Learning from our – and other people's – mistakes

Published on Monday 15 September 2008 20:58

THE number of complaints in the Scottish Health Service is, according to the latest published data, up 7 per cent for family health services but down 7 per cent for hospital and community services. It is difficult to know whether this is good news or bad.

One argument is that an increase in the number of complaints is good, as it shows the service is encouraging people to complain and will therefore be able to address the issues, learn from its mistakes and change more quickly. The counter argument is that a falling number of complaints demonstrates that the service is improving and there is less need for patients and families to complain. You can, therefore, read what you want into the statistics.

However, at the front line, it is sometimes difficult to decide what actually equates to a complaint. It is easy if a letter comes in saying "I want to complain", but is it a complaint if a patient says "I just wanted to give you some feedback" or "Could I have a little more information about this problem?"

Similarly, should we log a comment such as "the water needs changing in those flowers" as a complaint alongside a potentially serious issue of a missed diagnosis?

Health service guidance defines a complaint as "an expression of dissatisfaction requiring a response", which could clearly be open to interpretation. Therefore, it is important both parties ensure there is a clear understanding as to what is wanted in any concerns, comments or feedback.

Doctors do take all complaints seriously and often they cause a lot of heartache, thought and soul searching. The system of how a complaint is handled was changed in 2005, and management consultants, contracted by the Scottish Consumer Council and the Scottish Government, are currently examining how these changes are working.

Generally, the changes to the complaints service have been welcomed, as it is now a much simpler procedure. If a complaint cannot be resolved by those complained against (hospital or general practice), then the complainer has the right to go to the Scottish Public Services Ombudsman. This institution considers all unresolved complaints, be they health, Scottish Government, local authority or education. It, therefore, has tremendous experience of complaint investigation and can, by its breadth and depth of knowledge, be considered truly professional and independent.

My practice recently had a complaint referred to the Ombudsman and I was impressed with the speed and thoroughness with which it dealt with the multiple and complex concerns. This led me to its website, which lists all investigations and the lessons that should be learned from the issues that had caused the complaints. A quick poll of local doctors, though, showed very few knew of the website's existence.

One of the main purposes of appropriate complaint-handling is to learn from mistakes. If we can learn from other people's mistakes, there is the potential to improve more quickly. I believe the Ombudsman should look at a wider dissemination of their investigation reports, which would influence change and potentially an improvement in care. Of course, whether this would make any difference to the statistics is a moot point, as is whether an increase or decrease in the number of complaints would represent success or failure.

Complaints in the health service are likely to continue as things, unfortunately, do go wrong – sometimes due to chance and sometimes due to mistakes being made.

Most doctors will experience several complaints about their care over the course of their career.

In the medical profession, we have to be more welcoming of complaints, rather than seeing them as a direct assault on our professional integrity. I think doctors are learning to change, but we're still a long way from that nirvana of "every complaint should be like a pearl – welcomed and treasured".

&#149 John Garner is a member of the BMA's Scottish Council and a practising GP.