The duo of Ann Clwyd MP and Professor Hart, a Francis Enquiry advisor, are tasked with coming up with recommendations on complaint handling in the NHS and the MAC Partners have sent them an email wishing them well. We added a link to our complaints report dating back to 2006 or so. I was reminded that one of the experiences we picked up in our survey – it gave us the title of the report: My Anger Propelled Me – was prompted by a respondent recalling the way the hospital cared for her mother – an experience which Ann Clwyd echoed with her recent comments about the treatment of her husband.
“Your (the hospital in question) negligence killed my mother…Disgraceful – is what I think” was the quote from our survey.
Does Anything Change?
The sad thing is how little changes. Our complaint handling report – institutional references aside – has a number of observations about process and behaviour that remain valid today. One part of it has never been followed up – we did an estimate of the money involved and came up with an astonishing cost per case if the Ombudsman’s office was involved and the complaint went through every stage of process then available, of over £20,000 per fully escalated case.
A Point of Praise
One positive point was that the Foundation Hospital where we did the survey, gave us permission to publish the material based on their data. We did not name the hospital then nor will we now but it was a brave step to air some of their linen and we do not know of anyone who has followed that brave example.
We have seen guidelines a plenty on this topic. The problem is not a dearth of ‘how to’ advice – the question is ‘why does so little of it get implemented?’ The currently fashionable explanation invokes “culture”. I do not feel so strongly about the word that I reach for my gun (Btw, it was not Goebbels who said that) but ‘culture’ is not a useful verdict because it is too wide and general, giving little clue where to start if you want to change things for the better. Where is the end of the thread that leads into the huge maze that is the NHS? Do you really want to go there?
Don’t care about ‘ fair’ – impossible for NHS?
Resolution of a customer problem depends on a willed simplification of complex organisational processes where ‘fairness’ may well be subordinated to customer satisfaction. Someone takes responsibility for the solution and if necessary, carries the can and any cries of ‘not fair’ are ignored in the interests of making a dissatisfied customer into a satisfied and loyal one.
For-profit non-monopoly organisations bite the bullet – listen, empathise, apologise, pay the money and move on – because the organisation and its people subscribe to the unifying metamyth that satisfied customers equals returning customers equals profit. In the absence of an equally compelling metamyth in the consensual yet heirarchical NHS, this may be impossible. So as yet another review of NHS practice begins, we have to look at the notion that the mixture as before is a dead duck. Ditch it and look for a new way of looking at how the NHS manages dissatisfaction and the complaints that flow from that.
A New Complaint Handling Paradigm for the NHS
As the person who introduced modern ‘value of complaint handling’ to the UK based on the work of the US consultancy TARP, I feel qualified to say that we now have enough experience to say complaint handling based on the for-profit, competitive model will never work in the NHS. The penalties for accepting responsibility for complaint acknowledgement and solution that accrue to staff are too high. The people are scared and so is the organisation – living in fear of the ‘flood gates argument’.
The punitive culture applies not just internally – there are no shortage of vultures circling to blight careers be they Francis, the CQC, the Ombudsman, Clwyd, Hart and Uncle T Cobley and all. The NHS is short on recognition of success and past successes buy nothing for those who get associated with a complaint. The fastest way to fall victim to the complaint handling toxin is to take ownership – everybody sensible is heading for the hills.
Another challenge to NHS culture is that successful complaint handling intially demands a policy of exceptionalism – making a deal with an individual for treatment that another individual who grinned and bore it, did not get. This is NOT FAIR – but it is if action for individuals can be aggregated and used for the benefit of the others.
The incentive must change from negative – ie a focus on the person getting it wrong or who got caught owning a complaint – to the positive – get rewarded for service quality improvement and use of initiative with no punishment for the occasional error, misjudgement or a harsh word. The best way to dramatise this is to give an award to the ward/ GP practice/ clinic with the most complaints and the highest satisfaction scores on how it was sorted out.
Other ideas please but it would be good if we all – including Hart and Clwyd – could agree the truth of the quote attributed to Einstein
Insanity is doing the same thing over and over again and expecting different results
Email your ideas and comments to ComplaintsReview@dh.gsi.gov.uk.