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I often visit care services to be told by the manager that they have few complaints, proudly demonstrated by the sparse entries in the Complaints Book. This is not surprising in a care service which regards complaints as a possible opening for censure, particularly by the registering authority, or the commissioners of care. Such a negative attitude is one of the unintended consequences of statutory regulation, and paradoxically causes the affected service to miss a golden opportunity to satisfy its customers and improve efficiency.
Contrast the scene painted in research conducted at the Universities of Alabama and Montevallo in the USA. The researchers (Powers and Lyon) describe a programme to introduce a complaints management system at a healthcare facility, and report, with evident satisfaction, that complaints increased markedly as a result of the introduction of the programme. This counter-intuitive view is based on earlier research and analysis of quality management programmes. Complaints, in contrast to the threat induced scenario described above, are proven to be a valuable tool to promote quality improvement, and gathering complaints data and critically analysing it is in turn established as a powerful management tool. The divergence of approach could be put down to the differing pressures and priorities between health and social care the UK and the USA. In the healthcare facility studied by the researchers, regulation was less of a pressure on management than was customer satisfaction. The facility operated in a competitive environment, where customer choice was real and always exercised, therefore management satisfied customers or went out of business. In the UK, the pressures have been slanted more the other way. Regulatory pressure has been high, and customer choice limited by a combination of lack of capacity and commissioning protocols. The effect has been of UK managers feeling pressure to manage compliance in preference to customer satisfaction.
As we all know, the rise of consumer choice in the UK care sector together with the focus of regulators on customer outcomes, have combined to shift the management priority more towards customer perceptions than may have been the case in the past. In that event, customer complaints management changes its flavour, and becomes significantly more important.
What is a complaints management programme? It is first of all a way of thinking; a culture; which regards complaints as a valued contribution to the organisation and that where employee has a duty to:
- Receive complaints positively, however formulated
- Deal with complaints as quickly and effectively as possible,
- Report back all complaints, however formulated, to the organisation,
- Analyse all complaints, however formulated, for information helpful to the organisation.
Point 1 requires effective training of a kind which is not normally seen. In the first instance staff require training in how they personally manage individually visitors, and manage and handle the visitor’s perceptions and communications. Staff also require training in the specific value of complaints, and how their workplace and the service which they are proud of, can be improved through a positive attitude to complaints. With confidence, staff can show a positive reaction to complaints, which will in turn improve the flow of information. Staff need to understand the wide range of communications which constitute a complaint; a verbal grumble is a complaint; a non-verbal negative physical reaction on the part of a person with reduced communication abilities is a complaint.
Point 2 requires managers of all ranks to have training in how to receive and manage complaints without exerting negative back pressure onto those communicating the complaint information. Managers need to approach complaints neutrally, investigating before pronouncing, producing solutions rather than blame, and acting throughout in a transparently fair manner which encourages both the complainant and the complaint communicator to repeat the exercise when next necessary.
Point 3 requires some focus on the processes for complaints receipt and recording. It is normal to have a recording system for “major” complains (the Complaints Book), but this has little or even nothing to do with a complaints management programme. A Complaints Book (note the capitals) is a regulatory pressure protection measure, not a complaints management tool. A complaints management programme first of all looks for the sources of all complaints, comments, compliments, gripes, grumbles, whether written or verbal, whether formal or informal, and examines the method used to deal with each flavour. When suitable processes have been designed and implemented to collect information on each and every source of complaint, management can then consider dealing with the information.
Point 4 looks at the analysis of the information gathered. Note that Point 4 is not about responses to complaints. Response, and immediate remedial action, should have taken place well before this stage. No customer wants to be told that their complaint will be “looked at” during the next Management Meeting, and no member of staff wants to feel powerless because of the same delay. Staff need to be given the authority, encouragement, and support to receive complaints and deal with them to the satisfaction of the complainant on the spot, or at the very worst initiate some action which the complainant recognises as a positive response to their complaint which will in a reasonable time produce a satisfactory outcome for them. After all, it will almost always be the case that individual front line staff members will be the first to receive a complaint, gripe, grumble or comment, they are the best placed to recognise the cause and usually the best placed to fix to on the spot, if they have the authority. The job of the manager in this process is to be very careful to continuously positively reinforce the process, and avoid unnecessary censure of the occasional member of staff who makes a wrong decision in response to a complainant. If that happens, the primary failure is the responsibility of the manager and their training, not the employee in their execution.
The process required for Point 4 is one of extracting improvement data from the complaints database. Complaints often have two or more dimensions. As a simple example, a grumble from a customer that their food is not hot enough is quickly dealt with by the staff member present, by them heating up the food to an acceptable temperature. That is the one dimensional presentation and reaction. Hopefully, although this is not the subject of this article, the staff member receiving the grumble will record it within the daily care planning reporting system in order that other staff become aware that the complainant likes their food hot, and is dissatisfied when it is not hot. That is the second dimension. However, this form of recording may well miss the third dimension, and the organisation will suffer because of it. This will happen if the information about the complaint stays on the individual customer file and is not gathered to a central point for data analysis. There needs to be a system for gathering such information together, because in that way, it can be analysed over time and trends can be discovered. In our example for instance, dealing with a single or a few cold meals one at a time is simple enough, but it is possible that the staff dealing with the individual incidents are aware of the extent of the problem. That realisation will only come from analysis of the complaints database, which in this case may for instance show that a significant number of meals are reaching customers at less than optimal temperature. Fixing that dimension to the complaint is likely to require identifying the source or sources of the problem, and a revision of the food preparation and serving processes to eliminate it. The advantage to the organisation of recognising and dealing with this third dimension is the permanent elimination of complaints on that subject and the probability of significant time and cost saving. By eliminating the problem at source, customer satisfaction is improved because they do not now feel dissatisfied and complaining; staff morale is improved because they do not have to receive and deal with the complaints; staff time taken up on receiving the complaint, reheating the food and redelivering it is saved, and management time spent analysing data and designing responses is eliminated. Altogether, a massive saving. A quick thought experiment, imagining all of the aspects of your service which are subject to this kind of effect, where lack of time taken to gather and analyse data leads to significant loss of efficiency and customer satisfaction will probably surprise or even shock you. The author’s pet theory, developed over many years of managing care services for a variety of client groups in a variety of settings, is that a shockingly large proportion of care provision input is “wasted” because it is deployed dealing with rework because problems are not identified and dealt with.
It is well worth taking time out, probably as a small cross dimensional group, to look at the way in which you handle complaints, measuring that against these ideas and principles, and identifying where you may benefit from changing the processes. But beware that you are probably going to have to change the complaints culture first if you are going to gain the maximum benefit and truly be said to be Managing Complaints.