Title: Enhancing the patient complaints journey: harnessing the power of language to transform the experience of complaining
Funder: Public Health Agency, NI

Abstract: This project aims to make the experience of complaining to the NHS better for patients and their families and improve the outcomes for the NHS. Complaints can be positive for the NHS because they help improve services for other patients. However, if a patient takes legal action, it is costly for the NHS and stressful for the patient. So what makes a patient resort to taking legal action? Surprisingly, it isn’t the seriousness of the medical error. What matters is how the error is dealt with and the communication that follows with the patient or their family. For example, in a case in Australia, eleven patients were given a contaminated solution injected into the heart during surgery. Five of the patients died. But none of the families took legal action because of the sincerity of the Chief Executive’s apology and the way he communicated his commitment to investigating what went wrong._x000D_ _x000D_ NHS complaints policies recognise the importance of good communication in complaints handling but the focus is mostly on systems and procedures. Although the goals of the communication are identified (e.g. apology, empathy, understanding), they are often not met because there is not enough understanding of how to achieve those goals when responding to a complaint. Research tells us what patients want from the complaints process, but there is very little research that looks at what actually happens in the communication with patients and how it can go wrong. This is the gap in our understanding that this research project aims to fill. _x000D_ _x000D_ This project will record and analyse the communication between the NHS and the patient or their family through the entire complaints journey from initial contact, when the complaint is first made, through to when the complaint is closed by both patient and Trust. As well as observing the actual communication, the project will use video diaries and interviews to analyse how the hopes and expectations of the patient change (or not) with each encounter in the complaints journey. This will allow us to understand how communication impacts on the patient’s experience of complaining. The two different types of data are essential because research shows that our perceptions of a conversation and what actually happened in that conversation can be wildly different. _x000D_ _x000D_ The recordings and analysis of real conversations and letters/emails between patients and NHS complaints staff will be used to develop training materials that will help complaints handlers reflect on how their communication impacts on patients making complaints. Previous research in other professional contexts shows that communication training that uses recordings of real examples is much more effective at getting trainees to think about the emotional aspects of their communication. This is particularly important for NHS complaints handling as it is the emotional connection with patients that is important to their experience of the complaints process._x000D_ _x000D_ Patient and public involvement will be influential throughout the project but particularly in the translation of the findings into relevant training materials, where the co-designing of the training resource will ensure the value of the outcomes to future complainants and complaints staff. The outcomes of the project will be accessible via the project website and will be disseminated through professional associations, conferences and journals as well as through patient organisations and academic publications.

Lay abstract: • Research question_x000D_ How can the power of language be harnessed to transform complainants’ experience of complaining in the NHS and reduce their recourse to litigation?_x000D_ _x000D_ • Background_x000D_ The strongest predictor for litigation in the NHS is not medical error or patient demographics but dissatisfaction with communication, either within the clinical encounter (Vukmir 2004) or subsequently in the complaints handling process (Durand et al 2015). A challenge in addressing litigation rates is therefore to develop effective communication interventions for healthcare complaints handling. An analysis of moments of interactional contact has been neglected in previous attempts to reform the complaints process (Cowan and Anthony 2008) and is likely to improve our understanding of good and poor communicative practice._x000D_ _x000D_ • Aims and objectives_x000D_ The purpose of this study is to develop a qualitative understanding of the experience of making a complaint from the perspective of the patient. The research objectives involve an examination of complainants’ lived experience of interacting with the ‘system’ a) through a contextualised micro-analysis of direct communications, spoken and written, with NHS representatives and b) through evaluative self-reports and interview accounts by patients of the complaints journey. Then on the basis of insights derived from cross referencing these analyses, an evidence-based “Real Complaints” communication training resource will be developed to address the interactional and interpersonal challenges of NHS complaints handling. _x000D_ _x000D_ • Methods_x000D_ The project’s innovative methodological design combines longitudinal, micro-level Conversation Analysis of complaints encounters with a parallel analysis of complainants’ appraisal of those encounters, a cultural-contextual analysis and the practical application of research findings in accessible training resources for NHS staff. _x000D_ _x000D_ • Timelines for delivery_x000D_ Pre-Grant phase: Co-design of qualitative data collection tools. Preparation and application for ethical approval. Recruitment of RAs and Steering Committee/Advisory Board. Initial project website creation._x000D_ Stage 1: Project preparation including information events. Updating literature review. _x000D_ Stage 2: Data collection and analysis (Initial online cultural audit, written and spoken recordings of complaints; (video) diaries, interviews). Tagging and scoping analysis of initial contacts and longitudinal encounter data. Analysis of diaries and summative interview. Conversation Analysis of longitudinal data and Discourse analysis of written responses._x000D_ Stage 3: Dissemination/publication of research findings; Development of “Real Complaints” training content and resources._x000D_ Stage 4: Piloting and evaluation of “Real Complaints” resource; Refining materials and disseminating outcomes; Web-based delivery of “Real Complaints”; Final project report._x000D_ _x000D_ • Anticipated impact and dissemination_x000D_ The project will deliver impact by providing targeted training resources to improve complaints handling and reduce litigation. The project outcomes will be published as a series of articles in academic journals, reported via the project website and disseminated through professional and academic associations, patient organisations, academic conferences as well as popular media to ensure that the results of the research are visible and able to inform policy and practice.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE