When the patient complains

She was having surgery the next day and the instructions from the hospital said someone would call the night before to tell her exactly what time the surgery would be. Kristin Baird, a national consultant with the Baird Group on the patient experience and customer satisfaction in health care, waited by the phone that evening… and waited… and waited.

She called the hospital, got cut off, called again, was told to call another number, called and listened to the phone ring over and over before being disconnected. Finally, after half an hour of trying, she reached a live person who took her number and promised to call back.

On her blog this week, Baird describes her frustration: “At that point, I was not only irritated, but I had lost trust in the organization. After all, if it couldn’t answer a simple question, or even answer the phone number I was told to call, how reliable could its staff be in cutting me open and doing the right procedure on the right body part?”

What should the patient do in this situation – complain to someone in charge or keep quiet?

Chances are, most people would say nothing, even when there are valid grounds for complaining. Researchers in Sweden who randomly surveyed 1,500 adults found that fewer than 3 percent filed a formal complaint after something went wrong with their care – but among those who didn’t complain, 18.5 percent felt they had good cause to do so.

The study was published last week in BMJ Open and demonstrates what the authors called “the tip of the iceberg” when it comes to dissatisfied patients: that formal gripes represent only a small portion of the problems and frustrations patients may encounter with their care.

To those in health care, it can seem as though every patient is a volcano waiting to explode at the slightest provocation. When I did a Google search of “unhappy patients,” I found hundreds of articles, many of them written by doctors for other doctors and often conveying the message that, gosh, patients these days are so demanding and unrealistic that no one can ever hope to keep them happy.

To be sure, there are patients who are impossible to please. But this mindset overlooks an inconvenient truth: When patients complain, it’s often a reliable sign that a health care organization is falling short in some area. If patients are consistently unhappy with their surgery results, are they too demanding or has the surgeon been unclear about what the expectation should be? When patients complain that the office staff is rude, are they just being touchy or is there a genuine customer service problem? If a complaint goes unvoiced, should health care providers breathe a sigh of relief or should they see it as a lost chance to build trust with the patient and provide better care?

There’s been an interesting shift in the past decade or so – away from viewing patient satisfaction as nice but optional and toward seeing it one of the essential ingredients in quality health care.

Nowadays we can find people like Mary Pat Whaley, a medical practice management consultant, proclaiming she “can’t wait to hear patient complaints.” Why? Because, Whaley explains, “complaints are the only opportunity managers have to understand the patient’s experience and hear in their own words what went wrong for them.”

Her blog posting on the topic last fall sparked similar sentiments from other medical practice managers. “Clinics should LOVE feedback,” one person wrote. “Otherwise you’re completely at a loss for what the practice’s weak spots are (and every practice has one or more).”

Someone who used to be “terrified” of patient complaints wrote that she now sees them for what they are: “an incredible opportunity to see things through the patient’s eyes and make improvements.”

Whether these positive attitudes are being conveyed to patients isn’t clear, though. Even allowing for cultural differences, the Swedish study suggests that many patients simply don’t, or won’t, complain. The authors uncovered several reasons: People didn’t have the energy, didn’t think it would make a difference, or didn’t know whom to approach with a complaint. In some cases, patients didn’t complain because they were afraid of reprisals. The study also found that when patients had grounds for complaining, those who reported positive health care experiences in the past were more likely to file a complaint than those whose experiences were negative – possibly because they were more confident there would be a response.

Not surprisingly, bad experiences led to less overall trust, setting the stage for poor relationships between patients and clinicians and making patients less likely to agree with or follow recommendations for their care.

Baird eventually did receive a call from a hospital department manager who apologized for the mix-up and told her when to arrive for her surgery. The nurse who admitted her knew there had been a problem and apologized too. The surgery, Baird wrote, “went well and the staff was thorough and confident.”

But trust is fragile and easily broken, she wrote. “… It reminded me that a patient experience is only as strong as the weakest link. Everything about the experience must be safeguarded in order to earn patient trust.”

4 thoughts on “When the patient complains

  1. I’ve been an RN for 12 years and I have never heard as many patient complaints as I have this year. While many patients do have valid complaints (and I have been a patient who has had valid complaints in the past), there are also some (it seems to be an increasing number) that seem to make it their mission to complain about everyone and everything.

    There are very few nurses that purposely do things wrong… like being rude, making a medication error, or making a patient wait for something they asked for and needed… Many times, we barely have a second to take care of our own needs (eating, urinating) during our shifts, so imagine the complaints our stomachs and bladders could lodge against us as well. We often neglect our own needs throughout our shifts to care for our patients… most of which are very reasonable people, but we also have a few that unnecessarily occupy our time.

    We have constant interruptions in our shift… some from our own alarm systems, patient call bells, and a barrage of phone calls from doctors, hospital departments involved in our patients care, family members (and sometimes multiple family members on the same patient), outside agencies involved int he patient care, and you name it… they’ll call. Often I can’t walk down the hall to get a supply without an interruption that makes me forget why I walked down the hall in the first place. Some days we have up to 8 -10 nursing students on our unit and we are battling to get to our computers to document or look up patient in information.

    In one study… (www.jcrinc.com/common/pdfs/nursesweek/multitasking.pdf)

    “Nurses were interrupted 10 times per hour, or 1 interruption
    per 6 minutes. However, RNs in one of the hospitals had significantly more interruptions—1 interruption every 4 1/2 minutes in Hospital 1 (versus 1 every 13.3 minutes in Hospital 2).

    And studies have shown that it take up to 25 minutes to get back on task after an interruption. (http://www.inc.com/magazine/20070201/column-freedman.html)

    It’s a miracle we can get anything done at all… So, I feel for the patients, but they also need to understand our side as well. And patients should not have to wait lengthy times for care or have anything negative happen to them while in the hospital caused by hospital staff… But when it does, hopefully anyone reading this will understand why it does happen, how unintentional it is, and the difficult conditions nurses work in everyday that contribute to the negative things that do happen.

  2. Pingback: When the patient complains, redux | HealthBeat

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