Patients may choose to provide feedback in a number of forms. Some of this can be helpful suggestions for how to improve the practice; some of the feedback may occur if the patient has not been happy with some aspect of the consultation process. Explicitly listening to patients’ feedback is likely to build their confidence in you as a healthcare professional and the osteopathic profession.
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Patients are more likely to provide negative feedback due to a complex chain of circumstances.
There are a number of predisposing factors that make negative feedback/complaints more likely and may relate to expectations, communication, and the patient-practitioner relationship. Some may be established even before the first appointment, for example, external pressures on the patient in their daily life, such as a marital break down. A specific event may, for example an adverse reaction to treatment, may then trigger a complaint. There is normally a desired outcome in mind to this process, so the way that the osteopath responds to the patient will affect its progression and resolution.
There is potentially an increased risk of negative feedback after the first appointment, often due to unmet or unmanaged expectations. For example:
- Patients like consistency so problems may arise when the patient has seen someone else for the same problem and they receive a different diagnosis;
- There may be inconsistency with the level of care they receive;
- They may expect total resolution of their symptoms; this may be based on information they have received from friends, family and even the media;
- Patients may expect a higher proportion of treatment at their first appointment than is given.
Follow up appointments may also give rise to negative feedback. Problems may arise if expectations regarding the number of treatments or outcome are not managed. Patients appear to have a tendency to judge appointments by duration so a shorter treatment than expected may trigger a complaint.
A common denominator for complaints regardless of the trigger is communication. Effective communication is required to manage expectations throughout a patient’s course of treatment.
Communication problems can be causes for complaints in their own right, for example a lack of empathy, poor listening skills, inappropriate conversation topics or lack of awareness of personal boundaries.
There is a need to provide information for patients before their first visit; this should include information about the osteopathic and any other allied techniques likely to be used (e.g. acupuncture), the need to get undressed, and the need for touch and physical examination. It is also important to inform the patient of the following prior to their first visit:
- The extent of treatment likely to be included in the first appointment
- The costs
- The need to bring suitable clothing and the need for a certain amount of undress
- The option of bringing a chaperone
A study investigating patients’ expectations of osteopathic care was undertaken by Leach et al, 2011.13
The overall message from the study was highly positive for the osteopathic profession; in private practices, over 96% patients were satisfied, and 69% of the most widely held expectations were being delivered well, many extremely well. However, some gaps were identified and all osteopaths can reflect on the study’s findings, which identified some key areas where patients’ expectations were not met. They included:
- Being provided with information and advice of how to prevent problems recurring;
- Being clear that a triaging process takes place at the first appointment, and onward referral may be required if necessary;
- Being clear about how and when communication is made with a wider network of healthcare professionals;
- Providing information on the risks and side effects of treatment;
- Providing pre-treatment information when possible;
- Providing telephone advice between treatment;
- Providing good access for patients with disabilities;
- Providing information on how patients can give feedback to the practice13.
The full report of the study and a summary report are available13,14.
Patients are more likely to complain about a treatment reaction if they view it as unacceptable. The patient’s acceptability relates to their beliefs about the process and healing, and is linked to the positive perception of the patient-practitioner relationship. It also relates to the extent to which the patient was pre-warned about possible treatment reactions. So again, information prior to and post-treatment is vital in the management of adverse events and complaints pertaining to them.
The aim of setting up a patient feedback procedure is to encourage most issues to be handled and resolved locally, therefore reducing negative feedback escalating and being dealt with by the regulator.
The Department of Health (DoH) introduced a report in 2009: “Listening, responding, improving”, which aimed to provide patients with a clear and simple route when they were unhappy with an aspect of their care15. Although the impact of this policy may mean even more feedback is elicited, because of the new structures for independent local resolution of such issues, there is the possibility of the regulator becoming involved much less. There is potential for a higher proportion of non-serious issues going to the regulator in professions such as osteopathy because local resolution can be more challenging in small private practices.
The General Osteopathic Council (GOsC) stipulate in their practice standards that osteopaths should operate a procedure for considering and responding to patient feedback about their practice16. Part of the procedure should ensure that patients know that they have the option to refer their issues to the GOsC. However, the GOsC should act as a safety net rather than the point of primary contact when issues arise. It can be helpful to promote local resolution. There are a number of steps that can be taken when dealing within patient’s negative feedback.
Patients may like the opportunity to give feedback about a practice, and give suggestions concerning how it could be improved. Presenting the complaints procedure as a ‘feedback’ system may invite positive feedback as well as areas for improvement rather than complaints alone.
Feedback procedures should be easy to access, well publicised, speedy, confidential, informative, simple to use, fair, effective, and regularly monitored.
The way you respond is vital; there are some key things to consider:
- Record what has occurred, and the key issues identified;
- don’t delay in responding don’t get angry;
- be prompt, polite and respond appropriately
- check with your insurer how they would prefer you to deal with negative feedback before you receive any. This may help you to respond quickly and appropriately.
Dealing with negative feedback in this way is more likely to lead to a quick resolution. Ensuring patients feel supported when they raise issues of concerns or areas about which they are unhappy is very important.
Following a patient expressing dissatisfaction, providing a sensitive explanation of what has happened and why, may prevent an escalation of the complaint16.
One way in which you can learn from patient feedback is through the process of clinical audit. Audit is essentially a quality improvement process that includes collecting data to measure current standards of practise and comparing these to previously defined standards. You could audit feedback to identify patterns, and see where things are going well, but also where things may have gone wrong so that you can devise a strategy to improve aspects of your practice. For information about clinical audit you can visit the audit page on this site.
In the event that a patient incident has occurred, it is a good practice to undertake a significant event analysis to identify what can be learned from this event, and whether any additional strategies need to be put in place for their management within the practice. Information about significant event analysis can be found at: http://www.rcgp.org.uk/clinical-and-research/clinical-resources/clinical-audit/significant-event-audit.aspx
In their practice standards, the GOsC suggest that talking about critical incidents and feedback with other colleagues may be helpful to aid learning16. NCOR are currently developing an online learning forum with access solely for the profession where osteopaths can anonymously describe their experiences relating to practice incidents so that the profession as a whole can learn from them.
For more information about complaints you can visit the General Osteopathic Council’s complaints page:
13. Leach J, Cross V, Fawkes C, Mandy A, Hankins M, Fiske A, Bottomley L, Moore A. Investigating osteopathic patients’ expectations of osteopathic care: the OPEn project Full report 2011. http://www.ncor.org.uk/wp-content/uploads/2013/02/open_full_research_report_public.pdf
14. Leach J, Cross V, Fawkes C, Mandy A, Hankins M, Fiske A, Bottomley L, Moore A. Investigating osteopathic patients’ expectations of osteopathic care: the OPEn project summary report 2011. http://www.ncor.org.uk/wp-content/uploads/2013/02/open_summary_report-_public1.pdf
15. Department of Health. Listening, Responding, Improving – A guide to better customer care. 2009. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_095439.pdf Accessed on 12/05/2013
16. General Osteopathic Council. Osteopathic Practice Standards. 2012. Available at: http://www.osteopathy.org.uk/standards/osteopathic-practice/ Accessed on 27/01/2016