Power to the people

“Complaint – An expression of dissatisfaction on a consumer’s behalf to a responsible body.” Wikipedia

Time was when complaints were the battery hens of the NHS: small, processed problems living short unhappy lives within bureaucracy’s little iron cages.

Today, complaints have loosed the surly bonds of due process. Now they are free range and as a consequence live longer, feral lives out on the wide open spaces of the web. Just take a look at this story:

“My mum … is too scared to comment about the care that she and others on her geriatric ward are receiving, which she feels is disgraceful. I have been consoling my mum for the past three days and have well and truly had enough but cannot do anything as I fear she will be treated even worse. Things like: her cannula popping out of her arm and being left for four hours, as the nurse reported being too busy; painkillers prescribed first thing in the morning by the doctor, yet waiting ten hours because, again , they are too busy; [ ] not getting her diabetes injection all day as there simply isn’t time, then getting told she can’t leave because her blood sugar is unable to stabilise.” Patient Opinion story from 2013

Complaints: a whole new genre

Despite complaining about lots of things, this story is not ‘a complaint’ because it is being made anonymously on-line and not to a ‘responsible body’.

In some ways, the traditional meaning of complaint is becoming redundant because the public itself has become the ‘responsible body’ to which citizens appeal for rectification, reform and retribution.

This change is significant – especially post-Francis. Traditional complaints had a sell-by date; they followed due process through to some kind of conclusion.

But these 21st century appeals to the public via online statements are really hard to kill off; blogs and tweets and Facebook stories will be roaming the web like zombies long after all the protagonists have forgotten entirely about them.

All this is deeply frustrating for big old hierarchies, such as hospitals, which have good solid systems in place to handle this stuff routinely and fairly – which all too often also means opaquely, slowly and on their own terms.

Acquitting yourself in the court of public opinion demands very different skills to running a complaints procedure designed by you, for you, and run by you.

Do what you’ve always done, and

For many PALS departments used to dealing with complaints on their own terms, there can be an overwhelming impulse to get them chickens back in their cages where they belong. Here’s the response to the above story:

“[ ] With no ward details I am unable to investigate your concerns further so I urge you please to contact the ward manager or the designated matron for that area so that we can meet with you to discuss these concerns further.”

No argument that responding here is not easy. But asking the author to do something they have already said – twice – that they are too frightened to do is not the answer.

A better response is possible and might go something like this: “From what you say it sounds like your mum has had a pretty bad time whilst she has been with us – I’m really sorry. I know you are too scared to contact us directly so I have discussed your story with all our geriatric wards and as a result we are going to change the following five things….”

As complaints escape from the written page and the formal process, they join a spectrum of public conversations that range from thoughtful commentary to the psychopathic ranting of ‘trolls’.

Navigating this can be tricky for providers, but one thing is certain – the corporate monotone of ‘we-value-your-feedback’ is worse than useless in the 21st century.

Authenticity, humanity, listening are what you need if you are going to win over unhappy patients, families and carers in this new world of the web. Sounds a bit like the things you need to give great clinical care in the first place, doesn’t it?

Paul Hodgkin

Paul Hodgkin is chief executive of Patient Opinion, a website on which patients, service users, carers and staff can share their stories of care across the UK. Patient Opinion is a not-for-profit social enterprise based in Sheffield.

Until 2011 Paul also worked as a GP and has published widely including in the BMJ, British Journal of General Practice and the Guardian and the Independent. Follow him on Twitter @paulhodgkin.