b11 handling private practice complaints - jan 2007

Advicesheet

B11Handling private practice complaints

Advicesheet

Handling private practice complaints B11

Complaints are a ‘good thing’ 3

Learning from complaints 3

General approaches to handling complaints 4

What do customers expect? 4

What sort of complaints are we talking about? 4

Practice procedures 5

Updating your complaints procedure 8

Training 8

Publicity 9

Putting it right 9

Customer involvement 9

Indicative pricing 9

Further information 9

Example fee scale 10

Code of practice for patient complaints 11

Skilful handing of complaints isessential to modern businessmanagement. A complaint, if

handled properly, can enhancerelations with the complainant,

turning a potential lostcustomer into a satisfied

customer. It can also offer anopportunity to improve the

management of the practice,ensuring that the same

mistake, which may havecaused other customers silently

to leave the practice, doesnot happen again. It is animportant part of clinical

governance. For theprofessional, if the customer's

problem is dealt with at anearly stage, formal complaintsprocedures, with their cost intime, money and anxiety, can

be avoided.

This advice sheet focuses oncomplaints in private practice.It shows how complaints can

be used as a positivemanagement tool and provides

a simple procedure forpractices. The GDC have now

set up a Dental ComplaintsService for private patients.

contents page

© BDA January 2007 2


Management theory is that valuable lessons can be learned from complaints. In a smallpractice reception area it can be hard to view complaining customers in a positive way.At the very least they can be an irritant, and at worst they may lead to a PCOinvestigation or GDC inquiry.

When a complaint is made at the practice reception, you know that everyone in theroom will be watching the interchange between patient and receptionist. Whatever thebackground to the complaint, it is hard to see it as a positive opportunity to improveyour practice - more a source of embarrassment than a 'moment of truth'! But it is reallya golden opportunity to demonstrate to customers how professional your practice isand what a high standard of care and service is provided.

In a small organisation, blame cannot be passed on to another department or an absentcolleague, and it is tempting to counter complaints with defensiveness. But complaintsare part of the communication process and are a very important aspect of your relationshipwith your customers. Successful private practice is built on the relationship between thepractice and the customer and a complaint can be part of this relationship building.

Most patients who are unhappy with the treatment or service they have received at apractice do not complain: they go to another dentist and tell at least a dozen otherpeople why. This, and the importance of referral in attracting new customers, are twovery important reasons for developing an efficient system for handling complaints.

Private patients paying the full cost of good dentistry will be expecting more from youand will feel entitled to complain. There is also the group of patients who expect to bedisappointed in the service they receive and complain very often. It is tempting just to tryto soothe and pacify them and not to take their grievances seriously. They may, however,only be expressing what many customers are feeling but are too indifferent or reluctantto tell you.

Do you keep a log of the complaints and negative comments you receive about thepractice? Do your staff ask customers directly after they have made an appointment orpaid for their treatment whether there is anything else that you can do for them? Thisgives the customer the opportunity to provide feedback. Do you analyse the number ofpatients who leave the practice after a short time and find out why? Do you discusscomplaints at staff meetings or with individuals if the complaint is directed towardsthem? Try some of these activities but do not at this stage focus on the amount or typeof adverse comments you receive. Look at what you are doing in response to help tominimise the need to complain. These opinions were there anyway and now that youknow about them you can choose whether or not to take action and rectify them.

Even if you do not receive any complaints or negative comments, it is a very good ideato encourage customers to comment on the care and service they receive from you.Your professional relationship with your patients as customers requires you to answercomplaints satisfactorily, put the matter right, and use the information provided toimprove your service.

To deal properly, easily and consistently with complaints, all that is needed is a simpleprocedure which is written down and understood by the practice team and complainants.Ensure that all members of the practice team are familiar with the procedure.

Complaints area ‘good thing’

Learning fromcomplaints


The General Dental Council established a Dental Complaints Service to resolvecomplaints about private dental care. Its aim is to “resolve complaints fairly, efficiently,transparently and quickly, benefiting patients and dental professionals.” Further informationcan be found at www.dentalcomplaints.org.uk.

Dental professionals should follow the guidance provided by the GDC. This can be foundat www.gdc-uk.org/Current+registrant/Ethical+guidance

The GDC has also published guidance on how the relationship between the DentalComplaints Service and the GDC is intended to operate in the course of handling complaints.

Standards for Dental Professionals is the main GDC guidance on what is expected ofdental professionals and contains the principles and values through which all registrantsare required to operate.

In general dental practice it is obviously in the interests of both customer and dentistfor a complaint to be resolved at practice level, thereby avoiding the need for a patientto complain to the General Dental Council or a solicitor. Complaints can however bedifficult to resolve, particularly if the customer has experienced pain, distress and/orinconvenience for which they expect compensation.

When making a complaint a customer usually wants to know:

● what happened

● why it happened

● what will be done to put it right

● whether anyone is to blame

● if so, what action will be taken

● what action will be taken within the practice to ensure that it doesn't happen again.

For most medical complainants, financial compensation is not the main motivation forcomplaining. In private dentistry, where customers pay for their treatment, complainantsmay reasonably want to recoup the cost of failed treatment or the cost of rectifying it.Litigation is often at the end of a complaints process during which the customer cannotsee any other way of making their feelings heard. That is not to say that dental customersdon't seek financial compensation for damages or that vexatious or litigious customers donot exist; but it is not inevitable that every customer who makes a complaint will be doingso for financial gain.

It is much better that a customer's objectives are achieved by communication betweenthe customer and practice, rather than the customer's solicitors and the dentist's defenceorganisation's solicitors and there is no reason why this should not happen with the helpof a clear procedure. The Dental Complaints Service recommends that an attemptshould be made in-house first, to try to resolve the complaint, but if the patient wishesto go directly to them, they will investigate it.

Complaints about private care cover a wide range of issues. For example:

● the cost of treatment not being fully explained or being seen as unreasonable

● poor cosmetic result

● ill-fitting dentures after a well-fitting pair had been promised

● restorations that need to be repaired or replaced

● the customer's initial request or expectation not being met.

Generalapproaches to

handlingcomplaints

What docustomers

expect?

What sort ofcomplaints are

we talkingabout?


Another source of complaint might be if you are changing from NHS to private practice.In these circumstances customers might feel that:

● the fact that they are now being treated on a purely private basis was not fully explained

● they were not informed in advance of your private charges

● they were told that they would receive better quality care, but they see no evidenceof this

● they were told that more time would be available for each appointment, but it is justas difficult for them to see their dentist as before

● the dentist is still abrupt even though they are paying privately.

These examples provide valuable indications of issues that you need to look at further -they may or may not be valid complaints but they are pointers that something isn't right.

How would you deal with each of these typical complaints? What would you say?What might others say?

● Why should the practice have sent a debt collector's letter to a customer who paidby credit card?

● Why did the same crown come out three times in three months?

● Why does the crown not match the shade of neighbouring teeth?

● Why did it take multiple injections to anaesthetise one tooth?

● Why has the customer lost the feeling in part of her tongue after an extraction andwhy wasn't she warned?

● Why can't the receptionist fit in the customer with a broken tooth until the dayafter tomorrow?

These are the type of complaints that are referred to dental complaints helplines andthe BDA. In some cases the patients did not wish to express their feelings to the dentistdirectly but wanted to inform a third party to whom the dentist might be accountable.These complaints have a good chance of resolution at a practice level without the patienthaving to go elsewhere by using and promoting an in-practice complaints procedure.

An in-practice complaints procedure should:

● Be simple

● acknowledge the customer's perception of the problem and give the opportunity forthe practice to express understanding

● be accessible and well publicised

● provide a thorough and effective means of resolving grievances

● be speedy

● be confidential (for complaints made in person a private area should be available fordiscussion)

● provide an apology, where appropriate, and a way of putting the matter right

● provide refunds and in certain cases reimbursement of the cost of remedial work

● provide a commitment and a mechanism so that the complaint can play a positivepart in monitoring and improving standards. Procedures do not need to bebureaucratic, expensive or detailed but whatever resources are expended initially, agood procedure will save hours of time, expense and anxiety and avoid unnecessaryformal complaints to the GDC or litigation.

Practiceprocedures


A procedure is just a set of general instructions to the practice on how you shouldcommunicate with a customer who complains. A sound procedure will deal withcomplaints in the following way:

● one person in the practice is given responsibility for handling complaints

● if a customer makes a complaint it should be responded to by way of a telephonecall and acknowledged in writing (normally within two working days)

● the complainant should be told how the complaint will be dealt with and theanticipated timetable

● the substance of the complaint must be investigated thoroughly

● the matter may need to be resolved by way of a meeting or telephone call withthe complainant. Any meeting should be in private and the outcome of such ameeting/call should be confirmed in writing. The response should not be bland orpatronising

● during the conversation the views of both dentist/DCP and complainant need to beheard

● if the complaint is not resolved to the complainant's satisfaction, they should beadvised to contact the Dental Complaints Service

● records should be kept of all complaints, investigations and responses

● under normal circumstances the whole procedure should be completed within tenworking days. If there is a delay, for example where you are consulting a defencebody or obtaining other information, the customer should be advised of this and theanticipated revised times

● communications to complainants should be sent by first class post and marked“private and confidential” or “personal".

1. Appoint a person to deal with complaints

There should be one senior person in the practice (usually the practice owner or thepractice manager) who has specific responsibility and authority to deal with complaintsand comments. When responding to a complaint, a practice manager might be referredto as the customer liaison officer or complaints manager. You might of course choosenot to give the person an extra title if it is not appropriate in your practice.

2. Initial response

A customer may make a complaint by letter, telephone or in person. Wheneverpossible, find an immediate solution. Resolving the complaint at the earliest possiblestage gives the least work to the practice and the highest level of satisfaction to thecustomer. Research has shown that a complainant's satisfaction with an organisationdiminishes as the number of contacts it takes to deal with the problem increases. If thecomplaint is over an administrative or management issue, the complaints managermight be given the authority to rectify it. If it is clinical, the patient should be given theopportunity to discuss the matter with the dentist immediately or as soon as possibleafterwards. An easily understandable system of rectifying complaints can beadministered by suitably trained people without reference to senior management.Enabling people to solve problems without reference to higher authority is a matter ofpractice philosophy, however, and will not be appropriate for every practice. In caseswhere it is not possible to resolve the matter as soon as it is raised, the complaintmight be dealt with in the following ways:

A written complaint

■ The letter is acknowledged in writing as soon as possible and in any event withinthree working days by the complaints manager (CM). The letter might include aninvitation to the customer to meet the CM as soon as practicable at a convenienttime for the customer. During any subsequent telephone call the CM has theopportunity to listen to the problem and ask questions.


A telephone call/visit

■ When a complaint is made on the telephone or in person, the complainant can talkimmediately to the CM who listens and ask questions as above. (If the CM is notavailable, another senior member of staff should deputise). The CM makes a note ofthe conversation and, at the end of the conversation or meeting, the complainant isgiven information in writing on how the complaint will be dealt with and a timetable.A copy of the complaints procedure is supplied with a note of the action to be taken.

3. Investigation

As soon as possible after the complaint has been explained to the CM, the circumstancesare investigated. The dentist and DCPs involved are asked for their views and suggestions.If appropriate, advice can be sought from the BDA or the dentist's defence organisation,but an adversarial stance should be avoided. The investigation should take no longer thanten working days, and in most cases a much shorter period is easy to achieve.

4. Meeting

Following the initial investigation, it may be necessary to invite the complainant to meetthe CM and the dentist to resolve the situation. During any such meeting someone elseshould be present to take notes. If the complaint involves the action of a DCP, it may bepreferable that they are not present at an initial meeting. Where the complaint wasjustified and the quality of care and service provided was not as high as the patient had aright to expect, an explanation of what happened and an apology should be supplied withan indication of how the occurrence will be prevented in the future. Reasonable redressshould be offered. It may be that the patient would prefer a change of dentist within thepractice, having the work redone free of charge or at reduced cost, or a full or partialrefund of fees. Any offer of redress should be made on the basis that it is being done as agesture of goodwill and without the dentist admitting liability. Check out the wording ofany letter with your defence organisation. Alternatively, you may seek help from theDental Complaints Service on 08456 120 540.

In cases where the practice and its staff are not at fault, it is equally important to attemptto resolve the complaint at this stage. The complainant must be given an explanation ofwhat happened and why it happened. Any cause that was beyond the practice's controlshould also be given, but avoid saying or implying that the practice is right and thecustomer is wrong, or that the customer made a mistake, or giving the impression thatthe complainant cannot be expected to understand clinical dentistry.

Where there was no basis for complaint, it is important to make it clear that the dentistor DCP acted properly. Try to acknowledge how the customer feels and give as muchexplanation as possible. The results of the meeting should be communicated in writingto the customer, normally within ten working days of the initial complaint.

If the customer does not wish to attend a meeting, a letter should be sent containingthe practice's response. It is a good idea for the CM to telephone as well to ensure thatthere are no misunderstandings.

5. Failure to resolve

At this stage, customers who are still dissatisfied should be told how to contact theDental Complaints Service, to whom the complaint must be directed, where possible.


6. Records

It is essential that full records are kept of complaints, investigations and responses.These records should not be filed with the clinical notes, but in a complaints file.Within the file should be recorded:

● the date of receipt of the complaint

● how the complaint was received (verbally, telephone, letter) and by whom itwas received

● details of the complaint and the results of the subsequent investigation

● contemporaneous notes of telephone conversations and meetings

● a record of the outcome of the complaint and action taken by the practice

● Correspondence between the customer and the practice.

An entry onto the customer's record card should also be made saying 'complaintreceived (date)' A template for recording the detail of complaints is contained in theBDA's Practice Compendium, together with model letters.

Every dental practice will have a complaints procedure. An example is provided onpage 11. Procedures should be reviewed periodically and it is a good topic for a teammeeting. Whoever is chairing the meeting should ask for participants' experiences ofdealing with complaining customers using the present procedure. Try to drawconclusions from the anecdotes about how the practice usually responds. You mightalso monitor complaints and responses for three months, then analyse the outcome ofthe research at the meeting. At the end of the meeting, write down some conclusionsabout how the procedure could be improved.

At the next practice meeting, discuss the modified procedure and make any furtherchanges. Using this participative approach will build commitment to the procedure, butyour customers' commitment is also important. Why not draw a group of customerstogether and ask for their views, particularly those who have complained before and arestill with the practice? Do you have customers who seem never to be satisfied but stillkeep coming back for more? Make use of their durability and energy. Guidance on runningthis sort of focus group is available in the BDA Private Practice Briefing Focus Groups.

Along with a good, simple procedure, training of the people who are handlingcomplaints is also vital. Arrange training for every member of the practice in:

● customer care

● communication skills, particularly in handling angry, aggressive or upset customers.

The Complaints Manager might also benefit from training in such areas as negotiation,conflict resolution and assertiveness. Consider inviting a real customer (perhaps a friendor family member of a member of the team) to role play an angry, confused ordisappointed customer. Practise different responses and ways of dealing with theconcerns, until you find some which feel right.

Training

Updating yourcomplaintsprocedure


It is important to make sure that your customers know how to complain and are awareof the procedure that will be used. It demonstrates that you care whether they have apositive experience of your practice. Mention the procedure in your patientinformation leaflet. Produce separate information to give to those who ask about it.

Improvements to services which result from complaints can be publicised in practicenewsletters.

It is good business sense to offer a system of replacement or reimbursement. You might:

● in appropriate circumstances, offer a full refund or to re-do the work

● use the same one year rule for repair and replacement of private work as apply toNHS care

● offer to redo the work with the customer paying for the laboratory costs only.

Some practices will publicise this system or offer these options according to theparticular circumstances. In your covering letter, do not admit liability but offer, as agesture of goodwill, a refund or to re-do the work.

Our way of involving patients in the development of the practice is to include them inthe complaints and learning process. A complaint might, for example, be directed toone of a panel of four patients (who have agreed to undertake the role and areappropriately reimbursed) in the first instance. Here the customer first discusses thecomplaint with a fellow customer, who can help to resolve it. The panel might also beuseful for dealing with difficult customers: those who regularly fail to attend might beapproached by a customer panel member to point out that frequent FTAs lead toothers having to wait longer for an appointment.

Having the essential information in order to make choices goes a long way to avoidingcomplaints in the first place. The OFT in its report on dentistry emphasised theimportance of giving patients a general indication of fees and you might find this modela good basis for developing your own indicative price list.

The BDA offers help and advice with private practice.

■ Advice Sheet A4 Simple steps to private practice

■ Advice Sheet C8 Fee setting in private practice

■ BDA Private Practice Support Pack CDRom (£25)

■ BDA Practice Compendium (£157)

■ Advice Sheet B1 Ethics in dentistry

■ BDA Advice Sheet C9 In-practice capitation schemes

■ BDA Private Practice Briefings (a series of short easy-reference guides)

■ Communications Pack (a collection of models on CDRom to help with customercommunication) (£25)

Publicity

Putting it right

Customerinvolvement

Indicativepricing

Furtherinformation


DENTAL PRACTICE

Private fee scale

We provide private dental care and advice based on our hourly rate or at the rateof £XX per hour. The cost of your care depends on the time spent with the dentist,dental hygienist or dental therapist and the cost of any laboratory work. Generallyspeaking, the time taken will be the same as the booked appointment time andwhen you make an appointment you will be told the amount of time that has beenbooked for you.

As a guide, the costs of some common private treatments are given below. You willbe given a full estimate and treatment plan after examination and will be advised ofany proposed changes during a course of treatment. Should you require any furtherinformation, please do not hesitate to ask a member of staff or your dentist. Pleasealso ask about the practice's payment policies and the different ways of paying.

Private consultation (new patient) £XX

Regular oral health inspection £XX

Simple oral hygiene £XX

Composite (white) filling £XX

Amalgam filling £XX

Root canal therapy (molar) from £XX to £XX

Simple extraction £XX

Surgical extraction £XX

Porcelain veneer from £XX to £XX

Tooth-coloured porcelainand gold crown from £XX to £XX

Set of complete dentures from £XX to £XX

Single partial denture from £XX to £XX

Sports gum shield £XX

Emergency appointment(out of practice hours) £XX

Examplefee scale


Dental Practice Code of practice for patient complaints

In this practice we take complaints very seriously indeed and try to ensure that all our patients are pleased with theirexperience of our service. When patients complain, they are dealt with courteously and promptly so that the matter isresolved as quickly as possible. This procedure is based on these objectives.

Our aim is to react to complaints in the way in which we would want our complaint about a service to be handled.We learn from every mistake that we make and we respond to customers' concerns in a caring and sensitive way.

1. The person responsible for dealing with any complaint about the service which we provide is:

2. If a patient complains on the telephone or at the reception desk, we will listen to their complaint and offer to refer himor her to immediately. If is not availableat the time, then the patient will be told when they will be able to talk to the dentist and arrangements will be made forthis to happen. The member of staff will take brief details of the complaint and pass them on. If we cannot arrange thiswithin a reasonable period or if the patient does not wish to wait to discuss the matter, arrangements will be made forsomeone else to deal with it.

3. If the patient complains in writing the letter will be passed on immediately to

4. If a complaint is about any aspect of clinical care or associated charges it will normally be referred to the dentist, unlessthe patient does not want this to happen.

5. We will acknowledge the patient's complaint in writing and enclose a copy of this code of practice as soon as possible,normally within three working days. We will seek to investigate the complaint within ten working days of receipt to givean explanation of the circumstances which led to the complaint. If the patient does not wish to meet us, then we willattempt to talk to them on the telephone. If we are unable to investigate the complaint within ten working days we willnotify the patient, giving reasons for the delay and a likely period within which the investigation will be completed.

6. We will confirm the decision about the complaint in writing immediately after completing our investigation.

7. Proper and comprehensive records are kept of any complaint received.

8. If patients are not satisfied with the result of our procedure then a complaint may be made to:

● The Dental Complaints Service (08456 120 540) for complaints about private treatment

● The General Dental Council, 37 Wimpole Street, London, W1M 8DQ (the dentists' registration body)

● Primary Care Organisation [include address] for complaints about NHS treatment

● The Healthcare Commission, Finsbury Tower, 103-105 Bunhill Row, London EC1Y 8TG

(www.healthcarecommission.org.uk)

Delete the last two if inapplicable to your practice

British Dental Association● 64 Wimpole Street ● London W1G 8YS ● Tel: 020 7563 4563 ● Fax: 020 7487 5232

● E-mail: [email protected] ● www.bda.org ● © BDA January 2007

b11 handling private practice complaints - jan 2007

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