Communication skillsHow to deal with complaints David Bartle Consultant Paediatrician RDE
Outline • Aims • To consider why patients / parents complain • Consider the skills we need when dealing with complaints • How to avoid complaints
Exercise • Think of a time when you were involved in a patient complaint – either directly or as a bystander • How was the complaint handled? • How well was it handled? • What went well and what could have been done better?
Scale of the problem • 5% of population reported adverse outcome from healthcare. 1:3 said it caused permanent effect • 850,000 estimated AE per year in acute trusts – 10% 0f admissions • 5,426 claims against NHSLA in 2006-7 • Far higher number of people complain
When people complain, what do they want? • Discuss in pairs for two minutes
Why do people sue? • 70% of litigation related to poor communication after an adverse outcome where patient feels they have been • Deserted • Devalued • Poorly informed • Misunderstood • Poor explanation of procedures • To find out what happened and why • To enforce accountability • Compensation for accrued or future costs
Why do people complain? • Apology and explanation 34% • Enquiry 23% • Non-financial support 17% • Money 11% • Disciplinary action 6% • Other 9%
You are on duty at 11 o’clock at night. SpR & consultant are busy in A&E. Nurses have done a drug round and realised that the dose of domperidone prescribed earlier that day was 5 times greater than it should have been. One dose was given by the afternoon shift. Nurses have told parents who are upset and angry. What do you do?
Risk factors • Negative communication behaviour by doctors increases litigious intent – even if no adverse outcome • >50% of patients who sued were minded to do so before the event happened
Who gets sued? • Males >>> females • 87% of complaints against male doctors • Those who have had training in risk management less likely to be sued • No evidence that litigation history is directly linked to clinical competence • BUT – complaints are accurate predictor of future lawsuits • 5% of doctors account for 30% of complaints • Further 4% account for 20% of complaints
Patient Expectations • Disappointment related to unmet expectations • Identifying and addressing patient expectations is important strategy in risk management
Expectations • Personal qualities of doctor • Quality of treatment received • How much time will be spent with them • How they will be treated as people • Doctor availability • Competence • How ancillary staff will treat them • Amount of information they will receive
Realistic Vs unrealistic expectations • Realistic • Adequate time • Doctor interested • Other staff helpful • Appropriate access to doctors • Respect • Heard • Unrealistic • Unlimited time • Unlimited availability • Errors or adverse events never occur • All treatment successful 100% of time • All issues addressed in one consultation
In the absence of predisposing factors, a precipitating factoris unlikely to lead to patient action against a doctor • What are predisposing/precipitating factors?
Expextation Management • This is a very difficult/easy operation • Moving the bar to achieve satisfaction • Dell computer delivery promised within 10/7 • Vast majority within 3-4/7 • Very nearly all within 10/7
What skills are needed when addressing complaints? • Effective communication • Verbal and non-verbal • Making human connection early • Listening as important as talking • Conveying empathy helps people feel heard and understood
Behaviours Non-sued Sued Patients felt rushed Received no explanations Felt less time was spent Felt ignored • Asked patient opinions • Laughed • Patient perceived sufficient time spent • Explained process • Confirmed patient understanding • Offered emotional support
Starting off the right way • First impressions • Staff, environment, greeting, CAR PARKING • Patient “rapid assessment” • Are you listening? • Do you care? • Are you going to get this right?
Comm skills • Greeting / welcoming • Maintain eye contact • Same eye level • Personal connection • Allow patients to tell their story • Often rehearsed, very important to tell in full • Tendency to interrupt • Expect you to listen • Failure to listen makes meeting feel rushed or you are not interested • Non-verbal communication very important
Non-verbal communication • 80% of communication is non-verbal • Doctors with competent NVC have significantly higher patient satisfaction scores and are rated as more caring • Poor body language can make things much worse
NVC • Mirroring body language • Adopt postures, gestures and expressions of patient • Appropriate eye contact • Matching voice and vocabulary • Rate of speech • Volume of speech • Vocabulary • Tone of voice • Convey empathy • Short summarising sentences • Relay history and add emotion
Establish patient expectations • “What were you hoping to achieve today?” • “What else would you like to discuss? • “Are you sure there’s nothing else?” • Check understanding • Check your understanding of patient’s expectations • Allow opportunities to ask questions • Provide information using non-technical vocabulary- Translate medical talk to English • Establish a management plan in partnership with patient
Working in teams • Up to 50% litigation initiated at suggestion of another health care professional • Ill advised comments • Encourage litigation against colleagues • Make sure you have facts right • May cause resentment against you • Acknowledge need for an answer, but need all the facts • Ask person to speak to the individual involved directly
If patient raises concerns about colleague • Confirm your commitment to care for patient • Stress you work as a team and each brings different skills • Realise you may not have the full facts • Offer to speak to others for further information and / or clarification
Documentation • Essential for good medical care • Reflects professionalism • Forms the basis for defence • “Claims were twice as likely to be successfuly defended if documentation was judged to be adequate”
Documentation • Contemporaneous record of relevant history (within 24 hours) • Recommended treatment (pro’s and con’s) • Record decisions made jointly • Actions expected by patient • Follow up plans • Questions you have answered
Documentation • Additions to records chould be • Clearly labelled • Dated • Signed • Altering records in any other way renders them at best worthless and at worst contributing to evidence against you
Summary • Cause of litigation is complex • As a result of predisposing and precipitating factors • Patients make an assessment of our competence based on our interactive skills • Convey Empathy • Address unrealistic expectations • Treat staff and colleagues with respect • Be honest