Inappropriate response to complaints - a missed opportunity for improvement

Citation

Jackson, S. (2003), "Inappropriate response to complaints - a missed opportunity for improvement", International Journal of Health Care Quality Assurance, Vol. 16 No. 2. https://doi.org/10.1108/ijhcqa.2003.06216baa.001

Inappropriate response to complaints - a missed opportunity for improvement

Inappropriate response to complaints – a missed opportunity for improvement

During the latter half of 2002 I was unfortunate enough to witness a poor standard of nursing care being delivered to someone dear to me. As a result I wrote to the senior team of the hospital to express my concerns about the sights I had seen. These sights included:

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  incorrect name being written on a bag containing personal belongings;

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  used urine bottles being placed on bed tables and straws from drink cartons being in direct contact with these bottles;

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  patients being expected to sit on a toilet seat (on a chair with wheels) in front of relatives and visitors; and

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  an inpatient waiting six days before receiving a medical opinion for displaying symptoms of pulmonary embolism (later confirmed to be present in both lungs).

As expected the response to my letter was dealt with via the hospital's complaints system. However, instead of feeling optimistic that care would change as a result of my complaint, I was left with more despair. I had hoped that the senior hospital team, who dealt with the complaint, would have recognised the opportunity to ameliorate their internal processes in an effort to strive for continuous improvement and possibly reduce the number of critical incidents. But this was not the case. Instead the senior team put a case forward for excusing and accepting the way they provide healthcare. A scenario that I believe created a missed opportunity for improving the quality of healthcare in the short and long-term.

To explain, the reason for the incorrect naming of belongings (a similar example being Barnet to Barker) was that there was not a bed available on the planned admission ward and so the staff on the ward where the patient was admitted to did not have the usual patient details. The senior team's efforts, therefore, were to gain sympathy from me for the incorrect labelling of the belongings. At no time was there a realisation that this type of system failure was unacceptable and could lead to more serious errors if left uncorrected. This left me wondering whether, on the whole, healthcare personnel have become complacent, a worrying situation when it is well known that America experiences more deaths from medical errors than it does from road traffic accidents.

With regards to the used urine bottles being kept on a table where food and drink is served and stored, the senior team explained that they had searched for years for better alternatives but had been unsuccessful. One example was that they had examined the possibility of using a urine bottle holder that is hung from the bed frame. I was informed that this was rejected due to health and safety reasons as patients could catch themselves on the holders when getting out of bed. The risk of infection and the sheer unpleasantness of the situation were not sufficient factors to ensure a solution. I recounted this tale to a colleague who immediately informed me that such a product was being successfully used in a local hospital. I have informed the senior team of my findings and hope that this helps their efforts towards finding a suitable solution for their situation. However, it did leave me wondering whether the senior team had made concerted efforts towards finding a solution or were they again seeking acceptance for their current standards of care, thereby missing yet another opportunity to minimise system failures.

When it came to discussing nurses condoning, by perpetuating, the practice of patients sitting on toilet seats in front of relatives and visitors, I informed the team that this was not a hospital wide practice. For instance on another ward in the same hospital a padded cover hides the toilet seat and is removed once the patient is wheeled into the toilet area, a practice in my view that is more aligned to preserving dignity. The senior team informed me that the chairs used by the other ward were bought at a later date and so had padded covers. I have worked in healthcare since 1978 and we used padded seat covers then, 25 years ago! What was difficult for me to accept was that the ward in question had at sometime been awarded Practice Development Unit status, something you would imagine would be associated with preserving patient dignity by investing in three to four padded seat covers for their "sani-chairs". Again the complaint handling approach of the senior team was that I should accept the situation, thus absolving them from taking corrective action. Another missed opportunity to improve the fundamental elements of healthcare.

As for the delay in receiving a medical opinion for suspected (later confirmed) pulmonary emboli, the senior team inferred that the ward team had done their best by chasing up the referral a couple of times during that week. However, on observation, the most effective intervention was my stern verbal complaint to the ward manager, as this resulted in a medical opinion within 24 hours. The situation, therefore, generates the following questions

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  How is it that the system functions better in the presence of a complaint than it does in its absence?

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  Do patients need to complain in order to get good healthcare?

If the answer to any of the above questions is "Yes", then the complaints system is one of the most crucial aspects of healthcare today. And yet if this were the case, it would suggest that the organisational response to complaints is not geared towards rectifying system failures, but instead focused on gaining acceptance of those failures on an individual basis as and when a complaint is received. Does this mean, therefore, that we who work in healthcare are bypassing the organisational improvement opportunities that are associated with complaints and if this is the case will we ever provide quality healthcare? I welcome your views.

Sue Jackson