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Journal of the Academy of Hospital Administration

Management of Complaints in Hospitals

Author(s): Yashpal Sharma*

Vol. 13, No. 1 (2001-01 - 2001-06)

Keywords : Complaints, communication grierance Redressal Committee.

All the departments receive complaints, but in hospitals where we deal with the human life, complaint recognisation and management are critical components of the patient care. When handled properly, a dissatisfied and angry person can achieve satisfaction. Alternatively, improper management of complaint can lead to disgruntled person who seeks retribution. To develop an effective approach, it is necessary to first understand why people complain?

Generally, people are dissatisfied because their expectations go unmet. When in addition, they percieve that they have been inconvenienced and treated rudely, they are much more likely to voice their dissatisfaction in the form of a complaint. The patient's expectations of health care providers go beyond that of clinical competence of doctor. Patients expect their doctor to be friendly, kind and concerned. Generally, the complaints are regarding quality of care, length of stay, attitude of the provider and the cost of care etc.. The greatest number of complaints lodged against workers are related to attitude and poor communication.

People who are dissatisfied with hospital service have four choices1. They 'Voice' a complaint, choose another provider ('Exist'); continue to use service despite being dissatisfied (remain 'loyal'), or continue to use the service and keep complaining to friend and family, influencing their behaviour and creating 'negative image' of the hospital. Now, lately the patients have started going to consumer protection courts for seeking satisfaction.

We create dissatisfaction by raising expectations. A doctor says 'go to x-ray deptt. And get an x-ray in ten minutes', Nurse says 'The doctor will see you in few seconds'. The inexperienced patient may believe this; and very little delay creates frustation. Like all other customers, the patients want three Cs: Convenience, care and reasonable cost. The patient also expects that he/she should be treated quickly, courteously and correctly.

Though it is not always possible to meet patient's initial expectations, we have many opportunities to modify or alter patient's expectations. For example, to a patient requiring an x-ray, the nurse or ward boy could explain: 'From here you go to registration area, where you will be registered and then wait in the front of x-ray room till x-ray is done; then it will take another 15-20 minutes for developing of film which will be the in reviewed by the Radiologist. Generally the whole process takes an hour. Do you have any question?' It is always appropriate to add few minutes to the estimate of the patients's waiting time.

An apology for or an explaination of the delay are always appreciated by the people. By sending a message in the Out-door that doctor is busy attending a serious patient in ward, will satisfy the waiting patients. It is often helpful to begin the response to a request or enquiry with a form of 'YES'. Once you start with 'NO' the communication begins to deteriorate and it becomes difficult to further develop good relationship. One should never write unnecessary tests, if the tests are absolutely necessary, then the patient is made to understand, so that he/she leaves satisfied and believing that you cared enough to make sure that he/she is O.K. In the end of meting ask patient, 'How else may I help You?' or 'Is there anything else I can do for you?' occassionally patients, if given the opportunity, divulge their true concern at the end of visit. The closing question allow the patient and the practitioner to come to a definite closure, and patient returns satisfied.

The hospital administration should evolve an effective complaint management system in the hospital. On receipt of a complaint, it should be handled properly, responded quickly by the administrator. The appropriate management of complaints, including their trend analysis (which points at certain deficiencies) helps to improve the system. A successful complaint management system contain the following components:2

  • Positive approach demonstrating sincerity and concern.
  • A system to track, investigate, resolve and document the complaint.
  • Follow up and reporting mechanism.
  • A complaint tracking system.

Most of the doctors recognise where a patient is frustrated and dissatisfied. By simply saying, 'you seem upset, may I help?' or sending a colleague to investigate the perception will resolve the problem; or else the patient goes dissatisfied and lodges a complaint.

Unfortunately, the staff of most organisations react adversely to complaint, ignoring them, leading to denial, which in turn leads to perpetuation of the problem. The person managing the complaint should demonstrate concern, sincerity and empathy. The handler must convey the feeling that issue is important to him. Even the questions 'How may I help you? and how did it happen?' make the complainant feel important. The complaint manager may be able to give the complainant a sense of great value. The message should be in the form of; 'Thanks for letting me know'.....; 'this is a real concern to me'....... 'I am going to investigate this now and get back to you' or 'your call come at an opportune time, we are looking at ways to improve our services'. What happened? How is she/he doing now? You have taken first step in resolving the complaint. The second step is to find out what the complainant really wants. People with complaints want one or more combination of the following3:-

  1. Respect and Understanding: It is necessary for complainant to believe that you sincerely want to hear and resolve the issue.
  2. Immediate Investigation and followup
  3. Censure: Some complainants believe satisfaction can best be achieved by some form of punishment, reprimand or censure.
  4. Assurance that the problem will not reoccur: If the complainant is assured than he/she will walk away with feeling that he/she has improved the system.

To achieve success in complaint management, it is necessary to identify a single nodal person to assume responsibility for the overall management of complaints in the hospital. He should be some one who has the authority and the leadership skills to create change. The other systems which can help to achieve the patient satisfaction and thus reducing complaints in the hospital are:

a) Having a Grievance Redressal Committee with 2-3 members from different specilities and incharge from hospital administration who could reply promptly without any delay to the complaints. Fixing up of complaint/suggestion boxes at the strategic points in the hospital where the public can put their suggestions and complaints regarding the system.

b) Patient satisfaction surveys can be done which help to find out grey areas/deficiencies in the system and administration can give inputs in this area to rise to the level of patient satisfaction.

The feedback from the public can be conveyed to practitioners, so that they can change their approach by which they are causing discomfort to the patients. The open minded practitioners will change their approach whereas the closed minded practitioners may reflect that they do not care what people think about them. 'I have been doing this for last 10-12 years, things have been going well without all these things, then why these committees?'. He/she doesn't understand that people want more than appropriate care, they want time and touching, care, comfort and compassion and above all accountability.

The time has come that we change and try to develop the system where we have less of complaints so that we can have good Doctor: Patient relationship in the new millennium.


  1. Hirschman AO: Exit, voice and loyalty: responses to decline in firms, organisation and states, Cambridge, Mass, 1970 Harvard University Press.
  2. Singh H : Industry Characteristics and consumer dissatisfaction, Journal of consumer affairs 1990 25:19- 56.
  3. Stranuss, Robert W: Complaint Management, Emergency Deptt. Mgt., Principles and Applications; 586-600.

* Dy. Medical Superintendent, Medical College Hospital, Jammu.

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