1. HOLLYHILL Medical Centre Dr Nick Flynn IMC 21468 Dealing with unreasonable complaint conduct. Healthcare Complaints Management Conference. 19 th November 2015 Royal Marine Hotel Dun Laoghaire

2. HOLLYHILL Medical Centre Dr Nick Flynn IMC 21468 GP Partner GP to Garda Prisoners GP in Cork Prison Medical Director Media contributor (radio/online/print)

3. HOLLYHILL Medical Centre Steve Jobs picked Hollyhill. Apple Computers employ 4000+

4. HOLLYHILL Medical Centre Hollyhill in the media:

5. HOLLYHILL Medical Centre Hollyhill in the media: :

6. HOLLYHILL Medical Centre Objectives of today’s session Understand unreasonable complaint conduct. Reflect on early flags that may predict UCC. Review management techniques in UCC. Discuss the fallout of unreasonable complaints in clinical practice.

7. HOLLYHILL Medical Centre Unreasonable complaint conduct: UCC 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 a complaint. UCC can happen anywhere. It is not limited to telephone communications or face-to-face interactions. It can occur over the internet or on social networking websites, in a public location or in written correspondence. There is no one size fits all approach to managing unreasonable complainant conduct.

8. HOLLYHILL Medical Centre Benefits of acknowledging & managing UCC: The interests and rights of complainants are protected. All complainants are treated with fairness and respect. Managing complainant behaviour can be separated from managing their issue. Staff stress is likely to be significantly reduced and this will help us meet our duty of care obligations. The impact of unreasonable conduct on resources is minimised. Equity and consistency in the handling of all complaints is maximised.

9. HOLLYHILL Medical Centre Why do patients complain? Access CommunicationTreatment

10. HOLLYHILL Medical Centre Unreasonable Complaint Conduct: Patients who have a complaint Patients who make a complaint Unreasonable Complaint Conduct

11. HOLLYHILL Medical Centre Complainant's Expectations: Have the matter dealt with quickly, fairly and properly; Be given information or an explanation; Be given an apology, if required; and/or Have action taken to address their concern or fix their problem and protect others. Complaints policy

12. HOLLYHILL Medical Centre Reasons for UCC varies: EmotionalAttitudinal Aspirational Recreational Harassment Information

13. HOLLYHILL Medical Centre Unreasonable Complaint Conduct: https://youtu.be/tcliR8kAbzc

14. HOLLYHILL Medical Centre Early signs that may flag UCC: Complainant’s previous history Outcomes sought Written complaints Interaction with the service Reaction to disappointing outcomes

15. HOLLYHILL Medical Centre previous complaints about this issue or related issues; a number of review requests, especially second review requests about the same issue; Made contact with other government agencies, TDs, Ministers or other oversight bodies about the current complaint; Sought legal advice about the current complaint or our handling of the complaint; Made FOI requests related to the issue of complaint; Raised issues about the case officer's integrity or competence in handling the case. Complainant history - the complainant may have:

16. HOLLYHILL Medical Centre Outcomes sought - the complainant may want: Manifestly inappropriate provision of services; Manifestly inappropriate compensation; Manifestly illogical or irrational solution; An apology where this is clearly not warranted or where the terms of the apology sought are clearly unreasonable; What amounts to revenge or retribution; Unrealistic expectations about what can be achieved

17. HOLLYHILL Medical Centre Written complaints - the complaint may: Display excessive emphasis; Show punctuation, font changes and bolding/highlighting excessively; Use legal or medical terminology inappropriately; Use excessively dramatic language; Multiple addressees copied on the complaint; Include excessive or irrelevant information eg adding an Appendix.

18. HOLLYHILL Medical Centre Interacting with the service - the complainant may: Make excessive written and telephone contact with the complaint handlers; Give forceful instructions about how the complaint must be handled; Refuse to define issues of complaint; Be resistant to the case officer's explanation if this runs counter to their own views; Refuse to accept the case officer's advice, Provide information in dribs and drabs, despite requests to provide all relevant information ;.

19. HOLLYHILL Medical Centre Interacting with the agency - the complainant may: Withhold information; Provide false information; At the end of the process, provide previously withheld information in an attempt to have the case reopened; Make excessive demands on resources - copies, expert opinion etc; Be rude, confronting, angry or aggressive; Be overly ingratiating, manipulative or make threats.

20. HOLLYHILL Medical Centre Reacting to the news that their complaint will not be taken up - the complainant may: Refuse to accept the case officer's or agency's decision; Reframe their complaint in an attempt to have it taken up again; Raise a range of minor or technical issues, arguing that these call into question the merits of the agency's decision; Expect a review of the decision based merely on an expression of dissatisfaction, without new evidence; Demand a second review after the first review; Take the complaint to other forums and go on to allege bias or corruption on the your part, simply because the decision went against them.

21. HOLLYHILL Medical Centre Can we prevent unreasonable conduct? 1.Manage complainant expectations 2.Insist on respect and cooperation The complaint handling process; The timeframe of the complaint handling process; What is expected of the complainant; What the responsibilities of the service are in relation to the complainant; and What the responsibilities of the complainant are in relation to the service. The Complainant must be informed regarding:

22. HOLLYHILL Medical Centre Categories of Unreasonable Complaint Conduct: 1.Unreasonable Persistence. 2.Unreasonable Demands. 3.Unreasonable Lack of Cooperation. 4.Unreasonable Arguments. 5.Unreasonable Behaviour.

23. HOLLYHILL Medical Centre General strategies for managing unreasonable complaint conduct: ‘setting limits’ or establishing clear boundaries ‘setting conditions’ requiring something of the complainant as a precondition to taking any action on their complaint identify the unreasonable behaviour ask the complainant to change their behaviour state the consequences if the behaviour continues (identify the limits) offer the complainant a choice, enforce the limits.

24. HOLLYHILL Medical Centre Unreasonable behaviour includes: Displaying confronting behaviour - e.g. rudeness, aggression, threats or harassment. Sending rude, confronting or threatening letters. Making threats of self harm. Making threats of harm to others. Displaying manipulative behaviour - overly ingratiating, tears or veiled threats.

25. HOLLYHILL Medical Centre Unreasonable behaviour: Saying ‘no’ to unacceptable behaviours, Setting limits and conditions for future interactions. Overt anger, aggression and threats in person, on the phone or in writing are never acceptable. Return letters framed in rude and intemperate language and request that the complainant reframe their concerns in more moderate language. Point out that more moderate language is clearer and therefore more likely to achieve better outcomes. End telephone calls and interviews if the complainant becomes abusive and confronting.

26. HOLLYHILL Medical Centre Unreasonable behaviour: aggression. https://youtu.be/Yj2oXMdZ4sk

27. HOLLYHILL Medical Centre Recognising Anger:

28. HOLLYHILL Medical Centre CARP method to defuse complainant anger: 1 Control – controlling your interaction with the complainant, as well as your own anger. 2 Acknowledge – acknowledging the complainant’s anger and giving them an opportunity to ‘let off’ steam 3 Refocus – refocusing the conversation onto the substantive issues. 4 Problem solve – finding solutions to the issues and problems that you've identified

29. HOLLYHILL Medical Centre I want my sausages! https://youtu.be/zJ4U5tQ6Ke8

30. HOLLYHILL Medical Centre Models of consultation Teach consultation skills Improve consultation skills Guide the consultation Analyse good and bad consultation Help us when analysing mistakes Help us when analysing complaints

31. HOLLYHILL Medical Centre 1997 Stewart and Roter Consultation Model Doctor’s Agenda Patient’s Agenda Merging of both frameworks to give a shared understanding

32. HOLLYHILL Medical Centre Discuss with your insurer Summary: Follow your complaints protocol:

33. HOLLYHILL Medical Centre Case histories: Mr John Doe 30 year old Significant drug abuse and forensic history.

34. HOLLYHILL Medical Centre Take Home Messages: All staff should be aware of UCC policies and procedures. Training must be provided. All complainants are treated with fairness and respect. Unreasonable complainant conduct does not preclude there being a valid issue. All complaints are considered on their merits. The substance of a complaint dictates the level of resources dedicated to it, not a complainant’s demands or behaviour.

35. HOLLYHILL Medical Centre Take Home Messages: In the absence of very good reasons to the contrary, all complainants have a right to access public services. Anger may be understandable as long as it is not expressed through aggression or violence. Staff safety and well-being are paramount when dealing with unreasonable complainant conduct. The decision to change or restrict a complainant’s access to services as a result of their behaviour will be made by senior management.

36. HOLLYHILL Medical Centre Consequences of unreasonable patient complaints Spiralling insurance costs Overuse of investigations/tests Over referral to secondary care Inappropriate use of scarce resources Defensive medicine

37. HOLLYHILL Medical Centre Finally: “The reasonable man adapts himself to the world…..” George Bernard Shaw….. “The unreasonable man persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man…..” George Bernard Shaw. “Do not wrestle with a pig. You get dirty and besides, the pigs like it.” George Bernard Shaw.

38. HOLLYHILL Medical Centre Thank you @drnickgp Questions?