Practice Plan head of sales, Zoe Close, spoke to head of dental at MDDUS, Stephen Henderson, to get some advice on complaints and litigation.
Complaints and litigation are a source of worry to dental teams. A 2018 survey of more than 1,000 dentists found that around 90% of them feared being sued by a patient.
This fear shows no sign of having lessened over the last three years and as providers of a personal service, complaints are almost inevitable. So, what is the best way for dentists to handle them?
I’d like to ask about ownership of a complaint please Stephen, and who’s responsible for responding to things. So, if the complaint were about an associate, should it be the associate that makes the response, or is that the responsibility of the practice owner?
SH: If we’re talking about care provided under the NHS, then in England and Wales it’s the provider who has the ultimate responsibility for dealing with the complaint in the eyes of the NHS and the ombudsman. If the complaint is about clinical care, the provider may ask the associate to give them the background to the complaint and compose a letter.
The provider will then counter sign the letter and send it on to the complainant. Really, that’s the gold standard. So, the dentist who carried out the treatment formulates the response, this is then adopted by the practice which then sends it to the patient.
If the complaint is also about administration, so something which is out of the associate’s control, I would expect the provider to provide a letter dealing with that aspect and introducing the letter from the associate about the clinical element.
For private care, the treating dentist is the person with a contract of private care, so they should be the one to provide a response and handle the complaint themselves.
In Scotland and Northern Ireland, the treating dentist holds the contract for treating the patient, so they should respond. The NHS in England and Wales will look at the practice for a response rather than the individual performers.
It’s the practice provider who should handle the complaint. So that is the reason larger groups and corporates have departments to handle customer complaints.
Thank you. So just thinking of something that happens quite often, and it’s something I’ve seen myself, a complaint comes in but the associate’s left the practice. What should happen in those circumstances, Steve? What should the practice do and where should the complaint be sent?
SH: The first thing is to engage with the patient. Acknowledge the complaint, send them a copy of the complaints procedure and explain what the practice is going to do to investigate it. That involves saying to the patient: ‘Dr X has left the practice and is working somewhere else/off on maternity leave, or whatever the reason is they’re no longer there, but we’re going to pass your complaint to them along with your records and ask them to help us with the response to the complaint.’
As I said, in the NHS world it’s the contractor’s responsibility (the provider) to get a response. So, they need to persuade the associate who’s either left, or is off on mat leave, to contribute so the practice can then provide the response.
Being on mat leave or being off absent is not an excuse to avoid the complaint. It’s important to engage and the defence organisations will help people with their response all day long. It’s what we do a lot of the time.
It’s a challenge if somebody’s completely vanished or they’ve sadly died. That’s really when the provider has to step in and investigate it as best they can and provide the best response they can.
However, if you are the dentist who’s treated the patient, you would presumably want to know somebody’s not happy and you’d want the opportunity to put it right.
I can’t say that I have noticed this myself, but do you think there’s a difference in the number of litigation or complaints between NHS and private practices?
SH: It’s hard to say. The difference is the stakes are higher in private practice because the cost of treatment is invariably higher.
The problem for dentistry is it’s transactional compared to medicine. So, patients pay for a service. Even the modest sums that patients have to pay for NHS care may be very expensive for those individual patients. A band one charge may not look like a lot to us, but to some patients it’s a very significant amount of money. So, perhaps the money side of things impacts on how patients perceive the service? And a lot of people when they complain say: ‘Well this has all gone wrong, I want my money back.’
The NHS has a very tight procedure to follow. With private patients a lot of it’s about goodwill and rebuilding relationships and often that starts with being honest and saying: ‘I’m sorry I haven’t met your expectations.’
So, that takes us back to the very beginning. What was the patient’s expectation at the outset? Was it clear? Did everybody understand the limitations of what was on offer? And that applies just as much in NHS practices as private ones.
So, in answer to your question Zoe, it’s hard to say but because in private practice we’re dealing with quite large sums of money, practitioners find it very stressful to have complaints.
Yes, definitely. I have seen how it can take its toll on people. This was something that showed too in our survey conducted by Savanta, called The Future of Dentistry. One of the questions we asked was around litigation and 49% of dentists who responded said they would consider leaving dentistry before retirement because of their fear of litigation. So that’s a big proportion. Do you have any practical tips to help deal with the stress and the fear of litigation when you’re trying to run a really busy practice?
SH: One of the main pieces of advice is to have a clearly established procedure and a culture in the practice that’s essentially a no blame culture. A culture that says, ‘So we’re going to learn from this however unpleasant it might look at the start.’
So, a really good starting point for every practice is to try to find some positives so that we can improve our service for others. If there has been a serious complaint, doing a proper root cause analysis is really important, but to do it in a way that’s positive for everybody rather than making it a negative event.
Another thing is, pick up the phone and talk to your indemnity provider. We deal with these types of things all day every day and most of the indemnity providers have counselling services that they can direct people to if they’re really stressed. That’s part of the benefit of membership.
So don’t feel like you need to suffer on your own. The defence organisations are there to help in many ways. Not only with the complaint, but also with a bit of pastoral care as well.
Thank you Stephen. I’ve been in this profession 35 years now and it’s interesting that there’s so much help out there, but we don’t always get things in order. So, the message I’m hearing from you is there is lots of help out there. Just speak to people, pick up the phone, spend some time searching for that help. And the fear will probably diminish when you’ve got everything covered.
If you are interested in finding out more about how Practice Plan helps practices to become more profitable, call 01691 694165 or visit www.practiceplan.co.uk. Or you can join them on stand K50 at Dentistry Show Birmingham.