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Putting out fires

Patient experience staff may be familiar with the idea that some types of patient complaint are perennial, pervasive and well-known.  

One example is "communication" or "attitude" - a sense from patients that even if their clinical care was good, the way they were spoken to could have been better.  Another is waiting times, along with difficulty getting appointments, or scheduled appointments being rearranged at short notice. 

According to one nursing unit manager interviewed for this Canadian study on patient complaints, "nothing is new, but we don’t have a solution".

So why is it that some types of patient complaint persist for years, without appearing to lead to institutional or system-wide improvements?  The authors identify three challenges:

Firstly, the nature of the issues are well known, but difficult to address.  Some clinicians, for example, simply apologise when a complaint arises about their attitude, rather than working on improving their communication style.  And although training courses on communication may be well received by staff, they do not necessarily stop communication coming up as an issue in complaints year after year.

A second challenge is the use of weak change strategies.  Again, there may be an over-reliance on one-off education sessions.  Or improvements may be restricted to specific units, rather than rolled out across whole institutions or systems.

The third challenge is resolution of complaints outside the formal complaints structure.  The study found that unit managers preferred handling patient complaints directly, as formal complaints might suggest failures in their management. Moreover, they considered the additional bureaucracy of a formal complaint burdensome, and many complaints lodged through the formal system would eventually come back to unit managers for resolution anyway.  But when complaints are resolved directly, the learning - about both the problem and the solution - may be invisible to the institution as a whole.

Faced with these challenges in embedding organisational learning and improvement, patient experience staff focus instead on "complaint resolution", typically defined as addressing patient complaints in as timely a fashion as possible. Many referred to this part of the job as "putting out fires".

The authors found that "in an effort to do something rather than nothing, [patient experience staff] reach for simple and inexpensive responses".  But "the daily work of 'putting out fires' and … simply placating patients and resolving complaints as quickly as possible… may in effect suppress the patient voice".  

The authors conclude that "the major categories of complaints remained unchanged year after year [which] in itself attests to difficulties in developing effective improvements from past complaints".

You can download the report via our website.
Complaints evidence on tap

The evidence uncovered in "Putting out the fires" is confirmed by similar research from elsewhere:

This study found that NHS staff "reported feeling overwhelmed and fatigued by the volume and variety of [patient feedback] data that the Trust collected".  In addition, "Patient experience was sometimes said to be the poor relation of patient safety and finance with a lesser emphasis and priority placed on it". 

A paper on Patient-Centred Insights reported that "The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools".  It argues for data-driven approaches to understanding and learning from complaints.

This toolkit aims to help people assess the effectiveness of complaints handling services.  It makes reference to the duty of candour, and to national evidence about the complexity of complaints systems from the patient's point of view.

For more evidence of patient complaints handling, search "complaint" here:  
This just in…
New evidence on all aspects of patient experience and involvement is being published all the time.  Check out our top picks from recent reports:
A citizen-led approach to health and care: Lessons from the Wigan Deal.
Reducing the need for restraint and restrictive intervention. 
Public involvement experiences of adults with learning disabilities and parent carers.
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