George Wright, Dentolegal Consultant and Senior Dental Educator at Dental Protection, offers a comprehensive overview of effective complaint handling
Fortunately, dental complaints remain relatively rare when considered in the context of the large number of patients that pass through our practice doors on a daily basis. It is however widely recognised that even a single complaint can have a significant impact on the recipient, with the potential to affect their professional and personal life.
Key features of effective complaint handling are being able to recognise a complaint when it is first made, early intervention to avoid unnecessary escalation, and the ability to reflect and learn when things go wrong, in order to improve patient experience in the future. This article sets out to explore these issues and provide a step-by-step guide for dental nurses on how to handle a complaint.
What is a complaint?
NHS England define a complaint as “an expression of dissatisfaction about an act, omission or decision, either verbal or written, and whether justified or not, which requires a response”.[1] Whilst some definitions vary, the above is a good starting place when considering whether a communication requires a response. It is important to recognise each of the components that make up the definition: a complaint may be verbal or written, remains valid whether the recipient feels the complaint is justified or not, and can be a mere expression of being dissatisfied rather than being labelled a ‘formal complaint’.
A concern among the dental team can be that by ‘formalising’ a complaint, the recipient or practice are either encouraging the complainant or making a bigger issue than need otherwise be the case. In fact, by taking these expressions of dissatisfaction seriously, patients are more likely to feel they have been listened to and this can strengthen the professional relationship. This approach also goes a long way towards ‘nipping things in the bud’ and resolving complaints without the need for unnecessary escalation – an otherwise timely and stressful experience.
What does the General Dental Council require?
The GDC Standards[2] outline the requirements placed on all registrants in relation to complaints. They explain that patients expect “Their concerns or complaints to be acknowledged, listened to and dealt with promptly” and that registrants must:
“5.1 Make sure that there is an effective complaints procedure readily available for patients to use, and follow that procedure at all times.
5.2 Respect a patient’s right to complain.
5.3 Give patients who complain a prompt and constructive response.”
Whilst it is not intended for this article to explore the GDC Standards in any depth, registrants are expected to be aware of their existence and readers are encouraged to review the Standards alongside this article.
In recent times, the GDC worked with a number of stakeholders across the dental sector to develop 6 key principles for effective complaint handling.[3] These serve as a helpful compass for managing complaints and understanding what is expected of all GDC registrants:
- All of your feedback is important to us.
- We want to make it easy for you to raise a concern or complain if you need to.
- We follow a complaints procedure and keep you informed.
- We will try to answer all your questions and any concerns you raise.
- We want you to have a positive experience of making a complaint.
- Your feedback helps us to improve our service.
Five steps to complaint handling success
There are always going to be patients that we can’t please; indeed, it is a fact of life that with differing personalities and characters, varying priorities and perspectives, a small number of patients will still find that they wish to complain. While most of these complaints will be resolved using the following steps, it is perhaps also important to recognise that you can’t win them all and some patients will want to escalate their concerns whatever your approach to in-house resolution.
Acknowledge and apologise
In making a complaint, patients are often seeking recognition that they are unhappy about something and an apology. Contrary to popular belief, “an apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty”.[4] At Dental Protection, we often recommend the ‘sad but glad’ approach to the initial response: saying you are sorry to hear that the patient is unhappy about an aspect of their treatment or care, and expressing your gratitude to them for raising their concerns directly – affording you the opportunity to investigate and respond to the complaint. Notice how in offering an apology to the patient for the fact they are unhappy, you are not agreeing with their perspective, or even agreeing to any wrongdoing. The patient though can be instantly disarmed by the early offering-up of an apology.
Listen to the patient’s concerns
Having acknowledged how the patient is feeling, it is important to allow them some space to tell you their concerns in their way. Some patients will be able to articulate their concerns succinctly and require little input whereas others may require some positive encouragement to open up about what it is they are unhappy about. Where patients struggle to articulate their concerns, it can be helpful to provide them with a copy of the complaints procedure and suggest that they take some time to put their concerns in writing. Alternatively, informing patients that they can make use of a friend or relative to raise concerns on their behalf can be a helpful way of empowering patients and reassuring them that their concerns will be taken seriously. When the patient has had an opportunity to outline their concerns, it is important to summarise and repeat their concerns back to them. This allows confirmation of understanding and also demonstrates to the patient that you have listened to them.
Explore a way forward
Patients will usually have an idea of how they would like to see their complaint resolved and it can be beneficial to invite them to propose a solution. For instance, a patient that is unhappy to learn the dentist is running late may respond better to being asked “how would you like me to resolve the situation” to being told that they have to sit and wait their turn to be seen. This allows them the opportunity to propose alternatives that they may be happier with – seeing a different dentist or re-booking their appointment, for example. It is certainly the case that giving a patient some ownership over finding the solution – empowering them – can support an early resolution of the complaint.
Complete any necessary or agreed actions
Even the best-handled complaints can fall down at the final hurdle of carrying out any agreed actions. A commitment to phone a patient back later in the day, if not carried through, can cause further irritation for the patient and act as the catalyst to them losing patience and escalating their complaint. It is also important to manage patient expectations at this stage and avoid the trap of agreeing to things outside of your control. Agreeing to ask the practice manager to call the patient at 1pm, for instance, could prove problematic if the practice manager has a meeting that day which leaves them unable to follow-through on your promise. It is much safer to manage the patient’s expectations and be realistic about what they might expect – reassure the patient that you have made a note of their concerns and will ask the practice manager to contact them as soon as possible. If for whatever reason this is not possible then a quick phone call to the patient to keep them updated on the progress of their complaint is valuable in avoiding patients feeling their complaint has been dismissed out-of-hand or ignored.
Document and reflect
The final stage in the process is to make contemporaneous records of any discussions, including outlines of the patient’s concerns, options discussed and agreed outcomes or actions. Records of any complaints do not form part of the clinical records and should be stored in a separate complaints folder in the practice.
The natural reaction to receiving a complaint is often to want to keep it quiet and avoid sharing with colleagues in the practice. However, staff should be encouraged to share and discuss complaints at regular practice meetings so that any issues identified and learning can be shared for the benefit of the wider dental team. It can also be helpful when responding to a patient complaint to outline to them any learning that you have taken away from the complaint and to reassure them of steps taken to limit or prevent the risk of a similar situation arising in the future.
Verbal and written complaints
Complaints about treatment or care can be made either by the patient themselves or someone asked by the patient to act on their behalf. All practices should have a written complaints procedure, setting out clearly how any verbal or written complaints will be managed. The NHS Complaints Regulations[5] outline the requirement in England for complaints to be acknowledged within three working days and private practices often choose to use these regulations as the framework for their own policy. The responsible person (usually the practice owner) has a responsibility under the regulations to investigate any complaints “in a manner appropriate to resolve it speedily and efficiently” and “as soon as reasonably practicable after completing the investigation… send the complainant in writing a response”. It is expected that a final written response includes an explanation of how the complaint has been considered, an outline of the conclusions reached and, if appropriate, any remedial action that is needed.
Where a complaint is made orally and is resolved to the complainant’s satisfaction not later than the next working day after the day on which the complaint was made then a written response is not required. Naturally, a patient may specifically request a written response and/or you may consider it necessary or helpful to provide one. Even where a complaint has been made and resolved verbally, following-up in writing can allow the opportunity to demonstrate to the patient that the complaint has been taken seriously. It also helps to prevent any misunderstanding – either of the complaint or the resolution that the patient has understood has been agreed to.
Going it alone
Being on the receiving end of a complaint can leave you feeling isolated and anxious. It is important to remember that you don’t have to, in fact shouldn’t, deal with a complaint on your own. All practices should have a designated complaints manager whose role it is to manage the complaint process and ensure the patient is provided with a response. It is recommended to take advice from your professional indemnity organisation before responding to a complaint. Doing so allows experts in the field to highlight any potential vulnerabilities, provide an objective viewpoint, and support you through the process.
It is also important to talk to someone you trust when dealing with a complaint; either a work colleague or trusted friend or family member whilst remaining mindful of the need to maintain your patient’s right to confidentiality. At Dental Protection, we take the wellbeing of our members extremely seriously and offer free counselling sessions through an independent provider as a benefit of membership.
Keep perspective
Unfortunately, there are and will continue to be, those patients who chose to escalate their complaints beyond local resolution at practice level. NHS providers are required to outline a patient’s right to escalate their complaint to the Parliamentary and Health Service Ombudsman (PHSO) should they remain dissatisfied after the final response and private practitioners are similarly encouraged to signpost patients to the Dental Complaints Service.
Inevitably, the suggestion of escalation to an external organisation may be a source of some anxiety among those on the receiving end of a complaint. It is generally accepted however, that when given the opportunity to escalate their complaint, patients feel more confident in the practice response; such an approach can suggest that you believe you have been fair in your assessment, and response to, their complaint. Keeping patients well-informed throughout, and at the conclusion of, the process helps to avoid the feelings of abandonment that otherwise so often lead to escalation of complaints.
Fortunately, escalated complaints rarely concern dental nurses. In their 2019 Fitness to Practise statistical report,[6] the GDC reports that out of a total of 141 complaints that progressed to a full hearing, only 37 (26%) involved dental nurses. When considered against the backdrop of dental nurses making up over 53% of dental registrants,[7] this represents a promising ratio of escalating complaints that should count as some reassurance to dental nurses.
Case study
Mr D, a recently qualified dental nurse, became frustrated by a dental patient, Mrs K, who refused to wear a face mask whilst waiting in the practice waiting room. Despite a polite request to follow the practice protocols, the patient continued to refuse on the basis of being health exempt.
That evening, Mr D wrote a post on a popular social media site outlining the challenging interaction he had shared with Mrs K earlier that day. From the unique description of events, Mrs K was able to determine the comments were directed at her and she subsequently wrote a complaint to the practice outlining her concerns in relation to Mr D’s professionalism and an alleged breach of confidentiality.
Mr D promptly contacted Dental Protection for advice and was assisted in providing his comments to the practice principal who was able to prepare a letter to the patient responding to the concerns. The response included an acknowledgement of Mrs K’s concerns, an apology for the distress caused and an overview of the complaint and the investigation completed by the practice. Critically on this occasion, the response also included an outline of the learning from the complaint, including Mr D’s commitment to undergo social media training and attend a refresher course on patient confidentiality.
Having read the response provided by the practice, Mrs K was satisfied that her concerns had been listened to and the necessary learning had taken place. She was therefore happy to draw a line under her complaint and consider the matter closed.