What happens when something has gone so wrong in your practice that it leads to a patient lodging a complaint – a complaint that makes you as a practice manager feel responsible for your patient’s grievance?
The problem may be one of too many colonels and not enough soldiers. In the army, each platoon has a hierarchy which starts with the leader at the top and ends with the soldier out in the battlefield. Only ONE person calls out the instructions; everyone else must follow. This rule should apply to each person in a position of responsibility. If the rule is broken, then the person responsible should be dealt with immediately. You need to re-trace the day’s events and go back to the root cause of the problem. For example:
A patient enters the reception area and is crying, as she is in pain. She asks to see her dentist, only to be told that her dentist is not in on a Friday. However, she is told that there is another dentist on duty. The dentist is fully booked for the day, and even though the receptionist approaches the dentist about seeing the emergency patient, the dentist says that he cannot see the patient as he is too busy. The receptionist returns to the waiting room to tell the tearful patient that the dentist is too busy to see her. The receptionist tries to help by telling the patient to go to another practice in the same area. The patient starts to cry and says that she cannot handle the thought as she is in too much pain. At this point, the nurse refers the patient to a clinic some distance away. The patient is so desperate that she takes a cab to the clinic, only to be told that their dental clinic is not open on a Friday. The patient is then directed to another practice where a dentist informs her that she has an abscess.
The saddest part of this story is that the practice manager was in her office the whole time, but neither the receptionist nor the nurse thought it was important to call her. As I personally come from a medical nursing background, this story mortified me! When I analyse what went wrong, several issues come to light. First, the receptionist was new to the dental environment and did not know the rule of never turning away a patient who is in pain. Second, the nurse tried to be helpful but due to a lack of knowledge, gave the patient the wrong information, which further aggravated the situation. Third, the practice manager was unaware of what was occurring. Fourth, the practice (which is of a substantial size) appears to have been understaffed. These issues all come down to poor practice management.
A complaint such as this should be discussed with each person involved in creating the problem. The role they played in it should be pointed out to them, and they should be re-educated in practice procedures and policies. They should then be monitored to ensure that they have taken on board what part they played in effectively mistreating a patient in pain.
Nine times out of ten, problems are due to poor (or absent) practice procedures induction sessions for staff. Development of practice procedures should be ongoing; it should never come to an end. Inductions must always be provided when a new member of staff joins your practice. As a practice manager, you can never assume that the new member of staff will just fall into the practice procedures because everyone else uses them. Failure to provide proper induction will cause stress to your patients, and to your dentists and nurses.
When a patient lodges a complaint, there is a standard Patient Complaints Procedure to follow. This can be downloaded from the BDA website, the NHS website or the Code website. These steps should be followed without failure until closure has taken place, and records of them should be filed away in your complaints folder to enable you to do an audit at the end of each year. The audit should monitor what your complaints were about and how they were handled. The PCT will also send you a questionnaire on complaints once a year to complete; this will be much easier if you follow this procedure as a matter of routine.
The moral of the story is that staff should never make any major decisions without consulting the practice manager first. My closing statement is from Winston Churchill:
From the neck down is worth minimum wage. From the neck up is priceless.
By Sharon Holmes
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