Key steps for complaints handing in Ireland...

In Ireland, where the level of litigation and the potential for Dental Council involvement is increasing, it is essential to have effective in-house complaints procedures and to make sure that patients are aware of their existence. Patients tend to take their complaints down formal channels (for example, to the Dental Council or to solicitors) when they don’t realise that an informal, effective resolution system is available within the practice, or when they don’t have any confidence that their complaint will be taken seriously by the practice. 

Invite patients to let you know if they are not happy with any aspect of the care, treatment or service they have received. It is sometimes a good idea to have a single, named person who is responsible for patient satisfaction and customer care in all its forms – this might include patient feedback (survey) exercises as well as dealing with complaints. Give this person a high profile in your practice so that patients will have the confidence to contact this person first, before considering any escalation of their complaint to bodies outside the practice. 

The key to complaints handling is a flexibility of approach. The complaints handling process should adapt to the needs of a patient and not the other way round. Although there is no single way to handle a complaint, there are some key steps that should always be considered:

1. Preparation and training

Good communicators usually make good complaints handlers. Most members of the dental team have no formal training in communication or complaints handling, so it is worthwhile training them in these skills. Consider your own reaction if you were a dissatisfied patient asking the practice receptionist for the name of a person dealing with complaints and the answer comes back: ‘I’m not really sure – could you call back tomorrow when the other receptionist is here?’

Would it improve your confidence in the practice and its ability to handle a complaint? Are you more likely to take the complaint further? It is important to train all those in the dental team who might be involved with the complaints handling process. Untrained staff should then be instructed to direct all complaints speedily to the nearest trained complaints handler.

2. Identifying complaints

Consider a proactive approach to identifying complaints. The majority of dissatisfied patients do not complain at all. They simply leave and go elsewhere, which is not good for business. There are many ways of identifying dissatisfaction:

• Surveys – although not all patients will respond
• Comment or feedback cards – usually only completed by patients who are particularly displeased or delighted with service. It is, of course, helpful to collect positive feedback as well as negative and neutral feedback
• Train staff to identify the body language associated with dissatisfaction. The aim is to encourage patients to tell you if they have a problem before they tell someone else! A review of 100 complaints received by an international indemnity provider showed that in over 40% of cases the patient referred to a previous unsatisfactory experience prior to the incident which gave rise to the complaint
• Early identification of the dissatisfied patient stops them accumulating a store of complaints

3. Accepting complaints

The complaints handler needs to co-ordinate the acceptance, investigation and response to the complaint. They do not necessarily have to provide the detailed response themselves. However, they should have a responsibility to ensure that an appropriate team member is always available to respond.

All complaints should be acknowledged quickly, informing the patient when they might anticipate a formal response. When replying to complaints, avoid over-promising and under-delivering. If, for example, the dentist involved will be away from the practice for a month, then inform the patient.

4. Obtaining the views of all the parties involved

It is important for the complaints co-ordinator to identify and contact all the parties involved. Any attempt to generate an instant response on behalf of another person who may have left a practice or clinic should be resisted.

• Identify all parties involved and seek their views
• Co-ordinate the response so that all the parties know their role in the complaints process

5. Investigating fully

A frequent mistake in complaints handling is to provide a detailed response before investigating and gathering the facts. It is important to remember that any response to a complaint could become part of the evidence considered at a later hearing. Any response made following a full investigation is likely to be more thorough and accurate and also fairer to all parties involved.

Don’t be over-hasty in your response. Get the facts straight and think it through.

6. Resolving the dissatisfaction

Understandably, many people become defensive when they receive a complaint, particularly if they regard it as unreasonable, unfair or without foundation. Defensiveness can be counterproductive to good complaints handling and at worst it can result in the dentist’s response sounding more like a counterattack than an explanation.

When a complaint is received, it is important to consider for a moment the desired outcome, i.e. do you want to retain the patient, to agree to differ or try to resolve the patient’s dissatisfaction? Each choice demands a different response. One common error that often results in a counterclaim is the aggressive pursuit of a debt when a patient has complained about the quality of treatment provided.

Try to establish an approach to patient care that encourages feedback about the patient’s perception of the service and the quality of care received.

7. Responding sympathetically

Complaints are best resolved at the lowest possible level. This does not always imply a formal written response. Many minor complaints can be resolved on a one-to-one basis, following which a short letter can be sent to the patient saying that you are pleased the complaint is now resolved. This sympathetic contact can make a significant difference in terms of continuing patient loyalty.

In the majority of cases, however, a written response is likely to be appropriate. This may include an explanation, reassurance, an apology, an offer of compromise or a way forward. It is important to decide in advance exactly what message you wish to convey in a letter. Not everyone is skilled at letter writing but always choose your words carefully.

Remember that your response is likely to be looked at by others at some stage and therefore any temptation to criticise the patient should be resisted. The more reasonable and professional your written response, the more credit you will be given at any subsequent hearing of the complaint.

8. Following-up

The hardest part of complaints handling is risking further contact with the patient to ensure that the complaint is being satisfactorily resolved. This may not be appropriate in all cases, but it can be extremely helpful, particularly when you want to retain the confidence of the patient. There is really no difference between this and a dentist contacting a patient after a difficult procedure to enquire about their well-being. Even if the patient is not completely satisfied, it provides a further opportunity to identify a complaint and deal with dissatisfaction at an early stage. It also demonstrates care and consideration.

The follow-up is a good opportunity to display your professional concern and to rebuild a constructive relationship with the patient.

9. Learning from the problem

All complaints can teach us something. For future risk management it is helpful to consider:

• How the complaint arose
• What steps could have been taken to avoid the complaint in the first place
• If the complaint was handled effectively
• If the practice/patient achieved the desired outcome
• If you need to make any changes to our procedures or protocols for the future

It is important to remember that complaints alert you to areas of service delivery that, if not addressed, could lead to a more serious complaint in the future.

People who complain often consider it a rewarding outcome if they feel they have made a difference that might benefit other patients.

10. Communicating

Complaints need to be handled with:

• Speed
• Fairness to all parties
• Transparency

A patient is more likely to accept the eventual outcome if they can see that a complaint has been taken seriously and has been investigated. This fact needs to be communicated to the patient.

Research shows that patients’ expectations in complaints handling are quite low. Never delay your response to their complaints; any perceived lack of interest or care is the one thing that can transform a dissatisfied patient into an angry obsessive, seeking vengeance against the dentist.

Time spent well at the initial stages of handling a complaint can save hours of stress, inconvenience and expense if the complaint is allowed to escalate or pass into formal complaints or disciplinary arenas.