Featured
Interview A conversation with Susan Baker
Do you know the secrets of handling patient
complaints successfully? Get fresh perspectives
in this heartening interview with Susan
Keane Baker, nationally known educator
and speaker on service quality, patient
satisfaction, and risk management, and author
of the highly acclaimed book, Managing
Patient Expectations.
As Ms. Baker explains, the manner in which
you deal with patient complaints DOES make
a difference. Handling complaints poorly
often results in new layers of problems:
damage to your health care organization’s
reputation, losses of patients and referrals,
and even costly lawsuits. Handling complaints
with the right strategies – and a healthy
dose of panache -- enables you to turn unhappy,
disgruntled patients into the most loyal,
satisfied customers around. Read below to
learn how.
Limited time? See our Key
Point Summary or click on the topics
of greatest interest:
How did you become interested in patient
expectations and satisfaction?
While serving as a hospital vice president,
one of my responsibilities was risk management.
Through that experience, I found that many
patient complaints were not handled well
and, as a result, often escalated into much
larger problems – even to the point of lawsuits.
When I started my own business, my initial
intent was to prevent mistakes that caused
patients to be injured and clinicians to
be sued, and to keep complaints from escalating.
Over time, my interest evolved into helping
people understand how to resolve differences
in ways that would maintain and even enhance
relationships.
Are patients complaining more these days?
Yes, for two reasons. First, while physicians
are certainly time-starved, so are patients.
Along with working outside the home, many
baby boomers are caring for children or
elderly parents. Since most of us don’t
have as much discretionary time as we once
did, perceiving that time was spent unproductively
in an office or hospital visit can be quite
distressing.
Second, people are more willing to speak
up when their expectations aren’t met, and
more willing to take their complaints to
the next level – whether that’s the CEO,
the newspaper, or the Department of Health.
Not only is our society more mobile, our
experiences with managed care have demonstrated
that switching physicians and hospitals
is not hard to do. When people don’t receive
the care or services they expect, they may
complain in the hopes that things work out.
If it doesn’t, they haven’t lost anything;
they simply go elsewhere and start anew.
Is there a greater need for effective
complaint handling in health care than in
other fields?
Absolutely. When you go to a department
store, you may have an unpleasant interaction
with a clerk, but your relationship ends
there. Health care involves close, intimate
relationships between patients and providers
that are expected to continue. In addition,
unlike other types of customers, many people
who visit health care organizations are
fearful, sick, or in pain.
Illness is the great leveler. When people
are sick, they often want and need attention
that they wouldn’t ordinarily demand. Simply
stated, they want someone to be nice to
them. For example, when I’m not feeling
well, I might ask a family member to do
things for me that I’d normally do for myself,
like bringing me a glass of juice. Hand-squeezed
juice if I’m feeling especially sick. In
complaint situations, a patient might be
simply looking for attention, someone to
listen. Or he might be asking for something
that he wouldn’t ordinarily need. When we
recognize that we all have days when we
rationalize our behavior with the explanation,
“I’m not myself today” – we’re less defensive
when a patient complains.
The
Art of Gracious Responses
What is the most important thing that
a practice can do to improve complaint handling?
Invest your resources into helping people
understand how to graciously respond to
complaints and cope with difficult people.
If you can satisfy difficult people, you
will be able to satisfy others as well.
And difficult people present such a nice
opportunity. After all, there’s little or
no competition for them!
What is the first step in developing
gracious responses?
Consider how the patient feels – and why.
Many people are familiar with the scene
from the movie, Terms of Endearment,
in which Aurora Greenway (the character
played by Shirley MacLaine) is running frantically
around the hospital nurses’ station screaming,
“GIVE MY DAUGHTER THE SHOT!” If you saw
the movie from the beginning, you’d know
why she was acting that way. Her daughter
Emma (played by Debra Winger) was dying
of cancer, arrangements needed to be made
for the care and custody of Emma’s three
small children, and the mother-daughter
relationship was fraught with problems.
Aurora couldn’t change any of those things.
But when Emma’s pain medication wasn’t delivered
by 10:00 when promised, and the nurse asked
Aurora to wait a few minutes more while
she finished her paperwork, Aurora began
screaming. Easing her daughter’s pain was
the one thing over which she had control.
In real life, health care professionals
may see that a patient is irate, but they
don’t see all of the things that happened
before that contributed to the patient’s
behavior. Ask yourself, why is this person
acting this way? For example, patients who
seem condescending may be overcompensating
for insecurities or personal problems that
have overwhelmed them. Perhaps, like Aurora,
they feel powerless about things they can’t
control and are trying to exert control
where they can. Considering the motivations
behind their behaviors will prevent you
from taking their complaints personally.
It will also keep you from blurting out
statements through top-of-mind thinking
– responses that are frequently inappropriate.
Tell us about top-of-mind thinking.
This true story involves a woman who was
pacing the floors in the Post-Anesthesia
Recovery Unit of a hospital, anxiously awaiting
her stepdaughter’s discharge after minor
surgery. The woman was especially impatient
because her son’s prom was that night. She
had promised to pick up her son’s corsage
and get home in time to see him off.
The discharge process took longer than expected,
and the physician had not yet written the
discharge order. As the stepmother became
increasingly upset, so did the nurse. “Why
isn’t her stepdaughter’s care more important
to this woman than her son’s prom?”
the nurse thought. As the woman continued
to complain about the delay and her time
pressures, the exasperated nurse said the
first thing that came to mind. “Mrs. Jones,
if you are looking for sympathy, you will
find it … in the dictionary.”
While the “difficult“ party might be defined
differently depending on whose perspective
you take, this was clearly not a gracious
response. As you might expect, the issue
soon escalated into a raging dispute that
reached the CEO’s office. The nurse now
faced a much more challenging situation
with several new layers of problems. All
of this could have been avoided by a gracious
response. That requires thinking before
we speak and trying to understand the other
person’s concerns from their perspective,
not our own.
How can we better understand the other
person’s perspectives?
One of the best things to say is, “I’m concerned
ABOUT THIS; PLEASE tell me more!” Paraphrasing
the person’s remarks in a warm and compassionate
manner may help the person to open up even
more. Having someone listen may be all they
require to resolve the situation to their
satisfaction.
Even if the complainant is unreasonable
and behaving badly, it’s fascinating to
see what happens when you respond calmly
and graciously. Regardless of how they act,
you are nice to them anyway! When the other
person catches on, they become somewhat
embarrassed and bend over backwards to prove
that they can be as nice as you. I call
this being gracious by response.
You set the example for their behavior,
rather than letting them set the tone for
yours.
How can a health care organization help
staff members understand patient perspectives?
The best learning device is to conduct role
plays during staff meetings by reenacting
recent complaints. Assign a staff member
to assume the patient’s role, acting with
as much realism and gusto as possible.
Interestingly, the staff member playing
the patient’s role starts to feel a sense
of what the patient feels. Staff members
start to see the situation more clearly
and suggest a variety of possible responses,
such as, “Perhaps if you said this …” Or,
“Wouldn’t she be more satisfied if you did
that…”
While this method is simple, costs nothing,
and takes very little time, the lessons
are huge. Complaints that initially seemed
trivial to staff members take on new meaning
when someone owns the complaint by acting
out the role of patient. You begin to see
things differently when you step into their
shoes.
In addition to thinking before we speak
and seeing the situation from the patient’s
perspective, what else helps us develop
a gracious response?
Be attentive and show genuine concern. When
people feel that you really care about them,
especially over a period of time, they are
less likely to expect perfection and far
more likely to give you some slack when
you need it. If they believe you to be arrogant
or condescending, each new reason for a
complaint adds insult to injury and either
the problem will escalate or the patient
will leave.
As an example, a patient returned to her
dentist three times, complaining of pain
after a root canal. Ordinarily, this patient
would not have left her dentist because
of a complication; these things happen.
But she couldn’t get past the idea that
her dentist didn’t care enough about her
to believe her. Each time she complained
about pain – which she later discovered
was caused by an infection of root tissue
that had not been removed from the canal
-- he quickly dismissed her concerns. This
was insult added to injury, in her mind.
What made it worse was that during the procedure
itself, he made vacation plans with his
travel agent via speakerphone. He had three
opportunities to resolve the problem with
a small investment of time and effort on
this part. Had he seemed to care or had
shown more interest when she complained,
the patient would have stayed. Instead,
the situation escalated to the point where
he had to pay the charges of another dentist
to re-do the procedure and had a former
patient telling friends about him in very
negative terms.
Dealing
With Difficult Behaviors
What’s your advice about dealing with
complaining patients who behave badly?
When a patient has a complaint or demonstrates
a difficult behavior or personality, it’s
easy to categorize them. But resist the
urge to label people.
Remember the episode of Seinfeld when Elaine
saw that her physician had referred to her
as a difficult patient on her medical
record? To rid herself of this label, she
asked her friend Kramer to steal the record.
After Kramer’s unsuccessful felonious attempt,
Elaine’s behavior became more difficult,
adding credence to the physician’s notation
in her record. Ultimately, she decided that
the only way to start with a clean slate
was to change physicians. In the end, she
learned that her new physician had requested
her prior medical records – and she was
labeled as difficult once again!
The lesson here is that once labeled difficult,
she became more difficult as the episode
went on. Returning to terms of endearment,
if Aurora Greenway’s daughter was in pain
again the following day, what would Aurora
have to lose by acting out in a difficult
manner to get what her daughter needed?
Once a person is labeled as difficult, they
have less incentive to be gracious and considerate.
You’re going to consider them difficult
anyway, so what do they have to lose. I’m
reminded of a cartoon of a wife handing
something to her husband with the comment,
“i have your faults on floppy disk, when
you have time.”
If we don’t label people as “difficult,”
how should we think of them?
Looking at ourselves, we all have days when
we say “I’m not myself today,” and that
especially occurs when we’re not feeling
well. In addition to giving ourselves the
benefit of the doubt, we should extend that
to others. Instead of assuming that certain
patients are difficult, we should first
think, “Maybe she is just having a bad day.”
What causes some patients to “act out”?
Patients tend to become emotional after
they’ve reached a certain threshold. For
example, if they’ve had difficulties in
their lives or experienced several other
problems at your health care organization
before, the latest incident on top of all
the others becomes one last thing,
and they think, “I can’t take any more!”
Typically, it isn’t a small matter that
causes a patient to become overly emotional;
it’s the last in a series of events.
Are special strategies needed for dealing
with difficult people -- beyond the gracious
response?
Sometimes it helps to change the physical
setting. Ask the complainant to discuss
the matter with you in a private area without
an audience of other patients. If they’re
standing, ask them to sit. Give the complainant
something to eat or drink. If the chemistry
isn’t right, ask a colleague to step in
who may be better able to deal with the
patient’s personality type, or who may have
other ideas on possible alternatives.
Also remember that sicker patients tend
to be more distressed and angry, and that
various medical problems, social problems,
and anxieties may be underlying their behavior.
Give attention to the medical and psychosocial
aspect of their care, take their complaints
and problems seriously, and teach them other,
more appropriate ways of dealing with their
problems.
What can we do about complaining patients
who cross the line from difficult to abusive?
If a patient is verbally abusive and other
strategies haven’t worked, you could say,
“Mr. Egan, would you mind telling me what
you are getting out of treating me this
way?” For this statement to have the desired
effect, watch your nonverbal behaviors and
tone of voice. Say it calmly, with sincerity,
and a look in your eyes that says, “I’m
trying to understand.” Most of the time,
the patient will recognize that he has displaced
his anger and offer an apology.
But use this technique cautiously. If you
make this statement to people who aren’t
too far out of line, it will offend them.
Only use this technique if your next action
would be to discharge the patient from your
practice.
Communication
Strategies
Which health care professionals hear
the majority of complaints?
Every front office person will tell you
that patients stand at the front desk and
make one complaint after another. By the
time they enter the exam room, they have
already vented their concerns. When the
provider asks, “How is everything?” patients
often say, “Just fine!”
Obviously, there’s a “disconnect” between
what office staff hears and what the clinician
hears. When staff members relay the complaints
reported at the front desk, some clinicians
will defensively take exception. The clinician
says, “I don’t understand what you’re talking
about. Patients tell me everything
is fine!” When providers “shoot the messenger”
like this, staff members will be reluctant
to bring complaints to their attention in
the future. The result is that opportunities
for improvement are lost.
To avoid this problem, physicians and practice
administrators should be more receptive
to staff reports about complaints. They
should see front office personnel as their
own market researchers who are in the best
position to tap into the perceptions of
patients and the community. Another reason
to share complaints is because it allows
you to fix the problem. If you don’t, the
problem is apt to continue – causing damage
to your practice’s reputation, the loss
of patients, or worse.
What mistakes do health care professionals
make when communicating about complaints?
Here are some of the most common gaffes,
all of which are avoidable:
Interrupting the patient’s story.
Because busy health care professionals
tend to be good at fixing things, they
can be prone to listening to only a few
words of a complaint and then interrupt
with a solution. That denies the patient
the opportunity to tell the whole story.
For some patients, telling the story and
having someone listen is ACTUALLY more
important than the solution.
Defensive responses. Defending
your position keeps you from listening
to the patient and shuts the door to further
communication. Don’t disagree until you’ve
heard the whole story and understood the
patient’s meaning. If you do disagree,
find something that the patient
is right about. Saying, “You’re right
– the phone could be answered sooner”
gives no reason for a counter-argument,
whereas a defensive response does.
Getting into a contest of right vs.
wrong. The opportunity for patient
satisfaction diminishes if a patient loses
face during complaint handling. If the
patient is clearly wrong, adopt the philosophy
used by the Disney Corporation when dealing
with guests at their theme parks. They
assume that their guests are right most
of the time, but when they are wrong they
instruct staff members to “let them be
wrong with dignity.”
Mirroring their behavior. If
the patient is being snippy, don’t be
snippy back. To do this results in an
escalation contest in which no one wins.
Ignoring their concerns. Don’t
change the subject or ignore a patient’s
complaint in the hopes that the problem
will resolve itself. Chances are, it won’t.
Dismissive comments. Saying,
“Nobody else has ever complained about
this” makes patients feel that their complaints
aren’t legitimate. Even if you don’t see
a situation the same way, realize that
the problem is real to them. Let
patients know that you take their opinions
seriously.
Besides, it’s irrelevant whether you’ve heard
the complaint before. Several other patients
may have perceived the same problem but didn’t
tell you. Instead, they may have seethed about
it silently or decided not to return.
How can we coax information from patients
who would rather leave a practice than complain?
Integris Baptist Medical Center in Oklahoma
City has a wonderful way to elicit feedback:
a postcard that asks for comments, concerns,
compliments, and critiques. Respondents have
the choice of filling out the form anonymously
or providing contact information in order
to receive a response. Allowing people the
option of complaining anonymously is important,
as there are many patients who would like
to help you improve, but are afraid of being
labeled as difficult troublemakers.
Just knowing that you have the opportunity
to voice your complaints safely and that the
organization truly cares what you think can
be quite satisfying. On a recent air flight,
for example, I noticed that the overhead compartment
housing the television screen was caked with
dust – something that flight attendants normally
wouldn’t see as they don’t have time to sit
in passenger seats watching inflight movies.
A comment card in the seat pocket in front
of me made it possible to tell them. Just
giving people the opportunity to learn what
customers think make this airline – and your
medical practice -- a better organization.
How does the encouragement of
complaints improve your organization?
It allows you to learn things that you’d never
find out otherwise. As those who own rental
property are well aware, renters who complain
most tend to leave the property in much better
condition than people who didn’t care enough
to complain. The landlord may resent gripes,
such as “the plumbing is starting to drip,”
and “the front door needs to be fixed,” but
when they eventually move out the property
owner is faced with fewer expenses. Why? The
pipes didn’t break, the door works, and the
house is in good repair. Complaints resulted
in improvements made in less time, and at
less cost, and before small problems turned
into disasters.
Addressing and Resolving
Complaints
What types
of complaints are most difficult to deal with?
Dealing with complaints about the organization
is challenging enough, but most health care
professionals find it hardest to deal with
complaints directed at them. That reaction
is very human: if my husband gives me advice
on how I could be a better wife, for example,
I MIGHT feel an urge to resist immediately!
The more personal the complaint, the more
challenging it is for the receiver to respond
without being defensive, much less admit fault.
How can we keep from losing our
cool?
Identify the types of patient behaviors you
find most challenging, e.g., patients who
are condescending, demanding, or those who
are late for appointments but still expect
to be seen right away. Next, rate those behaviors
on a scale of 1-10, with 10 being the most
challenging. Complaints about the parking
garage might be rated a “2.” Then decide that
behaviors that rate less than an 8 on your
irritability scale will be handled graciously
and forgotten. Is the problem worth carrying
around all day? Keeping the ratings in mind
when a patient complains will help the health
care professional maintain perspective.
How can we identify our options in
complaint resolution?
Ask the patient, “What would you like to see
happen next?” Some people may tell you that
they only needed someone to listen. Others
may ask you to take a reasonable action, in
which case you can easily accommodate their
needs. If they suggest an unreasonable remedy,
you can explain why meeting their request
isn’t possible and offer an alternative. Even
though the patient wouldn’t be receiving a
gold standard response, a silver standard
response may suffice.
In most cases, people will accept your suggested
solution if they believe you’re sincere about
wanting to help them and that the complaint
has been handled fairly. But some patients
will say that whatever you offer is not good
enough and ask to speak to a higher authority.
What should you do when people
ask to speak to someone “higher-up” before
you’ve had a chance to assist?
Start with the person’s name, followed by
a sincere plea. For example, “Mrs. Weiner,
please give me a chance to help.” This technique
usually works because hearing their name has
a calming effect: it’s harder for people to
be obnoxious when they’re recognized. When
you demonstrate through words and tone of
voice that you sincerely want to help, the
person will almost always give you a chance.
If the practice is at fault,
should you accept blame?
Yes! Be upfront and honest about mistakes,
starting with an apology. For example, “I’m
sorry, I should have greeted you when you
arrived,” or “I apologize, I should have double-checked
this statement before we mailed it.”
Let’s say that a patient comes in for an appointment
and the receptionist looks in her book and
says, “Your appointment was for yesterday!”
The patient hands over the appointment card,
showing that the appointment is for today.
What will you do? Say that your book is right,
and the card is wrong? Blame the situation
on somebody else? Do you give a flip, top-of-mind
response, such as, “I’m not the doctor – I
can’t take care of you!” Or do you take responsibility
and say, “I’m terribly sorry. Obviously the
mistake is ours. I’ll arrange for you to be
seen as quickly as possible.” If the physician
isn’t in that day, you could say, “I’m sorry.
Unfortunately, the doctor is not in today,
but let’s work out a time that’s convenient
for you to come back. I’ll work around your
schedule, not ours!”
Is an apology
enough if a mistake causes the patient a great
deal of inconvenience?
In those instances, make a sincere gesture
to demonstrate goodwill. Your gesture might
be as simple as a parking validation or even
a handwritten note.
Here’s an example. A physician was urgently
called out of town and asked her staff to
reschedule patients who had appointments during
the time she’d be away. Staff members were
able to reach all patients with appointments
except one – a patient scheduled for a colonoscopy.
Although staff members did everything they
could, they were unable to reach him.
Imagine showing up for a colonoscopy, having
undergone all of the necessary preparation,
and the physician is not there. As instructed,
the patient had taken enemas, ingested laxatives,
and followed a diet of clear liquids. Not
only did the patient have to come back for
another appointment date, he would have to
go through this preparation all over again!
Although quite annoyed, he listened to the
staff’s explanation of their efforts to reach
him and acknowledged that they had done their
best.
This physician knew that an extra apology
was in order. I have a line of special greeting
cards, each card is hand made by an artist
in Arizona. The physician sent the card, with
a cover that read “in a word, terrific” and
the inside message: “having you as a patient”.
She wrote a short personal note, again apologizing,
and praising him for the way he handled the
matter with staff. Shortly thereafter, the
patient responded by sending the physician
a gift!
What types of gestures
are inappropriate?
When trying to rectify a situation, don’t
make promises that you or your colleagues
can’t keep or you’ll lose credibility. For
example, if you know that one of the physicians
in your medical group doesn’t routinely return
phone calls, don’t promise that he will. If
you do make such a promise and the doctor
doesn’t follow through, make the return call
yourself.
To keep from making unrealistic promises,
conduct a staff meeting in which you ask,
“What promises do we typically make that are
difficult to keep?” Vow to avoid such empty
promises In the future. Ask your colleagues
about the types of things you can offer,
especially when making promises on others’
behalf.
What if the complaint
is due to the patient’s misunderstanding?
Let’s say that a patient calls about a bill,
thinking that she was charged $4000. A good
technique is to ask the patient, “Do you have
the bill in front of you? Great! Could you
read the section you’re referring to?” When
reading the sentence aloud, many patients
realize that they misread it the first time,
and that the bill was $400, not $4000. Without
you telling them, this allows patients to
discover the mistake for themselves.
Despite your best efforts, are there
times when it’s necessary to give up on a
complaining patient and ‘throw in the towel’?
While service recovery isn’t always possible,
an attempt at service recovery certainly
is. Don’t give up until you’ve exercised all
reasonable options.
If you and your colleagues have tried everything
and it still doesn’t seem that there’s any
way to satisfy the patient, it may be time
for the relationship to be terminated. You
could say, “It doesn’t appear that we’re going
to be able to meet your expectations. Since
you continue to be dissatisfied with our organization,
perhaps you’d be happier under someone else’s
care.” In most instances, you won’t have to
resort to this measure. Your efforts should
be aimed at satisfying patients and turning
the relationship around.
Closing Comments
Thank you for a great interview, Ms.
Baker. Do you have any closing comments?
The best way to address a complaint is by
preventing it in the first place. Ask, “Is
there anything we could be doing to improve
your visits with us?” When you are the one
to ask first, you’ll get constructive criticism
or feedback as opposed to a complaint. When
comments are received this way, you’ll be
less prone to respond defensively.
When a complaint does surface, remember that
the manner in which you react and communicate
with the patient can be just as important
as the solution itself. Give patients the
benefit of the doubt. Think before you speak.
See the problem from the patient’s perspective.
Develop a gracious response. Seek the patient’s
input on satisfying solutions. Provide patients
with feedback on how their issues have been
handled. Finally, see complaints as opportunities
to make improvements – and fix underlying
problems so that whatever provoked the complaint
doesn’t ever happen again.
Contact
Information
Susan Keane Baker
Phone: 203-966-4880
Email: susan@susanbaker.com
Susan Keane Baker, author of Managing
Patient Expectations, provides seminars
and workshops on patient satisfaction and
risk management topics at meetings of health
care organizations throughout the United States.
Watch for her next book, yet untitled, on
ways that front line staff can best respond
to patient complaints.
Key Point Summary
To improve your organization’s complaint
handling, invest resources into helping
people understand how to graciously respond
to complaints and cope with difficult
people.
Trying to understand the motivations
behind a patient’s behaviors and thinking
before you speak will allow you to avoid
problems that result from labeling and
top-of-mind comments.
See problems from the patient’s perspective
through interpersonal communication (asking
for more information and paraphrasing)
and organizational communication (conducting
and analyzing role play exercises by reenacting
patient complaints at staff meetings).
Avoid labeling patients as “difficult.”
Their behavior during a single interaction
may be due to the fact that they are sick,
reacting to other pressures, frustrated
as a culmination of numerous other unexpressed
problems with your practice, or even because
they are simply having a bad day.
Consider the possibility that medical
or psychosocial factors may underlie a
patient’s difficult behavior.
Regularly share reports of complaints
with colleagues, realizing that staff
and providers are privy to different information
about various types of complaints.
Identify ways to invite and encourage
patient complaints in order to address
problems when they are at a manageable
level, as well as to make necessary improvements
within your organization.
Ask patients to share options for a
satisfactory resolution by asking, “What
would you like to see happen next?”
If a mistake has been made, be honest
and upfront about it, starting with an
apology. When mistakes cause major inconveniences
to patients, follow the apology with a
gesture of goodwill.
If all reasonable efforts to satisfy
a patient have failed, it may be necessary
to terminate the relationship. But don’t
give up too soon – many of the most challenging
relationships can be turned around with
the right strategies.
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