ESRC Virtual Festival – Difficult conversations: when complaint communication falls short of patient expectations…

Catrin S Rhys (Ulster University), Bethan Benwell (Stirling University) & Jack B. Joyce (Ulster University)

Real Complaints: www.realcomplaints.org

In 2019/20, HSC Trusts in Northern Ireland received a total of 4,370 complaints, relating to 6,105 complaint issues. This equates to 84 complaints per week or approximately 12 complaints per day. Complaints about healthcare can be a positive; they can resolve problems for patients in the short term and in the longer term, they can help to improve services for other patients. However, if a complaint goes badly and a patient takes legal action, it is both costly for the NHS and stressful for the patient.

So what makes a patient resort to legal action? Surprisingly, it isn’t the seriousness of the medical error. What matters is how the error is dealt with and the communication that follows with the patient or their family. For example, in a case in Australia, eleven patients were given a contaminated solution injected into the heart during surgery. Five of the patients died. But none of the families took legal action because of the sincerity of the Chief Executive’s apology and the way he communicated his commitment to investigating what went wrong.

Here in Northern Ireland, the importance of open and honest communication was a recurring theme in the 2018 report on the Inquiry into Hyponatraemia Related Deaths (IHRD), in which a significant proportion of the 96 recommendations relate either directly or indirectly to issues of communication. Justice O’Hara’s report acknowledges policy developments at all levels which recognise the importance of good communication, but nonetheless concludes that “familiar problems” remain.

The challenge is that policies tend to focus on systems and procedures. Although the goals of communication are identified (e.g. apology, empathy, understanding), they are often not met because there is not enough understanding of how to achieve those goals. As Justice O’Hara succinctly notes: “it must be recognised that a list does not equip staff to manage difficult conversations with empathy and credibility. Successful interaction at times of distress is difficult”.

The Real Complaints project, based at Ulster University in collaboration with colleagues from the universities of Stirling, Queen Margaret and Loughborough, addresses this challenge. Our pilot study (Benwell & Rhys) analysed a collection of initial calls made by patients wishing to make a complaint. What emerges very clearly from those calls is that there is no simple prescription for achieving the “empathy and credibility” that O’Hara notes is so essential. Complaints handlers have the very difficult task of juggling the institutional requirements for effective complaints investigation with the significant interpersonal and emotional needs of the communication with the caller.

Our research shows that “successful interaction at times of distress” is not simply a matter of expressing sympathy. The callers in our data want to tell their story. They want to express the impact of their experience of what went wrong and know that they have been properly heard and taken seriously. Detailed analysis of our data shows how this can be achieved with responses that express factual or emotional understanding of what the caller is saying.  However, our analysis also shows that it is not just the nature of the responses that a complaints handler gives but also the timing of these different responses that can make the difference between escalation of the complaint or a positive resolution.

Ongoing Real Complaints research will analyse patients’ experiences of these “difficult conversations” throughout the complaints journey from initial contact through to when the complaint is closed by both patient and Trust. Understanding the patient experience of complaints communication is important because as O’Hara notes of the families involved in the IHRD: “all could have given invaluable advice about how not to communicate.”

Talking matters: the social power of language takes place on Tue, November 10, 2020 6:00 PM – 7:30 PM. Register for free here…

Click here to view all events in the ESRC Virtual Festival.

Photo by sasint is licensed under CC BY-NC-SA


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