In rare circumstances the trust between members of the dental team and a patient may breakdown and they may log a complaint which may be an expression of dissatisfaction with their treatment, or with their care at the Practice. This may not be due to the skills or quality of service but due to expectations that have not been met. Patients do not set out to become complainants, so when they do express a concern or a complaint it is usually a significant thing for them to do so. How we then handle these complaints can enhance the relationship between the patient and turn potential lost patients into a satisfied patients, or if handled poorly can result in the breakdown of the professional relationship. Incidentally not everything patients, relatives and carers raise as a concern is necessarily a complaint even if made in an anxious manner and need not always be shunted down a bureaucratic chain of events in a complaints procedure. Often an acknowledgment of the patient’s distress and an apology for the fact that they are dissatisfied can go a long way to resolving issues quickly. However, if a complaint is lodged, successful complaint handling can be used as an opportunity to improve the management of the practice ensuring that the same mistakes are not replicated and are used to add quality focused improvements in line with clinical governance.
Principals of complaints handling
We are required to have systems in place for investigating when customers feel services are not fit for purpose or have failed to live up to their expectations. Having received a complaint, dental teams must follow through a process of investigation and reporting before moving on to problem solving. It is in the best interests of the practice to resolve complaints at practice level.
Research into complaint behaviour reveals that only a fraction of dissatisfied patients complain and thereby this gives the practice an opportunity to correct the problem. There is evidence that some consumers do not complain because they are sceptical about the Practice’s willingness or ability to resolve disputes fairly. Disputes that are resolved in a positive way can enhance the Practice reputation and actually build patient confidence
Any complaint received by the Practice should be considered carefully, then a course of action decided to achieve the most positive result from the situation. This begins by carefully listening to the concerns being expressed in verbal or written format and recognising the complaint as an expression of dissatisfaction about a dental service or treatment, whether the Practice feels it is justified or not.
Dental complaints can be difficult to resolve, particularly if the patient has experienced pain, distress and/or inconvenience for which they expect compensation.
The aim of complaint handling is to react to complaints in the way in which we would expect a complaint about any service to be handled. Complaints are often urgent, and should be dealt with before they have time to grow.
Always make time to listen to complaints and acknowledge, even if you do not feel that they are justified.
How to deal with complaints
Appoint a person to deal with complaints
There should be one senior person in the practice (usually the practice owner or the
practice manager) who has specific responsibility and authority to deal with complaints and concerns. However, all team members should understand the protocol for an initial response and following steps.
A patient may make a complaint by letter, telephone or in person. Resolving the complaint at the earliest possible stage gives the most likelihood of a complaint being handled at this level, and no further action being taken. If the complaint is over an administrative or management issue, the patient complaints officer might be given the authority to rectify it. If it is clinical, the patient must be given the opportunity to discuss the matter with the dentist.
An easily understandable system of rectifying complaints can be administered by suitably trained team members, without reference to senior management. Enabling team members to resolve problems without reference to senior team members is a matter of practice philosophy and will not be appropriate for every practice. In cases where it is not possible to resolve the matter as soon as it is raised, the following steps may be taken.
A written complaint
The letter is acknowledged in writing as soon as possible and in any event within two working days by the PCO. The letter might include an invitation to the patient to meet the PCO as soon as practicable.
A telephone call / visit
When a complaint is made on the telephone or in person, the complainant can talk immediately to the PCO who listens and asks questions as above. (If the PCO is not available, another member of the team should deputise). The PCO makes a note of the conversation and, at the end of the conversation or meeting the complainant is given information in writing on how the complaint will be dealt with and a timetable. A copy of the complaints procedure is supplied with a note of the action to be taken.
As quickly as possible after the complaint has been explained to the PCO, the circumstances are investigated. The dentist and team member/s involved are asked for their views and suggestions. If appropriate, advice can be sought from the British Dental Association or the dentist's defence organisation, but a hostile stance should be avoided.
The investigation should take no longer than ten working days, and in most cases a much shorter period will suffice. If the investigation requires the patient's records to be disclosed to a person other than the contractor or an employee, the patient must be informed and consent gained. This includes disclosure to self-employed associates and other members of the dental team.
Following the initial investigation, the complainant may need to be invited to meet the
PCO and the dentist to resolve the situation. During the meeting someone else should be present to take notes. If the quality of care and service provided was not as high as the patient had a right to expect, an explanation of what happened and an apology should be supplied with an indication of how the occurrence will be prevented in the future.
Reasonable redress should be offered, for example a change of dentist within the practice, redoing the work free of charge or at a reduced cost, or a full or partial refund of fees. Any offer of redress should be made on the basis that it is being done as a gesture of goodwill and without the dentist admitting liability.
Check out the wording of any letter with your defence organisation. In cases where the dental team or the practice are not at fault, it is doubly important to attempt to resolve the complaint at this stage. The complainant must be given an explanation of what happened and why it happened. Any reason why the complaint occurred, which was beyond the practice's control should also be given, but avoid saying or implying that:
- The practice is right, the patient is wrong.
- That the patient made a mistake.
- The complainant is only a patient and cannot be expected to understand clinical dentistry or how the NHS works.
If there was no basis for the complaint, it is important to make it clear that the dentist and team acted properly; try to acknowledge how the patient feels, give as much explanation as possible and provide empathy for the situation. The results of the meeting should be communicated in writing to the patient, normally within ten working days of the initial complaint.
If the patient does not wish to attend a meeting, a letter is sent containing the Practice's response. It is a good idea to telephone the person as well as ensure that there are no misunderstandings.
Failure to resolve
At this stage, patients who are still dissatisfied should be told how to contact the appropriate body. If the complainant is aggrieved about private care, the complaint should be directed to the Healthcare Commission or the Dental Complaints Service for private patients.
It is essential that full records are kept of complaints, investigations and responses. These records should not be filed with patient's clinical notes. If the patient makes a request for access to his/her health records, the records of the complaint would also be accessible. The NHS contractor is required to provide information to the PCO about the number of complaints dealt with under the procedure at such intervals as the PCO determines.
The NHS regulations require records to be kept for two years from the date the complaint was made. All complaints should be recorded in the Complaints File, which should be kept in a central place.
In conclusion, the effective management of dealing and resolving patients complaints can not only help the practice improve but can also help build a lasting relationship with the patient.
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