A qualitative study of National Health Service (NHS) complaint-responses.

BACKGROUND: Healthcare complaints are grievances that may be indicative of some system failures, individual failings, or a combination of both. Moreover, the experience of making a complaint, including its outcome, often falls short of patient expectations, particularly in relation to the interpersonal conduct of National Health Service (NHS) staff. Over half of unresolved (local) complaints are subsequently upheld by the ombudsman with others potentially resulting in costly litigation. METHOD: A nuanced discourse analytical approach to analysing the language choices within complaint-responses could potentially provide greater insight into why many local complaints continue to remain unresolved. Over a period of 1 month we collated a data corpus of written complaints and their responses (n = 60) from an NHS healthcare area in Scotland, United Kingdom (UK) following anonymisation by NHS complaint handling staff. We took a qualitative approach to analysing the data drawing upon Discourse Analysis with this paper reporting on the complaint-responses only (n = 59). We had undertaken a similar review of the initial written complaints and this is reported elsewhere. In this paper we examine how, and to what extent, the complaint-responses fully addressed the complainants' perceived grievances. RESULTS: The complaint-responses rarely acknowledged the amount of detail or 'work' involved in making the complaint. Complaint-responses constructed complainants' accounts as subjective by using specific discourse strategies. Further, complaint responses used unintentionality or exceptionality to mitigate sub-standard experiences of care. We also observed the 'fauxpology' - a non-apology or false apology (e.g. I am sorry you feel) which imputes the cause of distress to the subjective (and possibly misguided) impressions of the complainant. The complaint-responses thereby evade blame or responsibility for the complainable action by implying that the complainants' feelings do not align with the facts. CONCLUSIONS: Complainants and complaint-responders work to different frames of reference. Complaint responders need to engage and align with complainants from the outset to ensure more appropriate complaint- responses. Complaint resolution as opposed to complaint handling could be enhanced by the approach of linguistic analysis and reference to the consumer literature's justice-based approach to post-complaint behaviour.

Traumatic journeys; understanding the rhetoric of patients' complaints.

BACKGROUND: Research on patients' complaints about healthcare has tended to focus on the typology of complaints and complainants to homogenise complaints and better understand safety implications. Nonetheless, complaints speak to a broader spectrum of harm and suffering that go beyond formal adverse events. Complaints about care episodes can take considerable time and effort, generate negative energy and may leave a dogged 'minority' embittered. METHODS: This study provides an overview of the process and rhetoric of how patients formulate written complaints. We collated a data corpus comprising 60 letters of complaints and their responses over a period of one month. This paper focuses on the complaint letters only. National Health Service (NHS) Complaint Department staff in a healthcare area in the United Kingdom (UK) anonymized the letters. We took a broad qualitative approach to analysing the data drawing upon Discourse Analysis focusing on the rhetorical and persuasive strategies employed by the complainants. RESULTS: What patients complained about related to how they complained, with complainants expending considerable effort in persuasive rhetoric that sought to legitimise the complaint drawing upon different sources of epistemic authority. The complainants struggle to be an 'objective' witness as the complaint evolves from an implicit neglect narrative to increasing 'noise' with other features such as Direct Reported Speech used to animate and authenticate the narrative. Many of the complex complaints appeared to evidence some psychological distress. This was associated with the complainants' reports of experiencing cumulative poor health care and their repeated failure to resolve the complaint. The subsequent delicate and potentially stigmatized formal act of complaining was a source of additional distress. CONCLUSIONS: Complaints are involved narratives often predicated on the expectation they will not be given due credence. Health care staff may benefit from understanding how complaints are formulated to be able to more appropriately address the focus and extent of patients' grievances from the outset and therefore, reduce the considerable associated harm.