staff meetings in health care settings are held for making decisions. Informational meeting differs from the former in that the decision is already made prior to the meeting. Decision making meetings can be further classified as parliamentary, hierarchical, and facilitated [18].
  • Parliamentary meetings are dictated by Robert’s Rules of Order for debating, decision making, addressing other members, and disagreeing with other speakers. Some executive level meetings are conducted in this manner. Decisions that achieve majority by voting get accepted.
  • Hierarchical meetings follow an individual centred approach, where the chair person gives information and takes the decision on behalf of the members. Members have more freedom to express their opinions.
  • Facilitated meetings have a group approach, where every member in the meeting equally contributes to arriving at a decision that is finally upheld. The decision is made by consensus, where every member of the group is amicably convinced to either adopt or support a particular decision at the end of the meeting. Since all members are stake holders of the decision, no one loses (win–win situation). Consensus decisions, though time consuming, are the most effective decisions for implementation [19]. The chair person or facilitator is the key person in these meetings.
Most of the meetings have characteristics of both hierarchical and facilitated type.
3) Planning for meetings
3.1 Main agenda:
The subject matter of the meeting is divided into various components which are described in order in the agenda . The time and person allotted to discuss each of the components is also listed in the agenda. An agenda format is represented in Table 4.3. The agenda, reading material/reminders must be sent much in advance to make the meeting productive. Consent agenda is a subset of the main agenda. It is a group of informational, self explanatory and non controversial items in the agenda, which do not require much discussion in the meeting . This is a tool to streamline meetings and direct members solely to issues that need discussion [20].
Table 4.3

Agenda format
Name of the hospital
 Topic of discussion
3.2) Participants
Meetings generally comprise of key decision makers, persons with analytical skills, managerial skills , persons to whom assignments will be allocated, sponsors, resource allocators, minutes recorder, and time keeper. Occasionally, a scribe would be required to express ideas on a board or flip chart. The chairperson is in charge of moderating the discussion. Not every meeting would need all these participants. Participation by no more than 15 people is usually required for effective interaction. The members are required to declare conflict of interest (COI) before the meeting in relation to any item on the agenda . Depending upon the nature of the conflict, the chair can allow the member to participate after registering the conflict, restrict his role in the meeting, or recruit another member in his position. In extreme situations, the member can be removed from the meeting/organisation and can be ordered to relinquish from the COI.
3.3) Venue and time
The venue should be easy to locate, calm, comfortable, and preferably sound proof. It should support optimised use of lighting and devices for projections, animations, videos, etc. Round table with chair arrangements is preferred if there are less than 15 members and all are required to interact. Theatre style chair arrangements is suited for a group over 20 people [21]. Name cards are required, if it is a formal meeting of important stake holders. Facilities for housekeeping and trouble shooting should be in place. Departmental staff meetings are preferably scheduled during lunch time, when hospital staff members are free of clinical commitments. Meetings on weekends, public holidays and Friday afternoons are best avoided to ensure attendance [21].
4) The ground rules for successful and productive meetings [22] and responsibilities of the chairperson are covered in Tables 4.4 and 4.5.
Table 4.4

Ground rules for successful meetings
Start and end on time
Avoid briefing late comers
Mobile phones in meeting mode
No smoking
Breaks after every 45 min
Coffee and refreshments during long meetings
Speak one at a time
Avoid personal criticism and private conversations
Respect everyone’s ideas
Avoid repetition and irrelevant discussion
Table 4.5

Responsibilities of the chairperson
Prepare the agenda
Select and invite the participants, organise venue date and time
Collect background information and review previous meetings
Introduce the participants
Set ground rules and time limits
Facilitate discussion, and consensus decision
Assignment of tasks with deadlines
Summarise and evaluate the meeting
5.1) Handling speakers
  • Incessant speakers: The chairperson can hint the speaker to stop by making gestures (turning around, looking disinterested, having side conversations), asking to summarise thoughts, promptly thanking for input, or by asking another speaker to comment on his/her opinion. At times, active interruption is needed.
  • Passive participants: Subtle cues like frequent eye contact, asking questions that will yield a yes-no answer (e.g. do you share the same opinion?), and complimenting the comments are likely to engage them in discussion. Breaking into smaller groups for discussion usually helps in shedding the inhibitions [23].
  • Disruptive speakers: The chairperson should announce a break, ask speakers to put their comments to paper, privately counsel the speakers, and make escape statements (e.g. can we have this discussion later?
5.2 Active listening includes non verbal responses (smiling, nodding) and verbal responses (compliments) to acknowledge the speaker’s idea. [24] This positively reinforces the speaker. Active neutrality (listening most of the time and asking few, but relevant questions) also has similar effect [25].
5.3) Confrontation
The preferred ways of confronting speakers to clarify the message include open ended questions (e.g. “Can you explain your point with an example?”), and ­paraphrasing (“Is that what you are trying to say?”
5.4) Handling antagonism
Partly agreeing with the opposing speaker without giving up one’s stand on the issue (fogging), asking another member’s view point and assertiveness while talking can control antagonism [26].
5.5) Handling mundane discussions
Coffee breaks can be a respite from mundane discussions. Visual presentations, ­videos, question answer sessions and tasteful humour can raise the spirit of ­meetings.
5.6) Body language
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Nov 16, 2015 | Posted by in General Dentistry | Comments Off on Handling Complaints, Meetings, and Presentations
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