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Practice comment

Involving nurses in the complaints process leads to more effective care

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Complaints can lead to valuable insights into care and nurses should be involved in the whole complaints process to ensure incident outcomes are used effectively, says Alison Norman

Dorothy Armstrong’s article makes the case for staff to say “sorry” when things go wrong – and to do so in a way that makes such apologies meaningful for aggrieved patients and their relatives. It is hard to argue against such a course of action, particularly with the reassurance that this does not constitute a legal admission of liability. We know that many patients often “only” want an apology, even after quite fundamental failures in care.

But an apology alone, however sincere, does not make an effective complaints system. It is essential that staff understand that an apology is only one (very important) event in the process of dealing with a complaint. Otherwise there is a danger that lessons will not be learnt, trends will be missed, and more patients will require apologies after further mistakes.

Complaints are an essential part of an organisation’s feedback mechanism and linked to incident reporting and other quality indicators such as pressure sores and infection. Nurses need to see the complaints system as an important educational tool for everyone, from the individuals involved in an incident to the board - rather than simply a paper exercise run by administrators, or a blunt instrument for NHS regulators to beat the chief executive with.

That is why trusts need to ensure their education and support for practitioners is broadly based, explaining the process, supporting proactive management and training in conflict resolution.

The National Patient Safety Agency has done a great deal of work to import principles and methodologies from other industries into healthcare. And one of its key tools is root cause analysis, which looks beyond the incident itself to explore why it was able to happen, what might have prevented it, and what could be put in place to prevent recurrence. This is good for learning and future improvements in safety – but it is also good for the individual involved.

The acknowledgement by those investigating a complaint that it is not just one individual’s “fault”, but more often the fault of a system that failed to prevent the incident leading to the complaint, helps to support the professional at a difficult time. This makes it much easier for them to make a sincere and meaningful apology to the patient or family, as part of the wider response to the incident.

We need to do more than just teach nurses how and when to apologise, and give them permission to do so. We need to involve them in the whole of the organisation’s complaints system, so that every clinical team feels familiar and comfortable with the investigation and learning processes.

‘The complaints system needs to be seen as an important educational tool rather than a paper exercise’

Professionals are always extremely anxious about complaints: understandably, because they are answerable not only to their employer but also to their regulatory body. The ultimate sanction of being struck off their professional register looms large in every nurse, doctor and therapist’s mind. But a greater focus on the learning process of complaints handling should help remove the personal, individual emotion from the issue, and replace it with a professionally-justifiable – indeed, professionally mandated – focus on turning a bad incident into a better service for future patients.

At The Christie Foundation Trust, we also recognise that some complainants are vexatious, occasionally vindictive towards individuals and unpersuaded by any explanation or apology. It is important to manage these relatively rare occurrences firmly, taking legal advice and action if needed. 

A meaningful apology is a very important point in the complaints process. Developing nurses’ and other professionals’ roles so they understand and participate in the whole of the complaints process (particularly pre-empting them) is just as important if we are to use complaints constructively to improve care.

ALISON NORMAN is director of nursing and governance, The Christie Foundation Trust, Manchester


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