After witnessing an emergency room visit during which an elderly patient with a sudden loss of consciousness was left without fluid and monitoring for several hours, we decided to write a letter outlining what we saw as the gaps in care in this case.
It was specific. It described each point where care broke down from the waiting room to the monitor that was never connected. It ended with an offer: we would be glad to talk about it in person.
When the head of the department received the letter, he replied almost immediately and asked when it would be convenient for us to get together with him in person. He didn’t defend the department or explain the day away. He told us he was embarrassed, that it happened under his leadership, and that he felt ultimately responsible. Then he asked whether he could use our experience, without names, as a case study for his staff.
That response turned a complaint into a lesson plan. His behavior is uncommon.
Why most complaints never get that far
When a complaint arrives, the reflex in many organizations is defensive. Someone reviews the chart, drafts a careful reply, and the file closes. The instinctive reaction makes sense. A complaint feels like an accusation, and people want to protect themselves and their organizations from accusations.
Yet the family that takes the time to write a detailed letter is usually handing you something very valuable. We weren’t writing to be difficult. We wrote because we cared, and we wanted to protect the next patient in a similar situation. We wanted the department protected, and we wanted the next family to have a better experience.
Seen that way, a complaint is providing valuable information. The research suggests it is some of the most useful information a hospital ever receives.
Complaints are data you can’t get anywhere else
Researchers who analyzed 1,110 healthcare complaints found that complaints expose blind spots other safety systems miss: problems at the points where patients enter and leave care, failures spread across many small steps, and errors of omission, especially the failure to listen to patients who raise concerns [1]. Furthermore, patients and families were often the ones who detected errors and helped recover from them. That was exactly our experience when we noticed the fluids that were never hung and the monitor that was never connected.
Complaints also carry a warning. In a study of 645 physicians, the number of patient complaints was significantly related to risk management events and lawsuits [2]. Ignoring a complaint doesn’t make the risk behind it go away. It only means you find out later, and usually at a higher price.
The research also shows what works once a complaint arrives. After the University of Michigan Health System adopted a program of full disclosure with offers of compensation, new claims, lawsuits, time to resolution, and total liability costs all decreased [3].
Those findings share a common thread. What protects patients, and the organization, is what leaders do in the first conversation after something goes wrong. More often than not, that conversation has to begin with an apology.
What an effective apology includes
An apology can’t change what happened. It can only change what happens next. So an apology must include what you will do to prevent it from happening again by successfully executing a corrective action plan.
Daniele learned this as the CEO of a large hospital system in Saudi Arabia. After a young boy was harmed during a minor procedure, Daniele met with the family himself. He took full responsibility, expressed sincere regret, and offered lifelong support. He described the corrective action that would keep it from happening again, promised to keep the family informed, and asked for their forgiveness. In his view, the head of the organization has to apologize on behalf of everyone, because responsibility ends at the top even when the leader is not directly involved. Without that, changing the policy is just checking a box.
Measured against that standard, the head of this emergency department did a great deal in one conversation. He owned it without qualifiers. He committed to have his staff learn from it. The effectiveness of his apology will be determined by what happens to the next elderly patient who comes through his department.
Most leaders will never receive a complaint as detailed as ours, or from a family as willing to help. They will receive plenty of complaints. Properly addressing the complaint is the difference between filing and closing the case and learning from it.
Seven steps for the next complaint that reaches your desk
- Answer promptly and meet in person when you can. A prompt response tells the family they were heard before you’ve said a word about the facts.
- Thank them. A detailed complaint is free consulting from someone who watched your system from the inside.
- Own it without qualifiers. “It happened on my watch” removes the resentment more than any explanation could.
- Ask the people who were there what got in their way. The frontline knows where the process breaks, so let them help design the fix.
- Teach from it without names. The whole team learns, and no one is singled out.
- Tell the family what changed. Closing the loop is how trust comes back, and it is the step often organizations skip.
- Track complaints alongside your safety data. One letter tells you about one event. Patterns across many letters tell you where to look next.
Healthcare Quality Week honors the people who turn problems into opportunities to improve. The leader in our story grabbed the opportunity with one email and one meeting. The families who write to you often care the most about your reputation. They want the next family to have a better experience than theirs. Answer them the way he did.
References
[1] Gillespie A, Reader TW. Patient-centered insights: using health care complaints to reveal hot spots and blind spots in quality and safety. Milbank Q. 2018;96(3):530-67.
[2] Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA. 2002;287(22):2951-7.
[3] Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010;153(4):213-21.