At a time of increasing consumerism worldwide, it is easy to develop a fear of complaints or litigation. No professional likes reading a complaint about themselves or receiving criticism from a patient whether it is valid or not. Here we look at why complaint handling skills are so important.

A significant majority of the complaints and episodes of litigation, experienced by members of Dental Protection, display some evidence of a breakdown in the interpersonal relationship between the patient and the dental professional.

Research which looked at the incidence of adverse events and negligence in hospitalised patients in the US, showed that of approximately 30,000 patients, 3.7% suffered an adverse outcome of which roughly a quarter could be attributed to negligence on the part of the clinician. But, only 1 in 8 patients actually sued their clinician. It would be reasonable to assume that there must be some other mechanism(s) involved in a patient’s decision to complain and/or sue a healthcare professional. Indeed, we can say this with some certainty because in 66% of those cases there was no evidence of negligence, even though the patient had chosen to sue their doctor.

Why some people complain and others don’t

Some dentists and dental practices receive a considerable number of complaints or regularly get sued; yet objective scrutiny of their dentistry has demonstrated that their standards are no different from those of their colleagues who do not receive complaints or get sued. Many complaints or law suits produce no evidence whatsoever of negligence or fault on the part of the practitioner, although the patient perceives a shortfall in the care that they received.

It is important to remember that receiving a complaint or being sued does not necessarily make you a bad dentist, hygienist or therapist. Sometimes it may just be bad luck. But frequently there has been a breakdown in the relationship between the patient and the team or a member of that team. The breakdown in communication may not rest entirely with the treating clinician. It can also involve any other individual that the patient considers to be a representative of the practice.

There is a considerable amount of literature to support the concept that the patient’s decision to take something further has often been made before the incident that apparently gives rise to it. A study of patients, who had sued their doctor and won, discovered that more than 50% of the patients wanted to sue the doctor even before the alleged negligent act took place.

Research shows that practitioners with a low claims experience possessed several common characteristics:

•  They spent slightly longer with their patients at each visit
•  Better patient knowledge of what was happening and why
•  Active listening skills
•  Warm, friendly atmosphere
•  Humorous, warm personality

It also shows a range of similar characteristics that existed in doctors who had never been sued:

•  Respecting a patient’s dignity
•  Respecting privacy
•  The ability to listen patiently without interrupting
•  Being available
•  Being polite and not over-familiar
•  Respecting a patient’s time 

A significant picture starts to emerge; if an individual is personable and a good communicator then there is a reduced risk of receiving a complaint or being sued.

Communication skills, and in particular non-verbal skills, significantly affect a patient’s satisfaction level towards outcomes of treatment. Providing patients with extra time during treatment, changes their perception of the level of care provided. Research shows that patients are more likely to sue if they feel rushed and that insufficient time has been spent with them.

It has been shown that explaining consultations and listening actively to patients so as to gain a comprehensive understanding of their expectations is important. In Dental Protection’s experience, it is the failure to grasp patient expectations at the outset that often leads to problems, particularly when there is an unexpected treatment outcome.

It has been said that there are two sets of factors that influence a patient’s decision to complain.

Predisposing factors

These include events which, when considered individually, may be of little consequence to a patient’s satisfaction. But collectively they may influence a patient’s decision when something goes wrong or is perceived to have gone wrong. Predisposing factors include events such as rudeness, delays, inattentiveness, miscommunication, and apathy, lack of cleanliness or minor system errors.

These predisposing factors tend to reflect the communication between dental team members and their patients. They have little to do with the quality of the clinical dental treatment provided. They are the drivers for the value judgements that patients make about dentists and their teams. They can create strong emotional responses that influence behaviour and satisfaction levels.

Precipitating factors

These are the factors that can trigger the patient’s final decision to complain. They include iatrogenic injuries, adverse outcomes, mistakes or major system errors. In the absence of predisposing factors there is far less likelihood of the professional person being sued even when these precipitating factors are present. However, the more serious the precipitating factor, the greater the likelihood of a complaint or litigation. It is the emotional response to the predisposing factors that is likely to act as the catalyst.

Complaints handling skills are a prerequisite to survival in today’s consumerist society. Time spent training all the team members in basic complaints handling and customer care skills will reap significant rewards for any dental team.

Whilst it is easy to assume that patients will complain or sue whenever anything goes wrong, the reality is that the vast majority of patients will not. Although patients who have been seriously harmed may take the matter forward, it is often the negative factors in the relationship, between the dental team and the patient that results in the patient deciding to do so.

All staff members can influence the level of patient satisfaction towards treatment. More importantly, every staff member can play a role in recognising and dealing with the early signs of dissatisfaction. There is a key risk management message here; develop a good impression at the outset and build a rapport with patients.

Perceptions influence our levels of satisfaction about treatment and the service that has been provided. Time spent in developing a reserve of goodwill with your patients can make all the difference. If the patient feels able to voice their concerns to your team, you are in a better position to keep the complaints under your control, and prevent the complaint from escalating and posing a far greater threat elsewhere.

From its unrivalled international perspective (with more than 68,000 dental members worldwide) comes the realisation that the dissatisfied patient will bring their complaint to whichever organisation or public body that seems most convenient, most accessible and appropriate, and most likely to provide a swift, meaningful and satisfactory outcome.

There will always be patients who are dissatisfied with their treatment, or whose expectations are not met in some way, and unless the opportunity is grasped to address and resolve these complaints, quickly and effectively at an early stage within the practice, there will be a likelihood that the patient will take their complaint to another, perhaps higher authority outside the practice.

There is often a very small window of opportunity to nip potential complaints in the bud, in the best interests of all concerned, and Dental Protection has always urged members to do so, thereby preventing a complaint from escalating into another forum such as regulatory bodies, or solicitors or other formal complaints schemes. Patients expect their concerns or complaints to be acknowledged, listened to and dealt with promptly. Members should appreciate that complaints, if left unresolved, can proceed on two or more of these fronts simultaneously.

Members (and their staff) are urged to contact Dental Protection at the earliest stage of any complaint, when our dentolegal consultants will be happy to advise on the best way to proceed in the circumstances of each individual case.

Each and every complaint needs a specific, individual response because no two practices (and indeed, no two complainants) are the same. Dental Protection is happy to offer specific advice on individual cases. Similarly, each practice must design and operate a complaints system which reflects the size, nature and style of the individual practice, and the strengths and limitations of its human and practical resources. The complaints system appropriate to various practices will have common characteristics, but the fine details must be a matter for each individual practice. Here again, Dental Protection is happy to offer advice on request.

Advice on hand

Dental members are encouraged to contact Dental Protection as soon as a complaint is intimated. The earlier you contact us, the more help we can give you in the important early stages. In addition to providing an independent, more detached and less emotional view, we may be able to suggest suitable responses for use when speaking to the patient as well as helping you to construct any written responses that might be appropriate.