Some 8,853 enquiries relating to hospital trust complaints were made last year – most of them related to errors in diagnosis, poor treatment and communication. Yet many of these complaints might not have been made formal if the situation had been handled differently at the time. Not receiving an adequate apology was the most common grievance, accounting for a third of all complaints made, according to a report by the Parliamentary and Health Service Ombudsman.
‘As we know from personal experience, if someone says sorry it means they have acknowledged our feelings and taken note of our concerns. Despite this, healthcare professionals can be reluctant to apologise when things go wrong,’ says JP Nolan, Head of Nursing Practice at the RCN.
Many nurses fear that offering an apology constitutes an acceptance of responsibility, yet that is not the case. Guidelines published by the NHS Litigation Authority state: ‘Saying sorry is not an admission of legal liability; it is the right thing to do. The NHS LA is not an insurer and we will never withhold cover for a claim because an apology or explanation has been given.’
How best to respond
Most people find it hard to complain, particularly when they’re in a position of vulnerability, and want a simple and swift resolution to the problem. While a complaint can start off as a simple matter, the way it’s dealt with can potentially turn into a complicated and time-consuming process.
Being open and honest, and providing a friendly and sympathetic approach may be all that is needed to satisfy the person raising a concern.
‘If you feel the person has a valid complaint you should apologise, irrespective of whether you are actually able to resolve anything personally, or contributed in any way to the cause of the complaint. An acknowledgment of the person’s situation and feelings is very powerful and does not indicate any liability,’ says JP.
According to the NHS Wales publication Putting Things Right: ‘If people feel that staff are not being honest or appear to be covering up the truth, this can often be worse than the original issue. In these instances, people are more likely to resort to legal action to obtain information and explanations, when there really should be no need for such action.’
The way you respond to someone raising a concern will set the tone for how the rest of the conversation goes and will influence what action is taken.
When things go wrong, it’s natural for emotions to run high. If you are faced with threatening behaviour or someone exhibiting the effects of alcohol or drugs, consider asking for support from security. While it’s generally best to have a conversation in a quiet place, preferably with seating, always let your colleagues know before you take someone to a separate area. If you’re concerned about a person’s state of mind, ask a co-worker to come with you or stay in a more public place.
Once you find a quiet place, encourage everyone to sit down, as this will help diffuse tensions. Open the conversation by telling people your name, and asking for theirs. Don’t raise your voice to be heard and keep your manner as calm as possible as this will encourage others to do the same. If someone continues to behave in a challenging or threatening way, inform them that you cannot continue the conversation until they stop.
Escalating the issue
If you are unable to resolve the problem quickly, escalate it to someone more senior. If the senor colleague isn’t able to resolve the issue, the person raising the concern should be given all the information they need to make a formal complaint.
Once it has been recognised that something has gone wrong, the initial discussion with the patient and their family should occur as soon as possible. Poor communication may make it more likely that the patient will pursue a complaint or claim.
The NHS Litigation Authority states: ‘Verbal apologies should be given as soon as staff are aware an incident has occurred. A written apology, which clearly states the healthcare organisation is sorry for the suffering and distress resulting from the incident, must also be given.’
An explanation of what has happened should be given using clear and unambiguous language, avoiding the use of medical jargon. This information should come from a single point of contact, who can answer questions or requests the patient or the family may have in future.
‘It is distressing for patients and their families if they receive conflicting information from different members of staff,’ explains JP. ‘For that reason the named point of contact should lead, and be a point of referral for anyone who is unsure. The local policy for managing complaints should explain how these communications are managed where you work.’
Finally, if you are the one offering an explanation, make it clear that the information you are giving is based solely on the facts known at the time and that new information may emerge as an investigation is undertaken – and that they will be kept informed of its progress.
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