National Institute for Health Research (NIHR)
About the Project
Real Complaints is a novel qualitative study combining conversation analytic research with ethnographic research to identify key moments across an entire complaints journey that influence what the outcome looks like for the patient and complaints handler.
The UK has the highest health litigation costs in Europe, and this is highly consequential for the NHS because litigation can result from dissatisfaction with, and exhaustion of, a system not meeting a patient’s needs.
The strongest predictor for litigation is not medical error but dissatisfaction with communication, either within the clinical encounter or subsequently in the complaints handling process.
A Healthwatch survey of 1676 adults reported that 60% either did not know how, or found it difficult, to complain and 61% of complainants did not feel as though their complaint was taken seriously.
Moreover, complaint handlers reported the need for communication training so they can ‘feel more confident in understanding the needs that patients and service users are expressing in making a complaint’.
To improve complainants’ experience, reduce litigation rates, and better support complaint handlers we need improved understanding of the very particular communicative demands of complaints handling in healthcare and the ways in which current practices do not meet expectations.
The study focuses on every encounter that a complainant has for the duration of their complaint and asks complainants to complete diaries to report their experience after each encounter.
The data set is comprised of a Cultural Audit of patient expectations and impressions; recordings of phone calls, meetings, letters and emails; and ongoing reflections gathered from diaries and semi-structured interviews.
We use a combination of conversation analysis to scrutinise the recordings, and ethnographic tools to capture how, over the course of a complaint, a patient reports their experience.
These two strands of the project when combined, will offer a full picture of the complaints journey. Our analysis will detail how patients understand the complaints process and what they identify as key moments during their journey; in addition, in-fine grained detail we examine the interactional record and what communication practices contribute to these being key moments.
We hope that through rigorous and accurate documentation of these interactions that we will be able to evince what best practice looks like, and how complainants and complaint handlers manage the delicate business of complaining.
The data collected to map the full complaints journey are threefold:
- Initial encounters, which are the first point of contact between the complainant and the trust or Patient Client Council.
- Ongoing encounters, which are any future interactions between complainants and the trusts; these can be face-to-face meetings, telephone calls, or written correspondence.
- Participants’ reflection of their experience will be collected from diaries that we ask the participants to complete, and post-complaint interviews that will offer the opportunity for people to evaluate their complaints experience.
Dissemination and outreach
Our resources will focus on communication in healthcare. The core focus is on the key moments which influence the outcome of a complaint.
These will be distilled into evidence-based learning points which we will make available to complaint handlers, and those who support complainants on their journey, such as the Patient Client Council.
All of these learning points will be based on the specific communication practices that we analyse using conversation analysis.
The training will incorporate real extracts and feature anonymised clips from actual recordings of conversations between a complaint handler and the complainant.
These will be used to show how the actual communication practices of complaint handlers influences the outcome and how the effect they have on how the patient feels.
The specific learning materials will be designed as an alternative to imagined, or fabricated ‘roleplay’ scenarios which do not fully represent the complex, nuanced, and sometimes protracted experience of complaining.
Each learning point will be developed with the complaint handlers themselves, focusing on individual cases of best practice so that all materials are tailored for trainers to use.
Real Complaints resources are designed to complement and enhance existing forms of training so that complaint handlers may feel more confident in understanding the needs of patients when they are making a complaint.