Underpinning Research

Benwell, B., Erofeeva, M. & Rhys, C.S. (forthcoming) Why affiliation matters: a conversation analysis of complaints calls to the NHS. Patient Education and Counselling.

• Abstract

  Objective
  Callers making a complaint share their negative experience and expect affiliation from an operator. We examined how call handlers’ language choices affect both the progress of the call and the stance of the caller

  Methods
  We identified episodes where affiliation is displayed or noticeably absent in a dataset of 95 complaints calls to the NHS. Two single cases were examined closely using conversation analysis.

  Results
  Affiliation at sequentially relevant moments in conversation helps progress the call and de-escalate the complaint while the absence or misplacement of affiliation may lead to escalation. The latter recurringly involves blaming while de-escalation includes practices that diffuse blame. Early intervention in the form of affiliation to the ‘hurt’ component and the reasoning of the complaint is essential to de-escalation.

  Conclusion
  Our analysis revealed three key functions of affiliation in complaints calls: 1) ratifying the reasonableness of the complaint; 2) progressing the institutional requirements of the call; 3) de-escalating the complaint.

  Practice implications
  Call handlers should listen to callers’ cues for legitimization of their complaint and seek to provide responses that express affiliation.

Benwell, B. & Rhys, C.S. (2023) Phase structure and resistance to progressivity in complaints calls to the NHS. Journal of Language and Social Psychology.

• Abstract

  This paper examines how callers to an NHS complaints helpline get to “tell their story”. As “project-based” institutional calls, closure of a complaints call is observably organised around “mutually ratified project completion” (Raymond & Zimmerman, 2016). Our analysis reveals the practices that callers deploy to resist CHs’ progress through the institutional phase structure of the call, thus also resisting ratification of their project as complete. We show how these practices are varyingly oriented to (re-)telling elements of the complaint or pursuing legitimation of their complaint and/or identity as “reasonable” (Mandlebaum, 1991; Benwell & McCreaddie, 2017).  Callers’ resistance to institutional progressivity is oriented to misalignment in the prior uptake of their complaint narrative, revealing the relationship between projects and “identities” in the context of helpline interactions (Raymond & Zimmerman, 2016) and the tension between the separate projects of caller and CH (Hepburn & Potter, 2011).

Benwell, B. & Rhys, C.S. (2018) Negotiating relevance in pre-operative assessments. Social Science & Medicine, 200:218–226. https://doi.org/10.1016/j.socscimed.2018.01.034

• Abstract

  Preoperative assessments provide an essential clinical risk assessment aimed at identifying patient risks and requirements prior to surgery. As such they require effective and sensitive information-gathering skills. In addition to physical examination, the preoperative assessment includes a series of routine questions assessing a patient's fitness for surgery. These questions are typically designed to elicit minimal, ‘no problem’ responses, but patients sometimes produce expanded responses that extend beyond the projected information. Our analysis reveals that troubles-telling is often invoked by both nurses and patients as an effective, patient-centred resource for negotiating the medical relevance of patients' concerns in these contexts.

Benwell, B. & McCreaddie, M. (2017) Managing patients’ expectations in telephone complaints in Scotland. In D. van de Mieroop & S. Schnurr (eds), Identity Struggles: Evidence from Workplaces around the World, Amsterdam: Benjamins, pp. 243–262. https://doi.org/10.1075/dapsac.69.13ben

• Abstract

  In this Conversation Analytical study we examine telephone complaints to the NHS which address a variety of issues raised by patients or their families. One area of ‘identity struggle’ for the patient caller is located in the difficult moral work that often needs to accompany the act of complaining. Complaints are an accountable activity, and legitimacy is ‘built into’ the complaint through a variety of means including invocations of the ‘right’ to complain, emotion discourse and constructions of the self as a ‘good’ or ‘reasonable’ patient. Similarly, identity conflicts arise for complaints handlers when the ideal forms of rapport involved in complaining sequences sometimes come into conflict with the institutionality of the event.

  It is hoped that a detailed and discursive exploration of this key stage of the patient experience will lead to productive observations about effective communicative strategies for addressing complaints in ways that successfully manage the patient’s expectations.