Richard Smith: Making your complaint count

richard_smith_2014I’m a great complainer. As I have written before, I believe that we have a duty to complain in order to improve services and products. We usually complain after a poor experience, so the benefit is mostly to others; in other words, there is something selfless and even glorious about complaining. Experts on complaints have told me that there are usually 500 dissatisfied people for every one person who takes the trouble to complain. “Every defect is a treasure,” because it offers a route of improvement. Both the NHS organisations that I have complained to recently say that they welcome complaints, and I have taken them at their word. But how can you increase the chances that your complaint makes a difference?

One way is to persist, making sure that you get a response, and challenge responses that are unsatisfactory. Your complaint should also be specific, detailed, and offer ideas for improvement.

One of my complaints was about multiple miserable experiences in an eye clinic. The next paragraph summarises my complaint, but it’s dull and complex and you might want to skip it unless you are a connoisseur of failures and the ridiculous. The complaint is not about my clinical care but about multiple administrative failures, reflecting the common observation that the NHS has 21st century care embedded in a 19th century unresponsive bureaucracy.

To summarise my complaint: every appointment has been postponed; the clinic has two receptions, and you are not told which to attend; I was called back after an operation for a postoperative clinic that wasn’t happening, and they took two hours to recognise this failure (indeed, I worked it out myself in the end and left); every time I’ve waited about 45 minutes to be seen and spent two hours in the clinic and am seen by staff for about 10 minutes (I don’t think I’m alone in this, which explains why the clinic is so full it’s hard find a seat); boiling hot tea is served by a volunteer in a paper cup (and remember this is a clinic where many people don’t see well); the clinic still has paper notes, and, although I’m not a complicated case, clinicians struggle to find the right page in the notes, and despite being written in my notes nobody seems to know what I have had done until I tell them; and my follow-up operation was marked by the doctor as urgent but that marking was lost until I rang up a month later to see what was happening and was made to feel by the person on the phone as if the failure was my fault.

I sent my complaint with full detail, making clear that there was nothing wrong with my clinical care and that I was complaining in the spirit of offering ideas for improvement. I made suggestions for improvement and pointed out that a family member’s surgical appointments had gone very smoothly, showing that the hospital can do things well.

An acknowledgement told me I would hear in 45 days, which struck me as slow. After 90 days I’d heard nothing, so I emailed the officer who had sent the acknowledgement. She’d left. After I’d emailed another address I received a response that had been sent to me two weeks ago (after about 75 days). For some reason I had never received the response. The officer suggested that it might have gone into my junk file, which prompted me to suggest that they might consider posting the response as well. The cost of the postage would be tiny compared with the cost of generating the response.

The response I have now received is signed by the chief executive of the hospital and covers all my complaints in about 1500 words. The hospital is clearly aware of the problems and is working to improve the flow of patients through the clinic, solve the problem of there being two receptions, improve the software, and introduce electronic records. A specific change in response to my complaint is that they have stopped the offering of tea and coffee. The chief executive thanks me for complaint, and the letter contains multiple apologies.

The second way to increase the chances that your complaint makes a difference is to place it on the website Care Opinion where it can be read by anybody. A patient advocate told me that a complaint posted there would be much more likely to get a response and be acted on. The spirit of the website is that it offers a way for patients, carers, and others to work with the NHS and social services to improve services. (Writing this sentence reminds me that I have never received a response from a long complaint I sent to social services about five months ago.)

One odd thing about the site is that you are told not to use your own name. Why? Could the implication be that somehow you might receive poorer services as a “punishment” for complaining?

A good thing about the site is that once you’ve submitted your complaint or feedback you are directed to other comments on the same service. To my surprise all the other comments on the eye clinic (about five) are positive: grateful patients praise the services. I’m immediately suspicious that negative responses may be filtered out and positive ones kept, but I assume that can’t be the case. It shows importantly that there is more need for complaining.

Richard Smith was the editor of The BMJ until 2004.

Competing interest: RS is the chair of the board of Patients Know Best, which has multiple contracts with the NHS to give patients access to and control over their health and social care records. He is unpaid but has shares in the company.