Complaints, contrition and constructive criticism

I wrote a letter to my MP last week. It’s fair to say that I was unimpressed with the response. There were some good points to be fair – it was sent the day after my email and it was polite. But that’s pretty much where it ends.

In essence my letter to my MP was a letter of complaint about the actions of a senior minister. I tried to keep to the basic rules of complaints – courteous, specific and some clarity over my expectations. The reply – in my view – avoided answering the issues raised, ignored one aspect completely and didn’t contain a hint of apology. I was left feeling cross and that my issues were not being taken seriously.

I’m not writing this to have a go at my MP. My MP is widely respected and rightly so. I suspect any MP of the governing party would have written much the same, and any opposition MP would probably have written a diatribe about the current government. Neither is helpful, but, sadly, that is the nature of politics.

“A complaints system that does not respond flexibly, promptly and effectively to the justifiable concerns of complainants not only allows unacceptable practice to persist, it aggravates the grievance and suffering of the patient and those associated with the complaint, and undermines the public’s trust in the service.” Robert Francis QC

But it got me thinking about how the NHS handles complaints. My experience of my MP’s response doesn’t relate to any physical or psychological distress but it still doesn’t feel right. How much worse must it be when patients feel (rightly or wrongly) that they have been fobbed off.

The media and politicians are constantly on the look out for a new problem but handling of complaints is fundamental to the success of the NHS. Get it wrong and we damage relationships, waste scarce resources on legal argument and perhaps most importantly fail to learn for next time. Thus the cycle continues…

Two years ago Ann Clwyd and Tricia Hart – an MP and hospital CEO – published their report on NHS complaints. (Putting patients back in the picture) It’s a sad and rather depressing read. The themes highlighted weren’t new then and I suspect they still persist.

“Complaints procedure attitude is knee-jerk: deny, defend and delay. We don’t need money to change attitudes. What we need is a compassionate, proactive approach.”

So are we getting any better? I honestly don’t know. Certainly the complaints team where I work try very hard to ensure that the specific questions that people want answered are explicit in the responses. I hope this means that people get the answers they seek.

“I just wanted to make sure no one else suffered in the same way again. Sadly I don’t believe anything at all was done… In the end I simply gave up.”

The experience of Joshua Titcombe’s and Elizabeth Dixon’s families would suggest that the NHS still has some way to go. It really shouldn’t have taken the intervention of the Secretary of State to sort out an appropriate response to the ‘regulatory gap  

“We want a sincere and heartfelt ‘sorry’ not just a grudging apology forced upon the person.”

I have a suspicion that we all have a part to play in this though. Whatever the shrill rhetoric might imply, healthcare professionals, and managers in healthcare, don’t come to work to harm people.  We all have our off days, where we don’t do as well as we know we should, but by and large we mean to do the right thing. And we do – most of the time.  But we’re not trained / educated / role-modelled to acknowledge our inevitable failings in public.

So here’s a few thoughts.

I was in conversation with a very experienced non-medical colleague a few weeks ago. Together, we came to the conclusion that perhaps the very first thing healthcare professionals should be taught is how to say sorry – not anatomy or physiology.  Given that making a mistake is one of life certainties, why not learn how to deal with it early on.

That extends to our tribes too.  How often does a specialty or professional group come to a case review, morbidity & mortality meeting, or even a quality improvement process and say, “Here’s what my group could do better? There’s other stuff to do, but let’s start with me and my lot?” 

Let’s stop working in binary. A healthcare professional is extremely unlikely to be all good, or all bad. To acknowledge or raise an issue is not an assault on the person – it should be given, and received as the opportunity to make the good better. The same perhaps is true of our views of politicians. Just because I disagree with something they have said and done, it doesn’t mean everything they say or do is bad.

Finally, let’s learn the habit of acknowledging our mistakes and flaws. I am indebted to John McGarva (@IamChirurgicus) for this one – I’ve nicked his idea.  The senior ones amongst you, try asking your trainees to feedback to you at the end of your clinic / ward round / operating list. What did you do well? (Hopefully something) What could you have done better? (Hopefully not a long list)

Six months of doing this with anaesthetic trainees has taught me a few things:

  • They are generally very polite (the authority gradient doesn’t magically disappear)
  • They can offer real insights into my practice (not smiling is not conducive to good training…)
  • It is difficult to sit in a room waiting for someone to tell you what you have done wrong, but I think I (and my patients) are better for it.

So back to where I started and my politician’s letter. I don’t suppose this blog will be read by many MPs but I’ll take my lead from Robert Francis…

“A complaints system that does not respond flexibly, promptly and effectively to the justifiable concerns of complainants not only allows unacceptable practice to persist, it aggravates the grievance of the constituent and those associated with the complaint, and undermines the public’s trust in the political process.”

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