Frequently Asked Questions

The experience of making a complaint, including its outcome, often falls short of patient expectations.

The UK has the highest health litigation costs in Europe, and this is highly consequential for the NHS because litigation can result from dissatisfaction with, and exhaustion of a system not meeting a patient’s needs.

The strongest predictor for litigation is not medical error but dissatisfaction with communication, either within the clinical encounter or subsequently in the complaints handling process. A Healthwatch survey of 1676 adults reported that 60% either did not know how, or found it difficult to complain and 61% of complainants did not feel as though their complaint was taken seriously. Moreover, complaint handlers reported the need for communication training so they can ‘feel more confident in understanding the needs that patients and service users are expressing in making a complaint’.

To improve complainants’ experience, reduce litigation rates, and better support complaint handlers we need improved understanding of the very particular communicative demands of complaints handling in healthcare and the ways in which current practices do not meet expectations.

Real Complaints’ resources are a collection of evidence-based learning points, learning materials and workshops designed with and for complaint handlers.

Our resources focus on communication in healthcare.The core focus is on the key moments which influence the outcome of a complaint. These have been distilled into evidence-based learning points which we will make available to complaint handlers, as well as those who support complainants on their journey, such as the Patient Client Council. All of these learning points are based on the specific communication practices that we have analysed using conversation analysis.

The training incorporates real extracts and features anonymised clips from actual recordings of conversations between complaint handlers and complainants. These will be used to show how the actual communication practices of complaint handlers influence the outcome and their effect on how the patient feels.

The specific learning materials have been designed as an alternative to imagined or fabricated ‘roleplay’ scenarios, which do not fully represent the complex, nuanced, and sometimes protracted experience of complaining. Each learning point has been developed with input from complaint handlers themselves, focusing on individual cases of best practice so that all materials are tailored for trainers to use. Real Complaints resources are designed to complement and enhance existing forms of training so that complaint handlers may feel more confident in understanding the needs of patients when they are making a complaint.

The study focuses on every encounter that complainants have for the duration of their complaint and asks them to report their experience after each encounter by completing diaries.

The data set is comprised of a Cultural Audit of patient expectations and impressions; recordings of phone calls, meetings, letters and emails; and ongoing reflections gathered from the diaries and from semi-structured interviews. We use a combination of conversation analysis to scrutinise the recordings, as well as ethnographic tools to capture how, over the course of a complaint, a patient reports their experience.

These two strands of the project, when combined, will offer a full picture of the complaints journey. Our analysis will detail how patients understand the complaints process and what they identify as key moments during their journey; in addition, in fine grained detail we examine the interactional record and what communication practices contribute to these being key moments. We hope that through rigorous and accurate documenting of these interactions that we will be able to evince what best practice looks like, and how complainants and complaint handlers manage the delicate business of complaining.

All participants are anonymised, to make them impossible to identify.

• Audio/video-recorded data will have names, dates, place names or any other identifying references removed, and voices changed.
• Video recordings can be further anonymised using specialised software, turning people into animations or  blurring their faces.
• Data will be securely maintained so as to be quickly located by the researchers, in the event of a participant requesting to withdraw from the study, or for any other legal or ethical reason.
• All transcripts will be stripped of identifiers, and pseudonyms (as with names and addresses), or replacements (as with dates) will be applied.
• Any identifying details in written communications (emails, letters) will be redacted.

Our data are securely recorded and securely stored.

• Unedited versions of the recordings will be encrypted and securely stored, with only the core project team having access.
• The recordings will be digitally edited to ensure anonymity. Only anonymised versions will remain. These will become the data worked on by the researchers.
• At the end of study, all unedited data will be erased. No versions of the unedited, identifiable data will exist after this time.