When Complaints Become Unreasonable Nick Nurden The Ridge Medical Practice Bradford, West Yorkshire

Introduction What is an unreasonable complaint? What causes unreasonable complaint behaviour? Managing unreasonable complaints What if matters cannot be satisfactorily resolved? Supporting your complaints team

What is an unreasonable complaint? Unreasonable complaint conduct is behaviour by a current or former complainant which because of its nature or frequency, raises substantial health, safety, resource or equity issues for the parties to the complaint. Unreasonable complaints have a big impact High resource cost High stress levels High reputational impact

2 Broad categories of “unreasonableness” Content of the complaint Where the nature of what is being complained about, or the desired outcome from the complaint is not what would be deemed within the spectrum of “reasonable” Behaviour of the complainant The complaint may (or may not) be reasonable but the approach taken in raising and pursuing the complaint is not

What drives unreasonable complaint behaviour Negative attitude – “perpetual complainer” Avoiding responsibility “displacing” Compensation seeking Unrealistic expectations Failure to resolve a previous complaint (unfinished business) Perceptions Those who wish to cause annoyance rather than seek redress

Causes of unreasonable complaints Unreasonable expectations of the service Poor communication in the first instance Poor management of the original complaint Compensation seekers Negative attitude – “perpetual complainer”

Preventing unreasonable behaviour Prevention is better than cure! But Beware, because those who become obsessed with litigation in the end find themselves in a disastrous situation. I have seen it all too often. I have had some experience in dealing with vexatious litigants, and most of them, one finds, start with something which was, if not a miscarriage of justice at least something at which they can understandably have been very upset about, but then it becomes an obsession and they go on and on and it is a recipe for complete disaster. (Mr Justice Collins PHSO v Jeremiah)

Upstream prevention Manage expectations from the outset of a complaint Fact sheets – on the process Be clear on possible outcomes Help with alternative routes Promote advocacy Explain a review/appeal process Communicate throughout Share draft reports

Where behaviour is a symptom of illness Those who are mentally ill Those with psychosis – out of touch with reality Those suffering from depression (tired and in poor mood) Those who are have an addiction Have an alternative agenda (get more drugs!) Under the influence of substances Those from different backgrounds (whose norms may be different to ours) Need to be sensitive – these people still need our services

When do you label a complaint unreasonable? Stick to your clearly defined process and records Follow that process in all cases Treat all complainants with fairness and respect All complaints should be considered on their merits Look past the behaviour of the complainant The substance of the complaint dictates the resource applied Anger is acceptable – as long as its not expressed through aggression or violence

Dealing with unreasonable complainants Remain unemotional, don’t get drawn in! Be firm from the start about the process to be followed Be clear at an early stage if you sense it is becoming unreasonable Ensure you remain polite and consistent at all times

Be clear what is unacceptable Being forceful Being abusive to staff Volume of information sought Unrealistic timescales Repeated phone calls Demands for contact with specific individuals Constantly changing complaint substance or raising fresh concerns

Unreasonable persistence Restrict their contact In person By phone Email Keep one channel open – either in writing or via a third party

Managing difficult behaviour Listen carefully and ask lots of questions Clarify what you will investigate Ask them what they want as an outcome Remember people say lots when they are upset Be patient and acknowledge their upset Tell them what you can and will do Clearly manage expectations

When they are still not satisfied Refusing to accept the decision following investigation Wants further investigation Wants to expand the scope of the complaint Wants some other form of redress Demanding a further review when no new evidence is provided

Reactions to the outcome Refuse to accept the complaint decision Reframe the complaint to have it reviewed Raise a range of minor/technical points Expect a further review – despite no new evidence Simply demand a further review Take the complaint to other forums

Supporting your complaints staff First and foremost ensure their safety is considered Mental health issues Suicide threats Support with abusive complainants Have good protocols in place Ensure staff have enough time Develop a supportive culture Consider the subject of the complaint as well as complaints handling staff

Ensure policy protects the staff This is a clear principle which should appear in your complaints policy Staff must be treated courteously, and with respect – complainants may be angry about the subject of their complaint but must not take this out on staff, who usually will not be the subject of the complaint. We have an obligation to provide our employees with a safe place to work and to safeguard their health and wellbeing

Skills required by complaints staff You are only responsible for your own behaviour Listening is the key Respond – don’t react Focus on what you can do Be impeccable with your word Do not take anything personally Do not make assumptions Always do your best

Early resolution is important Patients sue for 4 main reasons Concerns with standards of care The need for an explanation Compensation Accountability (staff or organisation) The decision to sue is determined as much not by the original injury, but also by insensitive handling and poor communication after the original incident

Its how you treat people People just don’t sue doctors that they like! They are as likely to sue on “how they were treated, on a personal level, by their doctor and where they were rushed or ignored or treated poorly” (Blink – the power of thinking without thinking by Malcolm Gladwell) https://www.youtube.com/watch?feature=player_detailpage&v=J1FI98xbYu0 Listen, Apologise, Find Solution, Follow Up

Develop your listening skills Listen carefully Get to the route of the problem (which may not be apparent at first) Speaking with or better meeting with complainants is more likely to succeed than writing letters Give them time and your full attention Allow them to speak Do not react or respond immediately, but ask questions Filter our the emotion if required

Summary Unreasonable complaints are inevitable at some point A good process will minimise the impact of these Distinguish between the “issue” and “behaviour” Robust policies will help manage these objectively Be aware of the vulnerable Train and support your complaints staff Be a good listener Have a specific policy