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Dr. Joshua Tepper

Ignoring Complaints Is Not an Option

When you’re on the receiving end of a complaint, it can sting. I know from experience that sinking feeling of having disappointed those I am committed to serving.

Complaints can feel unfair (and sometimes they are); responding to them can be a drain on physical resources, time, and emotional energy. It can be tempting to want to avoid criticism and complaints.

This is an understandable human reaction. Unfortunately, it might limit the opportunity to learn and be better next time.

When it comes to learning from complaints, we can look to the attitude often held in the business world. Organizations that consistently produce quality products or deliver quality service view customer complaints as opportunities. Zig Ziglar, a well known sales expert, once said that “when customers complain, business owners and managers ought to get excited about it” because it represents opportunities. Bill Gates, Microsoft’s founder, agrees: “Your most unhappy customers are your greatest source of learning.”

This approach resonates to those of us dedicated to improving the quality of Ontario’s health care. Complaints from patients, clinical providers, and health care managers can be the fuel for learning, and learning is the essence of continuous improvement. Each complaint can provide the sort of on-the-ground intelligence that simply does not show up in standard health care monitoring systems. Mined for trends, they point to system breakdowns and offer insights on the nature of patients’ and providers’ dissatisfaction.

Having a robust patient relations process, where patients, families and residents can provide feedback, is part of committing to quality care. It is one of the prime channels of communication for patients and caregivers to register their concerns, and they watch closely to see how those concerns are treated.

In the coming months, we’ll hear much more about patient relations in general and complaints handling in particular. Both long-term care (LTC) homes and the home care sector have existing legislation that sets expectations for how complaints are handled. New regulations under the Excellent Care for All Act that took effect in September 2015 require Ontario hospitals to ensure that patients know how to register complaints and that patient relations representatives are available to promptly handle these interactions.

The regulations will certainly help to raise the expectations for how hospitals deal with complaints. Using a regulatory lever on its own, however, doesn’t get at the cultural factors that drive enduring change. Health care organizations will travel faster down this road with supportive coaching and promoting a culture of learning than they will with critical oversight alone.

Providing that kind of support is part of what Health Quality Ontario (HQO) can offer. One of HQO’s recent contributions, for example, was to commission surveys in the fall of 2015 to learn how hospitals, long-term care (LTC) homes, and Community Care Access Centres (CCACs) are currently handling patient and resident complaints and to understand where organizations felt more support was needed.

From the surveys, organizations reported consistency in a few key practices: all have formal complaints handling policies, collect complaints data and delegate core responsibilities to staff for handling complaints. On the other hand, in all sectors there are opportunities areas for improvement and more consistency. Consider the ways in which organizations track their complaints and train their staff:

  • Fifty-three percent of hospitals, forty-six percent of Community Care Access Centres and forty-six percent of LTC homes are tracking the number of days it takes to resolve a complaints.
  • Seventeen percent of hospitals, fifteen percent of Community Care Access Centres and twenty-one percent of LTC homes are tracking the number of organizational changes that have resulted from receiving a complaints.
  • Sixty-five percent of hospitals, sixty-two percent of Community Care Access Centres and seventy-nine percent of LTC homes train their staff on the complaints handling process. For those who are trained, this occurs most often at employee orientation and staff meetings.

All sectors need help structuring their complaints processes, so over the past year, HQO has partnered with a province-wide advisory group including representatives from all sectors as well as several patient, client and family advisors to develop a set of standard performance measures and complaint categories that can be used to support quality improvement. In the upcoming year, these resources will be pilot tested.

We have also been developing resources for organizations looking for guidance on patient relations. Whether you are looking for information on how implement a patient relations process or learn strategies for partnering with patient advisors on your patient relations processes, these guides offer practical examples and tips for your work.

This is hardly the end of the story. Standardizing ways to manage complaints and training staff represent the patient relations infrastructure, necessary but not sufficient.

All of us in the health care system will need to move deeper by addressing key questions: Are we using patients’ missed expectations as insights to learn more about our operations? Are we finding ways to embed patient relations in all areas of the health system? Are we incorporating complaints data into quality improvement plans and sharing the information with the knowledge forums in our organizations? And what about health care providers: do they have similar opportunities to share concerns about workplace issues? Can they register their views without fear of retribution? Are their complaints being used to create a culture of quality?

Ultimately, good quality care involves focusing on the patient and ensuring the well being of our health care providers. That means listening and being witnesses to their experiences, the good and the bad alike.

These surveys offer many more insights on the state of complaints handling in Ontario’s health care system. I encourage you to see for yourself by visiting the Patient Relations Practices in Ontario page.

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