Guide to Complaint Handling in Health Care Services

Point of service
complaints/enquiries
Ideally, most complaints should be dealt with
directly and quickly at the point where the
problem arises – with as little formality as
possible.
Often, no changes to procedures are
required – most complaints involve an acknowledgement
of the consumer’s perspective and an
explanation.
If the complaint is made to staff at the point
of service, they should first assess whether they
can deal with it themselves (informal or
straightforward complaint) or whether they
need to refer it to their line manager or the
complaints manager (a more formal, serious or
complex complaint).
If staff at point of service decide they can
deal with the consumer’s concerns, the strategies
and tips in the section on ‘Complaint handling
skills’ will help. For example, it is important to
listen carefully to what the consumer is saying
to make sure staff understand what the
problem is.
Staff need to know what action they can
take to resolve complaints. For example:
• They can give an explanation of what
happened – but ONLY if they do know why
it happened.
• They can offer an apology if warranted. This
acknowledges that the consumer has been
listened to.
• If it is a problem relating to a clinical issue,
they can encourage the consumer to discuss it
with the relevant doctor or other health professional.
If the consumer is still not satisfied,
they can lodge a complaint.
• The staff member can speak to the relevant
doctor or other health professional on behalf
of the patient.
Recording
Even if a complaint is resolved at the point of
service, the complaint and action taken can be
recorded on the feedback form (see sample
form in the ‘Tools’ section). Sometimes staff are
busy and complaints are quickly resolved – staff
may feel they don’t have time to record the
complaint. For a minor matter it may not be
warranted. Staff will need to use their discretion
about this.
The organisation needs to decide how much
data it wants collected and how it will be
recorded. Nevertheless, in general, staff should
be encouraged to record complaints as often as
possible for quality improvement purposes.
This will enable monitoring of similar complaints
across the organisation.
Recorded complaints are given to the complaints
manager to collate – a seriousness assessment
can be done and the complaint given a
rating (this process is described in detail in the
section on ‘Using the SAM matrix’).
When to refer a complaint on
Complaints should be referred to the complaints
manager if they:
• are unresolved,
• involve serious consequences,
• involve complex medical issues or a number
of different staff,
• need action that is beyond the responsibility
of the staff at point of service,
• need to be dealt with by someone with more
authority.
Staff need to be informed about what the
system is in their organisation so that they
understand when to involve the complaints
manager.
Immediate follow up and feedback to
the consumer can avoid an escalation
of the complaint.
18 Complaint handling process