Posted by: ayrshirehealth | October 1, 2014

How can we truly learn from patients’ and families’ poor experiences? by @murrayawallace

From the latin – planctus 

LamentThe word ‘complaint’ has a latin root: planctus. It means to beat the breast in grief; to mourn for something lost.

What would it be like if we routinely treated ‘complaints’ in healthcare as laments for the loss of something important, rather than seeing them as criticism, feedback, or just a burdensome administrative task?

Through my work with patients, their families and with clinicians, I have come to see the significant difference that such an approach can bring. But let me be very clear, I am not suggesting that this shift is a simple one. Indeed, faced with apparently difficult patients, upset families, belligerent colleagues and limited time, it can feel utterly impossible.

A learning exercise !

When things go wrong, the prevailing consensus is that patients and their families want transparency, an apology, and information about what will be done to ensure that no-one else suffers. HumaniseBut there is a risk that unless we actively ‘humanise’ our approaches to these matters, we will ignore the heart of the complainer’s ‘lament’ and totally miss the point.

Talking to The Guardian newspaper following the inquest into her baby son Axel’s death, Linda Peanberg King said of the organisational explanation she received: “It felt like a powerpoint exercise; it was shocking to hear your dead son being described in corporate speak as ‘a learning exercise.’” (Guardian March 2nd 2013)

Depressingly familiar

In a recent interview Sir Robert Francis QC described to me the depressingly familiar’ pattern of complaints that he had found at Stafford Hospital ( For an extract of the interview with Sir Robert Francis click the link: http://www.andersonwallace.co.uk/blog/power-patient-stories-interview-sir-robert-francis-qc/ .

“There would be a complaint, there would be a formal response and an apology, plus an action plan that would not be put into force. The same thing would happen again, the same apology would be issued and pretty much the same action plan.”

That is what happens when responding to complaints becomes a purely administrative managerial task.

Emotional energy and clinical time

So, how do we start to make this shift in culture? Well, for me the first step is to recognise that cultural change happens in the everyday things we do, today, tomorrow and in the future. ConversationIt involves conversations about what things mean to us, and what they might mean to others. It happens in the detail of everyday encounters between people – one-to-one and in groups – and it does not happen without conscious effort over time.

There is no doubt that addressing these intensely human dimensions of care is demanding of emotional energy and clinical time. But far from sapping energy, nurturing the healing relationship that lies at the heart of compassionate healthcare has the potential to enrich professional experience, and takes little if any more time.

American author Anatole Broyard wrote movingly about his encounters with medicine while he was dying.

“I wouldn’t demand a lot of my doctor’s time” he wrote,

“I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way.”

(Intoxicated By My Illness)

I contend that we should think about ‘complaints’ in the same way that Broyard talks about illness. It is time for us to ‘survey the soul’ of the complaint and ‘not just the flesh’.

Time well spent

During late October, we will be holding a number of workshop discussions to find out more about your experiences of learning from poor experience. NetworkI hope very much that you will join the discussion and contribute your ideas.

Without your co-operation and commitment, we can’t address the issues with any degree of real insight.

Please make the time to participate – it will be time well spent.

This week’s blogger is Murray Anderson-Wallace (@murrayawallace); he is a specialist in healthcare communications and an independent media producer. He has a background in nursing, social psychology and organisational communications research.

 Murray is currently working with NHS Ayrshire & Arran supporting work to improve organisational approaches to learning from poor experiences.

 Footnote:

I am indebted to my colleague Dr. Suzanne Shale, as co-author of the article upon which some elements of this blog are based. The article was first published in The Health Service Journal in 2013.

 

 

 

Advertisements

Responses

  1. I really enjoyed this blog, I think if, as you say, we thought about complaints in the Broyard way it might result in better outcomes for everyone. thanks you for your insight

  2. Thanks for this Murray. I have often said that most people who complain look for a sincere apology (they know the difference between that and one which is routinely rolled out!) and a reassurance that processes/systems will change in some way to ensure the same thing doesn’t happen to others – most people are altruistic! When we don’t provide that it causes further harm to the person who has complained.

    People generally aren’t quick to complain – they do still worry about repercussions. I think this demonstrates the power imbalance that continues to exist between patients and healthcare staff.

    We need to respond to people promptly when they complain, listen to what they say and make them feel that that’s your most important job that day/week/month to truly understand what’s happened and act upon their suggestions to improve it. Many thanks for your blog.

    • Totally agree with you Angela. I actually sent in my thoughts on “apologies” saying that it would be better if the person responsible,would do the apologising and not representatives of the hospital.
      I was censored the last time and more than likely this time.

      • Jayne
        I apologise for the delay in moderating your comments from Friday.

        I usually moderate comments and have them posted within 24 hours. Unfortunately my phone had disassociated itself from the blog and I didn’t get an alert to say a comment had been posted – my apologies you felt this was censoring, it was simply an IT glitch at my end.

        Your comments have all been posted in their respective blogs.

        Derek

  3. It’s not the lack of apologies that irk me,it’s who is making them.It should be that the “culprits” that made the mistakes should apologise,and not someone from the management on their behalf.Name them and shame them,and you’ll find that they may become better clinicians.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

%d bloggers like this: