Exploring Experiences and Attitudes about Health Care Complaints among Pregnant Women, Mothers and Staff at an Opioid Treatment Service

Article excerpt

Abstract

There is little information about managing frontline complaints with opioid-dependent women. Semi-structured interviews were conducted with a purposive sample of 13 opioid-dependent women and 10 staff at an Opioid Treatment Service. A multidisciplinary team conducted a thematic analysis on the transcripts. Difficulties that prevented women making complaints included the anticipation of not being taken seriously, the fear of repercussions including infant removal, and practical difficulties in making written complaints. Staff reported that complaints at the dosing window were often delivered emotively and could be personalised. They had difficulty assessing complaints to determine whether there were substantive health care issues that should be followed up. Women and staff believed that case managers had a role in providing support for the complaints process.

Aust Health Rev 2008: 32(1): 66-75

THE HEALTH CARE sector in Australia has placed an increasing emphasis on complaint processes in the last decade. Complaints have been defined by New South Wales Health as an expression of dissatisfaction by a complainant which may have one or more issues associated with it.1 Organisational support for improving health service complaint management systems was introduced through the establishment of Health Care Complaints Commissions in each state in the early 1990s.2 Their role is to support health services to resolve serious complaints through conciliation, and to promote good practice for complaints handling within health service systems. The Commonwealth government and several state governments have developed policies, standards and guidelines on complaints handling for use in their health care systems.2 Policy documents in Australia place an emphasis on recognising consumer rights to access complaint mechanisms, and the contribution of complaints processes to improving health service quality and safety.1,3'7 Transparent and sound complaints management also helps to restore consumer trust and satisfaction in the public health care system.8,9

Surveys conducted in Australia report that less than half of consumers who were dissatisfied with health care formally lodged a complaint in these hospital settings.10,11 The majority of consumer complaints are expressed informally to frontline staff. This includes clinicians, nursing and allied health staff, and administrative staff. Frontline staff and their managers have a role in documenting complaints, resolving minor complaints at the point*of service, and referring more serious or unresolved complaints to designated complaints managers within the health service.1'8,10 Frontline staff who receive a complaint should respond by listening to the complainant and showing empathy, identifying the problems and outcomes sought by the complainant, providing an explanation or apology, taking action to implement the solution offered, confirming satisfaction, asking if they want to take it further and making a quick record of the complaint or concern.12 Health service managers need to support their staff to receive and respond to complaints made at the point of service,2 and minimise the barriers to consumers making these complaints.1,4

Good complaints management is needed if complaints are going to effectively contribute to health care improvement and to uphold consumer rights. Fair and effective complaints processes are particularly important for marginalised or disadvantaged groups because they have the potential to identify problems in health care delivery which have been overlooked by health service providers within these groups, and to redress experiences of discrimination. However, there are specific challenges in managing complaint processes with these groups. Marginalised groups can face barriers to participating in mechanisms for service feedback, including complaints, which are closely linked to the difficulties they have in accessing services. …