Complaints – Is Big Beautiful?

complaints boxYet another report on complaint handling – Healthwatch has made a video about how difficult it is for people with a problem with some part of the NHS to complain. They had done some research which showed:-

Our work to map the complaints landscape has shown a staggering 75 types of organisations in England have a role in complaints handling and support, from councils and CCGs locally to national regulators.

Research we conducted in October last year showed that 1 in 3 people report having experienced or knowing someone who has experienced poor care. Yet a YouGov survey we commissioned of 2076 UK adults showed that less than half of those who had a bad experience between 2010 and 2013 actually did anything to report it.

The results showed that 2 in 5 (43 per cent) said this was because they didn’t know how to complain or provide feedback and half (49 per cent) said it was because they lacked confidence that their complaint would be dealt with effectively or thought that it wouldn’t make any real difference.

Of those who did pursue their complaint over 1 in 10 (13 per cent) entered a formal complaints process. This means the system is failing to take any formal learning from almost 9 out 10 experiences of poor care.

The last point is the saddest one – what is not heard is not used. The report follows on from Frances and Clwyd/ Hart – like patient engagement, there is a booming industry of diagnosis and advice with a worrying lack of impact on the ground.

Simplification with easier entry is the focus of work being led by Julie Mellor the Health Service Ombudsman. However making it easier to start says nothing about making it easier to finish with a result that satisfies complainants – preferably one that agrees the complainant’s case or at least a process that says ‘you have been heard’.

The fact that complaint managers have to face is that complaint handling is a second level management process that takes its style and process from the dominant management system of the wider organisation. Result? the complaint process cannot be better than the organisation’s principal processes. It cannot create a micro world populated by happy staff dancing with merry customers whose problems have been resolved with a wave of the Mellor magic wand. It is an innately simple process – reception, investigation (or not), decision, communication and feedback – so a system common to all should be simple – yes? No.

Complaints are tough because the process mimics the day to day reality of a service filled with complex processes and complicated loyalties divided between self, team, place, professional standing and all the little bits of grit that can sometimes produce a pearl but also jam the gear and seizes up the machine. Complaint handlers have to know their own organisations – how that machine works, whose hands are on the levers, who to call, when to escalate, when to resolve, when to say yes and when to say no.

Build the Big One

It would be perfectly feasible to build a big unified organisation – the National Ombudsman Scheme has a nice ring to it: populated by departments labelled Health, Local Gov etc. Single HR department with lots of new opportunities for employees; a switchboard with one number -GHOSTBUSTERS – and one email and associated social media addresses all linked to a wonderful website where cheery and highly qualified staff are seen engaged in intense but productive phone calls whilst staring in a committed and concerned way at their screens. Savings from common management services etc etc. We are familiar with the mantras of building the unified universes with their big staffs, big sticks and big salaries. Link it to the NHS Litigation Authority and you are talking a serious organisation with a budget to match.

So the temptation for people with a problem is to go there first and the local organisations  – in hospitals or boroughs –   are glad to see them go away. Sub-contract complaint handling to someone far far away.

Big is not beautiful in the world of complaints – it means slow and expensive and the great casualty is early ownership of a solution. The more it is taken away from quick, robust local resolution, then the distance between experience and event and any form of redress or making good grows and grows. Integrate the data and the learning but do not supersize the principal process.


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