Introducing Our Research: Why Research NHS Complaints?

Dr Jack B. Joyce; Dr Tom Douglass    16.10.20

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Complaining is a sensitive and complicated social activity which is shaped by the existing institutional and social contexts within which it occurs. Handling complaints is particularly challenging for the NHS where the topic of the complaint is likely to be emotionally difficult and where clinical staff subject to the complaint may be defensive in their communication and conduct. In 2019/20 alone the Health and Social Care sector received 4,370 complaints, and since 2013 complaints in Northern Ireland have cost the NHS an estimated £393.5m in legal and settlement fees[1].

Importantly, however, the experience of making a complaint, including its outcome, often falls short of patient (and patient’s family) expectations. Indeed, the recent 2018 inquiry into Hyponatraemia-related deaths in Northern Ireland found that there were fundamental failures in communication with families.[2] More generally, the most cited reason for litigation is reported as dissatisfaction with the complaints process and the interpersonal conduct and communication of NHS staff (both complaints handlers and clinical staff) rather than, for example, medical/clinical error.

Importantly, litigation is costly both to complainants’ health and the NHS budget and our research aims to help improve the complaints process for complainants whilst also contributing to reducing litigation rates. Our innovatively designed research combines a number of approaches in order to do this. The research will longitudinally record and analyse all types of communication employed throughout the complaints journey. It will additionally use complainant diaries and interviews to understand the experience of the complaints journey from the perspective of the complainant. Further, it will conduct an audit of patient expectations of the prevailing context in which complaint handling takes place.  These combined approaches will improve our understanding of the types of communicative strategy that are employed within complaints handling within the NHS. It will also grant us evidence of the ways in which these approaches may not sufficiently meet complainant expectations as well as additional evidence about the actual lived experiences of the complaints procedure.

At the end of this research project we will use the findings to develop an evidence-based communication training resource called the ‘Real Complaints’ training resource. This training resource will harness the power of language to transform the experience of complaining. The training will deploy real examples (rather than simulated/role play) for communication training to encourage reflection and learning about emotionally challenging communication. The findings will also be used to create guidelines for complainants that will help them understand what to expect from the complaints process. The findings will moreover be used to develop resources to support complainants in preparing for communicating their complaint issue(s) and their hopes and expectations at different stages of the complaints process.

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