The word ‘complaint’ has a latin root: planctus. It means to beat the breast in grief; to mourn for something lost.
What would it be like if we routinely treated ‘complaints’ in healthcare as laments for the loss of something important, rather than seeing them as criticism, feedback, or just a burdensome administrative task?
Through my work with patients, their families and with clinicians, I have come to see the significant difference that such an approach can bring. But let me be very clear, I am not suggesting that this shift is a simple one. Indeed, faced with apparently difficult patients, upset families, belligerent colleagues and limited time, it can feel utterly impossible.
When things go wrong, the prevailing consensus is that patients and their families want transparency, an apology, and information about what will be done to ensure that no-one else suffers. But there is a risk that unless we actively ‘humanise’ our approaches to these matters, we will ignore the heart of the complainer’s ‘lament’ and totally miss the point. Talking to The Guardian newspaper following the inquest into her baby son Axel’s death, Linda Peanberg King said of the organisational explanation she received: “It felt like a powerpoint exercise; it was shocking to hear your dead son being described in corporate speak as ‘a learning exercise.’” (Guardian March 2nd 2013)
In a recent interview Sir Robert Francis QC described to me the ‘depressingly familiar’ pattern of complaints that he had found at Stafford Hospital. “There would be a complaint, there would be a formal response and an apology, plus an action plan that would not be put into force. The same thing would happen again, the same apology would be issued and pretty much the same action plan.” That is what happens when responding to complaints becomes a purely administrative managerial task.
So, how do we start to make this shift in culture? Well, for me the first step is to recognise that cultural change happens in the everyday things we do, today, tomorrow and in the future. It involves conversations about what things mean to us, and what they might mean to others. It happens in the detail of everyday encounters between people – one-to-one and in groups – and it does not happen without conscious effort over time.
There is no doubt that addressing these intensely human dimensions of care is demanding of emotional energy and clinical time. But far from sapping energy, nurturing the healing relationship that lies at the heart of compassionate healthcare has the potential to enrich professional experience, and takes little if any more time.
American author Anatole Broyard wrote movingly about his encounters with medicine while he was dying. “I wouldn’t demand a lot of my doctor’s time” he wrote, “I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way.” (Intoxicated By My Illness)
I contend that we should think about ‘complaints’ in the same way that Broyard talks about illness. It is time for us to ‘survey the soul’ of the complaint and ‘not just the flesh’.
Footnote: I am indebted to my colleague Dr. Suzanne Shale, as co-author of the article upon which some elements of this blog are based. The article was first published in The Health Service Journal in 2013.