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Recognition (Not Instant)

At last the recognition I deserve for working for and with consumers since 1969. My ground-breaking article on Instant Potato (the February 1970 issue) was selected for inclusion in the Which? 50 Years supplement sent out to subscribers this month. The killer piece of consumer information that earned me my accolade was that we called a cookery book from the Potato Marketing Board "the Kama Sutra of the potato world". How I got that past the eagle eye of Eirlys Roberts the Editor and the squad of verifiers that Which? employed to check the pieces with a rigour that seemed specially designed to dampen all frivolity not to say creativity, I will never know and certainly cannot remember. It was perhaps edited after lunch in the Ship and Shovel pub and Which? watering hole underneath Charing Cross station. But the article did reveal the scandalous news that the way instant potato was made removed most if not all the Vitamin C - 'shock horror' press release no doubt followed.

More of the shock horror press releases no doubt went out with the results of the latest bit of Which? work on the health service. 

49% of those interviewed were unhappy with some aspect of their healthcare and of that number 51% said nothing. When asked why, the answers were:-

• 35% said it would not make a difference
• 27% said they did not want to make a fuss
• 23% said that they just expected it to be like that
• 23% "staff were too busy already"
• 12% said that raising the issue would comprimise other aspects of their healthcare.

Of those that did go to the bother of raising the issue, only 27% were happy with the way that it was dealt with and 74% were left with the feeling that it would not lead to better healthcare.

Sad stuff if hardly unexpected. We did some research into complaint handling at a London hospital and recorded a satisfaction level of only 20% with the formal complaint handling system.

When trying to understand how well an organisation is dealing with its customers, we need to have information on all of them, namely finding out what we call the shape of their iceberg (iceberg because you only hear from a minority of those who have problems - the tip of the iceberg - while the great mass of the unheard lurks unseen beneath the surface). The data you need to know, as we wrote at the time, are:

• % of users who had no problems with their experience of the hospital
• % of users with problems who did not mention them to anyone
• % of users who mentioned a problem to someone and were satisfied
• % of users who mentioned a problem and were dissatisfied but did not escalate it beyond the front line

In addition, a survey of all staff involved in complaints to compare is very informative and one way to use the data is to contrast the two views - internal and external (i.e. the complainant) - of the system. A workshop on closing that perception gap is always a lively debate and switches the emphasis from contemplating problems which appear intractable to deepening understanding and focussing on solutions.

All this is very researchable especially if the Patient Liaison Service (PALS) is well used and takes the names of those who contact it for information and advice on a wide range of issues and problems and if the hospital does an exit survey (sorry - discharge research - even worse: a survey done when an inpatient leaves the hospital).

All the findings above will come as no surprise to anyone who has worked in this area. The saddest findings of the Which survey for me were the views expressed by the 23% of those with problems who said they had "just expected it to be like that". The combination of low expectations and silence guarantees poor service. The most sensible were those that feared comprimising other aspects of their care - better leave it till you are safely home. Health staff are frequently heard to say 'if only they had mentioned at the time". Well now you know why some do not.

Three quarters of those who had taken the trouble to make a complaint, did not in the end believe that it would lead to better standards - again a great source of disappointment in our complainant survey. It seemed to them that the central promise of what was for all a very challenging complaint handling system - that a complaint would improve the system for other future patients - was not being fulfilled. Our internal evidence from the hospital was that improvements had in fact been made in some areas but the complainants never heard about that.

Bearing in mind these findings from our and Which?'s research, it was no surprise to see the latest report from the Healthcare Commission which said

"Of the 32 trusts in which concerns had been raised, we found:

• that two trusts met all aspects of the standard
• notified 12 trusts of significant lapses in one or more parts of the standard, saying this would affect the organisation's rating in the Healthcare Commission's annual health check
• warned six trusts of evidence to suggest the standard was not being met, urging them to consider this carefully before making their declaration for this year's health check
• told the remaining 12 trusts to make improvements ranging from improving access to complaints systems for people with disabilities to improving communication of the outcome of a complaint."

I think we will drop them a line and see how we can help.

Read more about M-A-C's complaint handling consulting, and download templates for reviewing and implementing better complaint handling at www.mooreadamsoncraig.co.uk/complaint-handling.html

Related posts: Spotlight on Complaints and Preparing for a complaint audit