Dealing with clinical complaints.

Complaints about the National Health Service (NHS) can be viewed as an irritating intrusion. Existing complaints systems are time consuming and stressful. Complaints cause extra work, may provide no visible reward, and can lead to disciplinary action. At worst, they can lead to protracted court actions for negligence against a trust or health agency. Yet, Being Heard, the review of complaints systems in the NHS commissioned by the Department of Health'; discussion documents published by the Complaints' Task Force2; and a growing body of management literature suggest that complaints can provide opportunities for risk managers and quality managers as well as threats.3 Moreover, the case for including complaints in risk management programmes has been increased by health service reforms, which have left hospital trusts responsible for financing claims made against them and accountable to purchasers for the way in which they handle complaints. In the United Kingdom the NHS Executive has made reference to complaints as one of several indicators of risk due to adverse events.4 Complaints can be used positively in several ways. They can provide an opportunity for providers to see themselves and their service as others see them and to identify the issues which concern users. Most importantly, complaints can allow for rectifying a past mistake and enabling services to be put right for the future. A well handled complaint can increase a patient's trust in doctors, nurses, other healthcare staff, and managers. Finally, complaints can enable the identification of adverse events which might otherwise go undetected, and they act as an early warning system for legal claims. Lessons can be learnt from individual complaints, and if properly categorised, contextualised, recorded, and analysed complaints can identify areas for action. But how far are these messages applicable to dealing with clinical complaints in healthcare settings? Are there aspects of doing clinical work that is, any expert work on the body which pose special problems? Even if there are, can clinical complaints be used more effectively for clinical risk management programmes? This paper begins with a brief discussion of the present complaints system and changes proposed in the Wilson report, which form the basis for the government's response, Acting on Complaints.5 It examines the barriers to effective handling of complaints and what complainants and the organisation want from the system. The final section examines the key factors in developing good practice in handling complaints. The focus is on mechanisms internal to the trust or general practice. Whatever the final shape of guidelines developed by the Department of Health, chief executives, clinicians, and managers will need to develop their own approach. We suggest that this will bring benefits for patient care as well as for risk management.