Improvement-focused approach needed in NHS complaint-handling policies

National policies for complaint handling in NHS hospitals in England may be missing opportunities for learning from the concerns raised.

This is according to a new Imperial-led study published by the Journal of the Royal Society of Medicine, which highlights that the current design of systems for handling complaints means that too much emphasis is placed on assessing a complaint’s validity, and not potential quality improvement strategies.

"The complex nature of the NHS complaints system is often cited as an obstacle to effective complaint handling." Dr Jackie van Dael Institute of Global Health Innovation

The researchers say the process for raising formal complaints can be unclear for patients and relatives. The case study identified that in order to reach targets set within national policy, NHS complaints teams were forced to focus on decisions over whether to uphold a complaint or not, rather than listening to the concerns and issues that have been raised by the complaint to see how to learn from it.

Lead researcher Dr Jackie van Dael, of the Institute of Global Health Innovation's NIHR Imperial Patient Safety Translational Research Centre at Imperial College London, said: “The complex nature of the NHS complaints system is often cited as an obstacle to effective complaint handling.

“However, a detailed examination of how national rules, regulations and infrastructure influence complaint handling, investigation and monitoring within hospitals has remained relatively unexplored.”

Learning from patient complaints

Between June 2018 and June 2019, the researchers interviewed 20 staff and analysed complaints documentation at a multi-site acute hospital trust in London, which consists of five acute sites and a range of community services.

"Some of the identified challenges resonate with findings from earlier inquiries – showing problems are systemic." Dr Jackie van Dael Institute of Global Health Innovation

The team identified four areas where the design of national rules and policies were reported to undermine a patient-centric and improvement-focused approach to complaints. These related to access to the complaints process; the conduct of investigations; data collection systems; and administrative performance targets.

“Although our study was conducted at one multi-site NHS organisation, some of the identified challenges resonate with findings from earlier inquiries – showing problems are systemic, rather than unique to poor-performing hospitals,” said Dr van Dael.

An issue that interviewed staff frequently mentioned was confusion regarding the routes for raising concerns. Central to this was a lack of awareness, among both patients and frontline staff, about the different roles of the formal complaints team and the Patient Advice and Liaison Service (PALS).

PALS is a point-of-contact within hospitals created to resolve lower-level concerns and queries directly on the ward. Dr van Dael said: “The visibility of PALS positions the service as a catch-all destination for patient concerns and queries and served to overshadow complaints departments in some cases.”

"All complaints are opportunities towards better understanding patients’ needs." Dr Jackie van Dael Institute of Global Health Innovation

In addition to clarifying the roles of PALS and formal complaints processes to staff and patients alike, the researchers suggest reviewing national data collection systems, and re-considering the regulatory requirement for hospitals themselves to judge whether complaints are ‘well-founded’.

“All complaints are opportunities towards better understanding patients’ needs and their unique perspective on organisational safety,” commented Dr van Dael. “We recommend involving patients and families in complaints investigations as standard practice and creating opportunity for dialogue between involved staff and affected patients.”

Visit the Journal of the Royal Society of Medicine website to download the paper. Publication title: ‘Do national policies for complaint handling in English hospitals support quality improvement? Lessons from a case study’.