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

2. 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

3. 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

4. 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

5. 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

6. 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”

7. 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)

8. 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

9. 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

10. 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

11. 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

12. 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

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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)
Listen, Apologise, Find Solution, Follow Up

22. 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

23. 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