Kristin Trafford-Wiezel, Case Manager at Dental Protection, looks at how and why communication can influence the outcome of a patient complaint.
The role of good communication in the delivery of safe healthcare is beyond doubt, but how does communication factor in how we respond to patient complaints? Can the tone of the response impact on the resolution of the issue?
In our previous RiskBites podcast “You’ve received a complaint – where did you go wrong?” we detailed the process of responding to a complaint, such as trying to look at things objectively to review the details surrounding the issue or appointment, and trying to remove unhelpful feelings such as the negative or defensive emotions that generally arise as a consequence of receiving a complaint. We also offered some helpful advice on compiling a complaints folder to ensure you can assess patterns in complaints received, to enable you to grow and evolve in how you communicate with your patients and grow as a practitioner.
But there’s even more to a good complaint response.
Style and tone in your response
Another aspect of dealing with the complaints process, and the intricacies of how to respond appropriately to a patient, is getting the tone and overall ‘vibe’ of your response right. In this article we’ll look at why this matters to:
• The patient
• Your colleagues
• A critical third party such as the dental board, fair trading conciliator or solicitor
As we’ve previously explored, every person has the right to be heard. If your patient has taken the time to bring a concern to you, they obviously genuinely feel they have a vital issue that they would like addressed, whether you believe so or not. No-one appreciates having their concerns belittled or ignored and doing so is a sure-fire way of issues escalating, rather than moving towards being resolved.
Many patients want the opportunity to be heard and perhaps are craving further clarification and information about what has happened and why things have progressed as they did. As you will be aware, the time we have with our patients can be limited, with patients often suffering an overload of information, or even difficulty absorbing information if they are in pain, anxious or sleep deprived. Replying to a patient with an “I told you so” response without acknowledging the difficulties they have obviously experienced, and your concern for their wellbeing, is not a helpful way to proceed to a positive outcome.
When responding to a patient complaint, it is always helpful to acknowledge the patient’s worry. Offer genuine concern for the issue and put forward a positive view that now you have been made aware of this, you will be able to work through the process together.
It may be helpful to provide a brief summary of what happened as you recall it, being careful not to sound rude and condescending. Then, a suggestion of how you feel you could move forward – that is fair to everyone when considering the facts – is also recommended.
This process of showing genuine concern for your patient and taking the time to go through the matter can sometimes be all that is required. I was recently working with a Dental Protection member who had experienced this exact scenario.
A patient had attended for an emergency appointment and though the clinical situation was explained at the time, the patient was unable to recall the particulars and this resulted in a complaint regarding the temporary restoration that had been provided. The member talked to the patient, taking the time to show his concern and explain his decision-making process, with the wellbeing of the patient his number one concern.
He very kindly offered a refund to allow the patient the opportunity to have his treatment redone should he wish. This resulted in a response from the patient thanking the practitioner for and politely declining the offered refund, as this was not his main concern; however, acknowledging that what he really appreciated was the time the practitioner had taken to provide a genuine response and not ‘fobbing off’ his concerns.
How does a complaint affect the wider team?
Handling patient complaints can be quite stressful, and that of course flows on to those around us. We are generally such small and close-knit teams in the dental environment, and what is affecting one of us really has the potential to affect the whole practice. I know that when I can see my colleague is stressed and anxious, it can be quite upsetting as it is easy to absorb other people’s stress and worry.
Also, when the practice is dealing with a patient with a complaint, it is not just the practitioner that is dealing with the situation. It’s also the front of office staff, reception or practice manager. It is important to remember that if we are dealing with an unhappy patient, those frontline staff are often the ones who are on the receiving end of much of that dissatisfaction, and unfortunately I understand that it is often the case that they receive the brunt of that frustration even worse than we do as clinicians. We need to be mindful of how we are handling the situation and that the repercussions of whether the situation is escalating or deescalating can affect everyone on the team. Everyone needs to feel supported in dealing with these difficult situations, so education and a complaints handling protocol can be really helpful.
Why complaints matter to a critical third party
The case I outlined earlier showed a great outcome as a consequence of an appropriate response to the patient. Had the response not been appropriate, and the matter escalated to a critical third party such as the dental board or a lawyer, the nature of the communication would certainly have come under scrutiny.
Let us revisit the case and assume that the practitioner had instead provided his response along with a good portion of eye-rolling and a “tough luck” attitude. The patient is now thoroughly incensed. Not only was he genuinely concerned about the filling he had been provided, he has been made to feel silly about his concerns to boot. An angry Google search reveals two appealing options – the first being a nasty online review outlining his exact opinion of the practitioner and his attitude towards his patients’ concerns, which he follows through on with great zeal and flair.
The next option is to proceed to escalate his “unacceptable filling” to the Health Consumer Complaints Commission. Unfortunately, the HCCC reviews the patient’s complaint and feels that as this is a clinical issue that is beyond them, it requires them to refer the complaint on – and now we find ourselves in receipt of a notification from the Dental Council. Not where any practitioner wants to find themselves.
The notification from the Dental Council requests a response outlining how the practitioner treated the patient and also how the practitioner addressed his patient’s concerns. The practitioner is now left explaining his treatment to colleagues whose job it is to judge the appropriateness of the said treatment, as well as viewing the appropriateness of among other things – the records, consent and communication, and billing, as well as the overall professional conduct in providing that treatment and duty of care to the patient.
A high-handed response to his patient’s communication, which has not engaged with the patient or attempted to address their concerns, is unlikely to be seen in a favourable light. I am sure you could imagine the added anxiety that comes with this scrutiny, even if the practitioner has conducted themselves in line with expectations and standards. As you know, we as health practitioners are held to a high standard when it comes to engaging with our patients and what is expected of us and our conduct with that position of care, knowledge and responsibility is really central to our values.
Why good communication matters to us
How do we want to perceive and conduct ourselves in our profession of caring for our patients? The complaints process can be a hard slog to deal with, and the defensive emotions that can come with it can really rock us and our sense of self. We did not get into the profession to hurt or make our patients unhappy, and having it brought to our attention that we might not be perceived as we thought can be really hurtful. This is the time for us to dig deep and try to reframe the negatives in a positive way, on how we can improve and how we can respond with care and grace. Obviously not every complaint will necessarily have a basis in fact or be valid, but how we respond in these situations can be a real test of character.
Research has also shown us that apologising has many benefits on our relationships with patients, and it has been shown to decrease anger and blame and positively impact on the trust between the patient and practitioner. If you are not completely sold on apologising as an appropriate communicative step in the complaints process, in The Power of the Apology Beverly Engel states that an apology is crucial to our mental and even physical health.
She goes on to say how research shows that receiving an apology has a noticeable, positive physical effect on the body. An apology actually affects the bodily functions of the person receiving it—blood pressure decreases, heart rate slows and breathing becomes steadier. She also highlights that apologising is good for the health and wellbeing of the person who gives the apology too. So definitely some food for thought there.
As we all know, complaints handling can be a difficult process for us, our patients and the practice. How we conduct ourselves and respond in these situations can be crucial in how the matter progresses and how it affects those around us. We hope that by taking the time to consider this process from all viewpoints, you can positively engage in these difficult interactions to facilitate their resolution, in a way that is a testament to your core values as a health professional.
 ROBBENNOLT (2009), “Apologies and Medical Error”, Clinical Orthopaedics Related Research, Feb 467 (2) Pp.376-82