A patient tells you they are unhappy with you and the treatment you provided. It is a heart-sinking moment, creating all manner of emotions, including frustration, resentment, a fear of being overwhelmed, a feeling of being ‘de-professionalised’, anger, helplessness, hopelessness and powerlessness. These feelings, while understandable, are also unhelpful in formulating your response to this dissatisfaction, as you may ‘react’ to the situation with emotion rather than ‘respond’ in a professional manner. They are also unhelpful to you, as they may lead to long-term stress and the consequences of this for your physical health and emotional wellbeing are well documented.
When we consider how to handle patient dissatisfaction or a complaint our approach should be threefold:
1. Resolve the patient’s concerns
2. Care for ourselves throughout the process, and beyond
3. Audit to safeguard against future complaints of this nature.
A patient complaint needs to be acknowledged in a timely fashion. But what is considered timely? Depending on what area of the UK you are based in, and whether you work within an NHS or private setting, there may be different expectations for acknowledging complaints.
In general, the following acknowledgement timeframes will apply for complaints received within the practice regarding NHS dental care:
England – within three working days
Wales – within two working days
Northern Ireland – within three working days
Scotland has a slightly different two-stage process, which allows the opportunity for early resolution to take place where a complaint can be resolved within five working days. Should the complaint be more complex, or early resolution is not achieved, then a formal acknowledgement should be provided within three days.
Quite often, private practices will have a similar timeframe in place for acknowledging patient complaints and you should review your own practice complaints policy for clarification.
Acknowledging a complaint when it is being expressed to you directly is simple, although you should take care to respond appropriately and not ‘react’ to this potentially stressful situation. Many practitioners, however, forget to acknowledge a written or emailed complaint. At the initial stage of having received a complaint, it is not necessary that a full reasoned response be provided, but rather an acknowledgement to your patient that their complaint has been received and that you intend to reply comprehensively. As part of this acknowledgement, the patient’s expectations regarding ‘what happens next’ need to be set:
1. Does the patient need to provide any additional information? For example, the records of, or a report from, their new treating dental practitioner.
2. How long will it take you to assess this matter – when should they expect to hear back from you?
This should get you through the acute phase of receiving a complaint. It is important that every staff member who deals directly with the public has the ability and training to be a ‘first responder’ to a complaint, as not only will this give them greater confidence when these situations arise, but better early management will render the complaint far less likely to escalate to a third party (such as the General Dental Council or a solicitor). Staff can become defensive too and react when they believe that a complaint is being unfairly directed at them; or a patient is demanding an immediate response. A little training and a practice policy detailing steps to be taken can help both the patient and the staff member in these situations. Patients who complain and then feel that they have been ignored or, worse still, rebuffed, are more likely to escalate their complaint.
It can also be helpful to have a dedicated ‘complaints manager’ at the practice. If you work within an NHS setting the practice should have a ‘responsible person’ appointed and often this is the NHS contract holder/practice principal, or a nominated person such as the practice manager. Preferably someone calm by nature, this person could have additional training in complaints management and should be a good communicator, to enable them to establish rapport with the patient. All future communications regarding the complaint can then go through them.
Work through the patient’s concerns to reach a resolution
The mechanism for doing this will vary from case to case and will depend on the nature of the complaint, the severity of the complained adverse outcome (if there is one) and its consequences for the health or wellbeing of the patient and, above all else, the willingness of both parties to engage in reasoned conciliation.
Regardless of the nature of the complaint, if you have any doubts about the approach to take or your ability to resolve it amicably, you should contact Dental Protection for advice. Our advisers are experienced in resolving patient concerns and, just as importantly, can be a sounding board for your thoughts and concerns. Information you provide us with and advice that we give remains confidential – except in some criminal events. We can provide an objective opinion on whether the complaint is reasonable, and tailor your response to suit the individual circumstances in a collegiate non-judgemental manner.
Take time for a debrief, and care for yourself
Feeling professionally challenged can be a terrifying and isolating experience. We may fear ridicule or a critical judgement from our peers because of the patient dissatisfaction, particularly if the patient had a genuine and legitimate reason to feel that way. We may feel that our reputation will be besmirched by a complaint and wish to keep the complaint or patient dissatisfaction to ourselves.
While all these reactions are understandable, they will not be helpful to you in the long term. Sometimes, as in this case, the old clichés are the best, and a ‘problem shared is a problem halved’. Talking through our complaints, concerns and distress with others can enhance personal growth and understanding. Furthermore, discussing our difficulties with others can help them recognise similar issues before they arise, and help them to better manage patient dissatisfaction in their own practice.
Audit
Finally, something that can be helpful, although it seems slightly counter-intuitive perhaps, is to keep a complaint file. This is kept separate to the clinical notes for each patient. While this complaint file may sit empty for many years or it may only have one complaint in it, it is important to take the time to review any complaints received to see if there is a pattern of issues. Is it timekeeping, fees or the way that the practice is making patients feel? If so, what steps can you take both personally and through the practice to safeguard against complaints of this nature in the future?
Conclusion
Dental Protection can offer you both support and advice during the often-stressful process of complaint management. We can assist with appropriate wording and help make this, as trying as it is at the time, a learning exercise for the future. The essential elements are that a sympathetic, polite, and objective reply needs to be forwarded in response to a complaint in a timely manner.
Useful FAQs
If I agree to provide a patient with a refund of fees, am I admitting liability for wrong-doing on my part?
No, as long as you offer a refund of fees to a patient as a gesture of goodwill this would not constitute an admission liability.
The patient has demanded a response from me within 7 days. Do I have to follow the patient’s timeline?
No, while you would be expected to respond to a complaint within a reasonable timeframe, the patient should allow you sufficient time to investigate and respond to their concerns. The designated person for managing complaints within the practice, should manage the complaint and acknowledge this in line with the timeframes set out within the practice complaints policy. This helps to manage the patient’s expectations for a response.
A complaint has arrived regarding treatment provided by an associate who has left the practice, as Practice Principal, does the responsibility fall to me to respond?
No, the practice remains responsible for managing the complaint until attempts at local resolution have been exhausted. Your role in this process is simply to ensure the concerns are addressed within a reasonable timeframe and correspondence facilitated between the relevant parties. If the complaint is of a clinical nature, the treating clinician should be asked to respond to the complaint and you can then share this with the patient as necessary.
Can verbal concerns from a patient be considered a formal complaint?
Yes, any expression of dissatisfaction, verbal or written, is considered a formal complaint. The practice should manage this accordingly, in line with the practice complaints procedure. Where verbal concerns have been raised, it can be helpful to summarise these in bullet point format within the initial acknowledgement letter, to allow the patient an opportunity to clarify any information which may have been misunderstood/misinterpreted prior to investigation into their complaint.
My former practice manager has notified me of a complaint regarding treatment I provided for a patient 5 years ago. Do I still need to respond to this?
There are various timeframes for patients to raise complaints depending on jurisdiction and clinical setting. You must remember, if a patient remains unhappy for any reason with the management of a complaint, there are many other avenues they can choose to pursue. It is always good practice to address any concerns which may arise regarding treatment you have provided to try and head off any potential unnecessary escalation of a complaint.