If you look at the flow chart that comes as part of the new HSCIC (Health and Social Care Information Centre) consultation, the biggest table labelled ‘Service Area’ is identified as ‘Primary cause of the complaint’. No. No. It is the place where the complaint originated – it is not the cause. It is a classic error of the introverted non-customer facing organisation to confuse cause – an experience of the user – with place – an organisational construct that means little to the user. The label also confirms the silo world version of the management universe and adds fuel to the blame game fire by provoking a defensive response by the area or the profession named as the cause. Of course the department may be the source of the solution – and again, commitment to solutions and satisfaction are made the easier in the absence of finger-pointing and blame.
Sample consumer complaint cause listings
A real complaint cause analysis has to begin with the problem described in words that the person making the complaint might use. To give you an idea, here is one that we cooked up for a client:
Before Being Treated at the Hospital
Long wait before I got a date/time for an appointment
Hospital Appointments staff rude on the phone
Hospital Appointments staff gave wrong information
Had to wait a long time in Outpatients clinic
Had to wait a long time before getting a bed as inpatient
Did not get admitted on date agreed and fixed
Operation cancelled with very little notice
Being Treated in Hospital
Had to wait a long time in Accident and Emergency
Attitude of staff (doctors, nurses) was poor
Found it hard to talk to and understand what hospital staff were saying
Felt that doctors had made a mistake in diagnosing/ missed what was wrong
Felt that treatment was not helping
The way patients were treated on the ward
Records and/or X-rays were lost
Had to wait too long for tests to come back
Waiting room was not up to standard- noisy, crowded
There was a mix-up between my GP and the hospital
The ward and/or toilets was/were dirty
The poor quality of the food
Was sent home too soon
Arrangements for leaving hospital were poorly handled
Did not look after patients’ property e.g.at a day clinic
Something else (please write in)…
Most Important Problem for Patients
We numbered all the reasons and asked which the complainant considered to be the most important problem and focused on what happened about that in the rest of the questionnaire. I mention this because the consultation struggles with the multi-cause complaint and suggests for the purposes of accurately recording all the complaints, each element of the multi-cause complaint be recorded separately while the responsibility for progressing the complaint lies with the department judged to be the owner of the most significant problem complained about. In a manual recording system, madness lies that way – let us hope they have decent case recording and management software used by very well-trained case entry specialists and not some temp who has been given half an hours training on spreadsheets. I do not fancy either being the complaint manager trying to keep all those balls in the air and meet a reasonable deadline for resolution and response. BTW, the new data being demanded has nothing on how the complaint finished up – how resolved, how satisfied the user.
Not just about the clinical
Worth mentioning too perhaps is the choice in our complaint questionnaire not to dwell on the clinical stuff – we do not ask people who complained about a wrong diagnosis to go into the gory detail but simply indicate whether that was the main problem. 33% of the sample in our survey said that it was – the only figure that came near it was staff attitudes with 21% choosing that as their main problem. Issues of clinical competence can be argued – and sadly increasingly are – in courts and cost fortunes to resolve. Staff attitudes – well they can be hard to shift as well but we would suggest can be addressed more quickly and successfully than clinical-related problems. Other actionable points were the classics – food, noise, dirt, long waits.
I am tempted to go back to what many dismissed as the old sheep-dip training where all staff were put through a customer care consciousness raising programme. They had their failings – they cannot of themselves break down long established craft or professional boundaries. I remember at the British Airways session I attended how the room divided into two large clumps of people – pilots in one corner and then the rest. The pilots spent the day grumbling to colleagues about seniority ratings while the rest paid some attention at least. But at least they start the ball rolling in the creation of a house style that could be rolled out throughout the organisation. Everybody knew how they should be behaving in front of customers – not all did of course.
Screams Unheard in Space
Finally, the consultation is about hospitals – never a mention of primary or social care. Unless the complaint system can enfold these dimensions of the user experience, any statistics that emerge from the system only tell a part of the story. We talked about silo thinking in hospitals being bad enough. But this failure of integration which goes much wider than complaints of course and leaves us with what we might call the black holes of the data universe and no one can hear you scream in space.