It is important to ensure that in an environment
of best practice and continuous improvement, issues raised by
patients are responded to appropriately and in a timely manner.
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.
What to do and what not to do
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.
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 or your staff.
Improving your practice
Every practice should have a protocol for dealing with
complaints, which includes the following principles.
Figure: Process and relationship of complaints to the
Handling the complaint
- 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
- It is a good idea to deal with complaints of a clinical nature
yourself (or the medical director if this is someone else's role
within the practice), while complaints about the practice could be
dealt with by you or your practice manager.
- Do not ignore complaints. It is good practice to deal with
complaints as quickly as possible with an emphasis on resolving the
- 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 does the patient expect from making a complaint - what
aspects of their care 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
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.
Resolving the complaint:
- Speak directly with the patient if they have made a complaint -
preferably face-to-face if practical.
- If the patient complaint is from a health care complaints body
or medical registration board, 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.
- Keeping 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.
How to wrap it up
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. 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
Terminating the doctor-patient relationship
When informing the patient that you intend to terminate the
relationship, do not blame the patient but rather the relationship.
Follow up this discussion with a letter to the patient repeating
your 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. Advise practice staff to make no further
appointments for the patient.
However, it is not appropriate to end the relationship if you
are currently treating the patient for a serious health problem or
you 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
Learning from complaints
Monitoring and review of complaints should be part of every
practice. Information about near misses, adverse events and
complaints provides an opportunity to improve the standard of
service and care. Ensure that near misses, adverse events and
complaints become a standing item at every practice meeting, and
discuss any recent issues in a de-identified manner - not
appointing blame but using it as a discussion point about what
could be done differently next time.
Looking after yourself
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, your partner, Avant's medico-legal service,
seek advice and seek support.
Patient safety is a fundamental part of providing quality health care in which doctors and practice staff play an integral role. Although doctors take great care to ensure the safety of their patients, adverse, or sentinel events do occur. When they do, it is important that practices have a thorough system in place for identifying and analysing the cause and effect of these events. The fundamental purpose of having a robust system in place is to reduce the risk of a similar incident occurring again.
Factsheet: Dealing with patient complaints
Factsheet: Open disclosure: how to say sorry
eLearning: Managing adverse events for registrars
Article: Sorry: little word with big impact