Keep patient complaints in-house

When the General Dental Council (GDC) introduced its Dental Complaints Scheme for private patients, the profession was told that complaints were to be welcomed.

The reasoning was that complaints help you to discover ways of improving your service and keeping your patients happy.

But there are complaints and complaints. If a patient is complaining that you are running late or they don't like the choice of music in the surgery, that's one thing. In these instances, if the complaint is dealt with willingly and sympathetically, your relationship with the patient will be enhanced.

A complaint directly to the GDC, on the other hand, which subsequently leads to an investigation into every aspect of the patient's treatment, is completely different. The result could be devastating to those involved and jeopardize the future of the practice.

But, here's the rub, it's possible for the irritant that fires up the patient to have a little moan about the music in the practice to be the very same irritant that finally triggers another patient in a different practice to make a complaint to the GDC. The reason for the disparity is unlikely to be the dental treatment the patient has received but how loyal they feel to the practice and the people in it.

Is it possible to avoid damaging complaints but also elicit helpful feedback? The answer is yes, in the main, it's possible to keep patients on your side, even when things go wrong, and this article sets out how.

Is it possible to avoid damaging complaints but also elicit helpful feedback? The answer is yes, in the main, it's possible to keep patients on your side, even when things go wrong, and this article sets out how.

Involving everyone

Every member of the dental team has a role to play in eliminating the causes for complaint. Team members, especially receptionists, can make a real difference between a patient being motivated to complain and not doing so; patients cannot readily assess the quality of their clinical care - but they certainly do know how they feel when they are in the practice.

As James Goolnik says clearly in his book Brush, dentistry is a relationship business. The most important aspect of dentistry is the people delivering the service. By this he means the whole team.

The receptionist

Do all receptionists ensure that everyone who comes into the practice is given a warm and smiling welcome? Are the patients made to feel at home with a suitable greeting?

• Would you like me to take your shopping?
• Can I hang your coat up for you?
• How was your journey?

I regret to say that this is not always the case. I am a visitor to dental practices and a dental patient too and am amazed at the number of occasions when a receptionist has failed to say or do anything to make me feel welcome. How do I feel? Irritated. And that's before I have stepped into the surgery.

Ties that bind

One marker of wellbeing which is widely recognised, is a sense of belonging. Whether it's your family, your friends, your colleagues, clubs or societies, they all help define who you are and where you belong. A dental practice can provide a sense of belonging to patients, especially if everyone in the team works together.

Team cohesiveness is not just important for job satisfaction; colleagues who work well together in a medical or dental setting are less likely to attract complaints. This point is made by Gerald Hickson, Chairman of the Board of Directors at the National Patient Safety Foundation in the US.

For 20 years he and his research team have studied patient complaints in order to identify which clinicians cause the most problems and how they can be helped. He spoke at Dental Protection's Premier Symposium in 2012. In a presentation entitled: Treat me nice, treat me good, treat me like you really should - he highlighted the impact that one person on their own can have on the entire team.

He says that part of a clinician's commitment to their professionalism is the ability to treat colleagues with respect - and there are some people who need to be taught those skills. He believes that the current high level of dento-legal claims is fuelled less by quality failures than by the breakdown of the patient/clinician relationship, particularly in effective communication.

Specifically, he says that complaints of rudeness, failing to respond to phone calls and not showing respect serve to predict future litigation.

Embracing communication

According to Sheila Scott, doyenne of UK dental consultants, there can never be too many discussions about or training on excellent communication skills and customer care routines from the whole team.

Her advice is to regard each patient contact as a building block in your ongoing relationship with them. But remember that relationships can go wrong and sometimes they need to be worked at. Sheila, who has a psychology degree, is a fan of the hospital drama Casualty and she advocates watching an episode or two to understand the potential for human misunderstanding which is often at the heart of the scripts.

Casualty storylines perfectly illustrate Sheila says, just how easily relationships break down when two people fail to understand each other. How can you eliminate those misunderstandings in a dental practice? The number one rule, says Sheila is to always be thinking about the patient and what their needs and expectations are.

The patient perspective

This is something that most advisers and opinion formers advocate. Alison Miles- Jenkins, founder and CEO of Training To Achieve Enterprises, suggests stepping into the shoes of your patients and seeing the world, and specifically your dental practice, through their eyes.

As she points out in one of her blogs, complaints from dental patients to the GDC rose by 42% in 2012. Consumers' rising awareness of their 'rights' can make them ready to complain when things do not work out as they thought they would. Expectation management should be a consideration for all businesses, she says.

How do you do this? By encouraging patients to make their expectations explicit. Unless someone in the practice explains what is involved at an appointment, whether it's the length of treatment or the cost, or both, then the expectations of the patient and dentist might well differ. Such dissonance can lead to complaints.

Direct access

If you are a hygienist or therapist or your practice employs dental care professionals in this role, it's worth fleshing out the kind of complaints which might arise. Direct access to hygienists and therapists, made possible when the law was changed on 1 May, creates a whole new set of patient expectations and opens up opportunities for misunderstanding.

Your practice might prefer to operate as it always has, and for patients to see the hygienist after their dentist appointment, so the hygienist can work to the dentist's prescription. The patient's expectation is that they can come in when they want for a hygiene appointment. It's worth making it explicit to the patient how you plan to operate since the introduction of direct access, so you don't have to deal with frustration or disappointment.

How did you get here?

Len d'Cruz, a dento-legal adviser for DPL, made a very interesting observation in a talk to the BDA conference earlier in 2013. He pointed out that patients who attend a practice having found it on the Internet may have high expectations of their treatment without the sense of loyalty that long-term patients have. The combination presents significant risk if the treatment outcome is sub-optimal. It's worth paying special attention to the expectations of people who find your practice on the web. Do not overpromise or under-deliver.

Surveys

Find out what your patients, both new and old, think of you. Invite patients to give you feedback on how they think the practice or their treatment could be improved. If you make the surveys anonymous, you might be quite surprised by what you learn. Respond to the feedback and you enhance loyalty and a sense of belonging to the practice.

Unspoken

Good communication is not just about what is said but also what is inferred by gesture and behaviour. According to Dr Cecile Carson, Clinical Associate of Medicine and Psychiatry at the University of Rochester Medical School, 80% of all communication is non-verbal (1) . Patients usually judge the quality of their care not on technical skill but on the quality of the relationship with the clinician.

So, it's not a question of going through the motions with the usual conversational cliches - 'and how are you today?' - but physically demonstrating you really do care about the patient through your body language, whether you are smiling, maintaining eye contact, listening or engaging with them.

Sheila Scott agrees but warns: 'If you focus solely on your body language, you will fail.

As human beings, it is difficult for us to 'learn' positive body language because we are emotional animals. If someone is standing in front of us shouting, it can be hard to think positively. You are much more likely to want to shout back. So try to be curious, understand why the person might be cross or agitated before you respond and that will make it easier to have real empathy which will be naturally reflected in your body language.'

Empathy

Across the board, everyone with knowledge of and expertise in patient complaints, advocates empathy as a system for responding when a patient is unhappy about their treatment. It's an extension of seeing the world through the patient's eyes.

Alison Miles-Jenkins again: 'Showing empathy is critical - this means understanding another person's situation.'

This is not the same as sympathy which means feelings of pity or sorrow for the distress of another, and is not necessarily helpful.

Alison writes: 'It's often hard to think that a complaint may be a positive thing but research shows that those motivated to complain are potentially loyal customers who will buy again from you. Try and treat the complaint as a gift, an opportunity to put something right, a positive thing.'

Very often, when patients are not happy, they want to know that the situation will never happen again. If someone shows they have understood why you are irritated or frustrated, it is reassuring for them to know that you have identified the cause. More importantly, you will stop the patient's dissatisfaction escalating to a complaint to a statutory body, whether it's a Local Area Team, the CQC or the GDC.

By showing empathy, you demonstrate you have understood the patient's concerns and that you or colleagues will take steps to change the system or approach which led to the failure or disappointment. This in turn should lead to a sense of mutual respect, because the patient knows their feelings are being taken into consideration while the practice team feels they have been given the opportunity to prove themselves.

We like this

Research also shows that people do not sue someone they like (2). It's as simple as that. The challenge is to align yourself with what patients might be expecting. Tune into their thinking and you will help develop an all-important sense of loyalty and belonging to you and your team.

Caroline Holland has worked in the dental world for 25 years, firstly as a journalist and now undertaking PR and writing roles for a variety of individuals and organisations.

References
1_ Carson C. Non-verbal communication in Clinical Encounters. Corlandt Forum 1990: 129-134
2_ Graskemper J. Risk Management. Dent Today. 2000 Dec;19(12):32, 36-37