What is a complaint?
Complaint sounds like a negative word.
In the context of this blog I don’t think of a complaint as a
negative. The reason I complain about
issues in health care is to create dialogue with health care providers. As a patient advocate I want to raise
expectations. Do we not deserve the best
care available? Is the purpose of health
care to be “average” or is the purpose to be “excellent”? The quickest and easiest way to understand
areas where we need to improve is by listening to the complaints of patients.
When I talk about complaints many immediately think of the
formal processes involved in doing so.
Contacting patient relations and filing a formal complaint. The problem with this is that when you get to
that point you have probably missed several opportunities to reach a positive
outcome. If you are at the point of
going through the formal complaints process, then it is likely that
communication with your care team has degraded significantly or harm has
already been done. The whole point of
this exercise should be prevention. This
is why informal complaints are the best tool a patient has of enhancing their
care right here and right now. Not 8
months from now. It is also important to
raise issues effectively while maintaining a good relationship with your care
team.
What is an Informal Complaint?
When I talk about informal complaints what I am really
talking about is communication. The skill
of raising concerns and complaints in a constructive way to achieve a mutually
beneficial result. These kind of
complaints usually involve front line staff who interact on a daily basis with
patients, not the high powered executives who manipulate the levers of the
health care system.
When you talk to many patients and they explain some of
their frustrations with health care, many of the concerns are not medically related. Numerous studies show this. Many times, patients are frustrated by a lack
of communication or not being given information that is relevant to them. Patients frequently complain about not have a
clear understanding of the diagnosis or the treatment plan. Having talked to many people who work in
patient relations the biggest issue that comes up over and over again is poor
communication. Simple misunderstands
that erode trust until the health care relationship is damaged so badly that
quality of care is negatively impacted.
Communication is a massive issue in health care.
We have to remember that health care is a world unto
itself. They have their own language and
processes that are completely non-intuitive to those who do not experience it
on an ongoing basis. Many who are
patient advocates are trying to help change this culture but it isn’t going to
happen anytime soon. So what do you do
today?
Ask Questions
Many of us who are not medically trained can be easily
overwhelmed by the health care system. Even
clinic visits can be very challenging if you don’t know the processes
involved. You have to ask questions to
figure things out. When making an
appointment ask about parking. When
arriving at a massive hospital stop at reception and ask for directions. When arriving at a clinic ask how long you
may be waiting. Do they have Wi-Fi? If you step away to go to the bathroom and
they call you will you miss “your turn?”
All of these questions are simple (and necessary to survive) but did you
notice how many very subtle complaints were contained in those questions. Parking is horrible, your clinic is
impossible to find, Wi-Fi is an absolute must, and your cattle call waiting
room system is archaic and demeaning. If
every patient asked these questions and staff had to answer these questions
over and over again…perhaps someone may get the hint and realize they need to improve. This is a great way to complain in an
informal way that doesn’t get anyone upset as these questions are all very
legitimate. In this example the questions I posed served two purposes. It provides you the information you need to survive your appointment and it also provides feedback to the health care system about the types of issues that are important to patients.
Modes of Communication
It happens to all of us.
We wait 6 months to see a specialist and we dutifully do our homework
and prepare for the appointment. We
prepare questions, bring a pen and paper to take notes, and do all of the right
things we as patients are supposed to do.
We have an engaging 10 minute conversation with the esteemed Doctor and
feeling empowered at a job well done we leave the appointment. Inevitably, on the way home we think of a
couple more questions and then recall one really important issue we failed to
bring up. You arrive home feeling like
an abject failure feeling the entire appointment was a waste of time. Here is my problem with the conventional
Doctor’s appointment.
If you met a really nice girl, engage in some conversation
and after several requests she finally agrees to go out on a date with
you. After the date, what message would
you take away if she never gave you her phone number or any way of contacting
her in the future? Probably not a good
sign. So if a Doctor gives you no way of
contacting them after an appointment, are they sending you the message that
they would prefer to never see you again?
When an appointment is concluding there should ALWAYS be an
exchange of information of how to contact either the Doctor or a Clinician who
works with the Doctor if there are any questions or follow up. We have so many methods of communication
today this should not be a difficult request.
Ask what works best for the Doctor.
Phone…email…text… what works for them?
This is not an unreasonable request.
If your physician refuses to offer any effective way of communicating outside
of a planned clinic visit (that you may have to wait weeks for), maybe you
should think about finding another Doctor.
Which brings me to my next point.
Build Your Care Team
When you ask questions or make inquiries about your health,
the hope is that you start a conversation.
In a conversation you can learn much more than reading a pamphlet or
dutifully listening to a well-rehearsed speech.
In a conversation, two people interact and learn about each other. You start to build a
relationship. If anyone in health care
is willing to engage with you… hang on to those people. As you start to build a relationship, from
that relationship you begin to build trust.
Trust is a huge issue. What is
the point of having a physician who is highly regarded and the “best in their
field” if you can’t communicate with them?
In spite of their list of qualifications, if they can’t communicate
effectively they can easily alienate a patient and trust becomes a factor. When we are admitted to hospital we always
try to make a connection with someone (anyone) who is willing to engage in
conversation and explain what is going on.
The trust that you build gives you the confidence to leave your child’s
bedside and actually stop, go to the cafeteria, and have a meal without the fear that “something”
might happen when you are gone.
Our care team is our life line. The beginning of our care team was formed on the day of my
son’s diagnosis. In addition to our
Doctors, we were introduced to our nurse clinician who gave us all of the
clinic’s contact information, the 24 hr pager
number for Cardiology, her office number and her own personal pager. We were encouraged to call if there were any
concerns. They were available 24/7 for
us. We felt like we had support. 5 weeks later we needed that support. It was the openness and engagement that we
felt that prompted us to page our cardiologist, without the fear that we were
taking up someone’s valuable time. That phone
call that likely saved our son’s life.
To this day I trust our team implicitly.
When we have a negative experience in their clinic or in the hospital I
have complete confidence in them to address any issues and openly communicate
with is. We may not always get the
answer we want, but we do get the best information available. Trust also adds the benefit to our clinicians who don't feel like they are being second guessed when we ask questions.
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| Minor Communication Errors can have dire consequences |
It's the Little Things that Matter
Yes, many of the things that I have discussed are small
things. Little frustrations that we all
face. However, when we don’t say
anything we facilitate the gap that exists between us (the patient) and our
health care system. There are many
things we can do to engage our health care providers, establish relationships,
and build trust. If we don’t question
policies & processes we are admitting failure before we even start. It is important to challenge the status quo
as we need to give our health care providers the feedback they need to improve
and succeed. They will never succeed if
we aren’t providing feedback. Even in an
Emergency Room environment it is possible to make a connection with a doctor or
nurse, engage with them for only a few hours in spite of the fact you may never
see them again. We are all capable of
this. Health care relationships should
not be sterile and unfriendly.
The whole point of addressing the small issues is so they
don’t become big issues.
Next Blog Post: Part 3: The Formal Complaint Process aka “The
Slow Boat to Frustration”
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