In the present private healthcare industry, handling of consumer complaints is of paramount importance due to the radically changing scenario of relationship between the three stakeholders.
Consumer awareness has increased due to IT. Consumer Protection Act and judicial activism have also contributed significantly in empowering the consumers. Needless to say, in the present era of competition, healthcare organisations are becoming more customer- oriented as patient satisfaction is increasingly gaining recognition as an important business process. It is no longer enough to ensure that patients are simply satisfied; rather healthcare organisations must also strive to guarantee customer service excellence in daily operations.
Complaints provide organisations with an opportunity to identify common failure points in the service that in turn enable the organisation to improve the quality of healthcare delivery.
Managing complaints well should be the cornerstone of an organisation’s customer-satisfaction strategy. But timely and appropriately complaint management practices seem to elude many organisations. Most customers are dissatisfied with the way their complaints are handled.
Need for complaint management
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Dr A K Khandelwal
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The private healthcare industry is living through an era of competition, communication technology, consumer awareness and activism.
Competition: Complaint handling should matter to healthcare organisations in a competitive industry. Research indicates that service failure cost organisations in terms of money and reputation, however most dissatisfied customers do not complaint.1,2 The same research indicates that customers who have used an organisation’s complaints procedure feel that they have been treated properly and are likely to remain more loyal to the company over the long term and provide a positive word-of-mouth review to their acquaintances.
Financial loss: In the present era of information technology, dissatisfied customers are no longer restricted to word-of-mouth comments about companies to their neighbours and acquaintances. They can now publicise their complaint through different media rapidly and cause irreparable damage to the hospital’s image. Needless to say, errors, misunderstandings, client dissatisfaction and unexpected problems occur in all administrative systems but they can also adversely affect the organisation’s reputation and hit the financial bottom-line.
Litigation: A dissatisfied customer often resorts to litigation. Timely and appropriate complaint management can significantly reduce litigations.
Quality improvement: Assessment, monitoring and exploration of patient complaints and patient satisfaction data provide an indicator of the quality of care and contribute to clinical care improvement strategies as well as provide healthcare consumers’ input into improvement of healthcare services and delivery 3, 4
What is a complaint?
A complaint is defined as. “Any expression of dissatisfaction by a customer or potential customer about service delivery by the organisation or its service providers, and/or about organisation policy.”
The dimensions of patient satisfaction include art-of-care (caring attitude); technical quality of care; accessibility and convenience; finances (ability to pay for services); physical environment; availability; continuity of care; efficacy and outcome of care.5
Complaints rate: In a study,6 it was revealed that there were 1.42 complaints per 1000 patients. Another study revealed that rate of complaints was 1.12 per 1000 occasions of service.
Types of complaints
Analysis of patient surveys carried out in Germany, Sweden, Switzerland, the UK, and the US in 1998-2000 in a study revealed that problems with information and education, coordination of care, respect for patients’ preferences, emotional support, physical comfort, involvement of family and friends, and continuity and transition were prevalent in all five countries.
In another study6 the major causes for complaints were:
Communication: Poor attention, discourtesy, rudeness.
Access to healthcare: No/ inadequate service, treatment delays
Treatment: Inadequate treatment and nursing care
Do all customers complain?
Literature reveals that the complaints actually received by healthcare organisations are only a tip of the iceberg. Consumers in the healthcare industry are reluctant to complain because they fear that they may receive lower service quality if and when the need for future care arises. This is unfortunate, since complaints are important to healthcare providers. The majority of customers who do complain to the provider about some aspect of service actually will use the service provider again if they perceive the complaint as being resolved.
So healthcare organisations should take initiatives to encourage customers to file their complaints if there are any. There are several ways in which a healthcare organisation can encourage the consumers to give their feedback.
- Patients and families should be informed of the complaint resolution process at the time of admission.
- Patient handbooks can provide information on the complaint management process, with a contact number.
- Hospital should ensure that the customer care officer visits every patient and their families and communicates the hospital’s commitment to service excellence and includes a customer service hotline number.
- Posters that encourage patients to express complaints and concerns can be placed in the hallways, with a contact telephone number listed.
- Ensure that complaints can be solicited from patient satisfaction surveys that are mailed to patients after discharge.
Five Ps of complaint management
A complaint management system should be built on all the following five elements.
- Priority: Top management should give top priority to complaints management of healthcare recipients. This should be percolated and integrated with the organisation’s operational system. Each staff should realise that timely and appropriately management will enhance the reputation of the organisation.
- Principles: A complaint management system must be implemented on the principles of fairness, accessibility, responsiveness and efficiency.
- People: Persons designated for complaint management must be proficient in the soft skills required for complaint management. Their performance should be monitored and continual improvement should be ensured.
- Process: It should perform in the following manner:
- Accept
- Apologise
- Amend
- Problem analysis: All complaints should be analysed by management tools:
- Root Cause Analysis
- 5 Why Analysis
Advantages of complaint management
Timely and appropriately complaint management provides many advantages for a healthcare organisation. Complaints provide direct information from the healthcare recipient about poor service delivery and deficiency in methods, machine, materials and skill of persons. Top management should use this information to the advantage of their organisation.
Remedy to a complainant: Timely and appropriate remedy should be provided.
Improve business process: Complaints should be used to identify deficiency, analyse causes, develop solutions and implement them to improve existing business process
Build clients’ loyalty: Timely and appropriately complaint management makes the customer more loyal to the healthcare organisation.
Quality dimensions of complaint management (Stauss and Seidel (1998)
- Adequacy/ fairness of the outcome: Both the problem solution and fairness of any compensation.
- Access: Ease of finding competent contact person.
- Friendliness: Politeness, courtesy, communication style
- Empathy: Willingness to take the customers’ perspective, including understanding the customers’ annoyance.
- Individualised approach to complaint handling.
- Visible effort to solve the problem.
- Active feedback, including notification about procedures, delays and decisions.
- Reliability: Keeping promises
- Speed of response: Reaction to complaint and resolution
Management responsibility
Top management should be responsible for managing the complaint handling system. This person’s responsibilities should include the following:
Promoting a positive culture: The complaint manager should be the internal ‘face’ of the complaint handling team and promote a positive culture that values complaint handling. They should be the complaint ‘champion’, ensuring that recovery of the patient is the goal.
Integrating complaint information: The complaint manager should be involved in all decision making process of complaint management. He should participate in evaluating the existing system, designing the new system and its implementation.
Following up: The complaint manager should give feedback of all strengths, weaknesses; opportunities and threats of the complaint management system.
Informed top management: Top management should ensure that the complaint manager must keep up-to-date with best practices, regularly review the organisation’s complaint handling system and participate in complaint handling.
Conclusion
Complaint management can be effective in resolving a problem before it becomes worse, providing a remedy to a client who has suffered disadvantage, and nurture good relations between the healthcare organisation and the healthcare recipient.
Complaints also provide agencies with information about the healthcare organisation’s weaknesses and service delivery faults. Hospital management should regularly review existing programmes, and the lessons learnt from the complaints should be used to improve the business process of the organisation. It also helps in building a healthier foundation, stronger brand value and avoiding legal penalties.
References:
1. (Stauss, B and Schoeler,A (2004) (2004) “Complaint Management Profitability: what do complaint managers know?” Managing Service Quality, 14, No 2/3, 147-156.
2. Stauss, B. and Seidel,W. (2004) Complaint Management: The Heart of CRM Thomson, Phoenix, USA.)
3. Leino-Kilpi H, Vuorenheimo J. Patient satisfaction as an indicator of the quality of nursing care. Nordic Journal of Nursing Research & Clinical Studies / VÃ¥rd i Norden 1992;12(3/4):22.
4. Bendall-Lyon D, Powers TL. The role of complaint management in the service recovery process. Joint Commission Journal on Quality Improvement 2001;27(5):278-86.
5. Ware J, Davies-Avery A, Stewart A. The Measurement and Management of Patient Satisfaction: A Review of the Literature, 1977.
6. Taylor DM, Wolfe R S , Camreon P.A.: Analysis of complaints lodged by patients attending Victorian hospitals, 1997-2001.Med J Aust 2004 Jul 5 :181(1) : 31-5
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