Resolving complaints: a new model

Introduction

Resolving complaints successfully is a key aspect of managing risk for any service organization, whether in the public sector or beyond. NHS complaints procedures have been available for many years now, but their remit is necessarily limited to treatment and care provided under the NHS. Clearly, private dental patients are excluded from using NHS procedures. For many years, if they were dissatisfied with the way a complaint had been handled by their dental practice and the issue was serious enough, their choices were limited. They could either turn to the fitness to practise procedures of the General Dental Council (GDC), the organization that regulates dental professionals in the UK, or the courts. Both could be expensive and inappropriate. This state of affairs was long recognized as unsatisfactory.

The lack of a user-friendly, inexpensive and timely redress mechanism for private dental patients across the sector as a whole was one of the reasons why, in October 2001, the UK Consumers' Association submitted a ‘super-complaint’ to the Office of Fair Trading (OFT) – a super-complaint being a means by which a designated consumer body may refer features of markets that are, or appear to be, significantly harming consumers' interests to the OFT for fast-track consideration.

In its complaint, the Consumers' Association highlighted six areas where it alleged significant harm was being caused to the interests of consumers. One of them was ‘the lack of a system for dealing with consumer complaints and offering suitable redress’.

Responding to the complaint, ¹ the OFT addressed this concern as follows: ‘Where problems cannot be addressed at practice level, we recommend that an independent complaints procedure is instituted. This would enable consumers of private dentistry to have access to a complaints procedure which is independent of practices, just as consumers of NHS dentistry already have.’

On 24 May 2006, just nine months after enabling legislation was passed by Parliament to allow the GDC to set up and fund this long overdue private patients' complaints service, Health Minister Rosie Winterton launched the Dental Complaints Service (DCS) at the Queen Elizabeth II Conference Centre in Westminster.

The DCS is operationally independent of the GDC, with its own staff, administration and offices (in Croydon), separate from the GDC's headquarters in Wimpole Street, London. The service allows patients across the UK to complain about any aspect of private dental care, treatment or service, involving any member of the dental team, including members of the team newly registered with the GDC such as dental technicians, clinical dental technicians, dental nurses and orthodontic therapists.

The service offers a new model for managing risk through best practice in complaints handling.

Handling complaints well is good (business) practice

Handling complaints well is an important aspect of the relationship between any organization and its customers. Successful practice is built on the relationship between the organization and its customers – and good complaints handling has a role to play in that relationship. However, to handle a complaint well, you first have to receive it. Although consumers in general have become more outspoken, there is still an understandable tendency among many with a complaint to avoid confrontation.

An OFT survey ² of dental patients found that, of the 6% it surveyed who felt they had cause to complain, just over half actually did, resulting in only 3% of all patients actually complaining. Those people who do speak up, however, arguably present real opportunities to address issues that may well be symptomatic of the feelings of other, more reserved patients. One brash complaint may represent the tip of an iceberg, offering the opportunity to deal with the matter, and positively. Had they simply grumbled to friends and family, the problem, potentially for others as well as for them, might never have come to light. The OFT explicitly recognized this when it stated ³ that unresolved complaints ‘can lead to dissatisfied consumers while leaving dentists unaware of the possible need to change their practices and procedures’.

The potential damage to business from handling complaints badly can be huge. Customers whose complaints fester may go on to tell many others about their bad experience, potentially damaging the reputation of a business. Contrast that with those who receive a good service, who may only tell a handful of friends or family.

The most enlightened businesses realize that dealing with concerns effectively helps to retain those customers, who may then become its most passionate advocates, leading to new business. Both sides benefit. That said, the reverse also holds true. Any business that makes complaining difficult or unrewarding risks its customers taking their complaints to a higher authority. That may mean added stress and expense, for both parties, and the business's reputation may suffer as a result.

These truisms of customer care apply equally to dentistry. Well-handled customer complaints can build loyalty among your existing patients and generate referrals and recommendations, reaping rewards for the future. Handling a complaint quickly and effectively can transform an aggrieved patient into a loyal customer and a marketing asset, at little cost. The organization that employs best practice in complaints handling stands to gain repeat business from satisfied customers, perhaps for many years, who may also refer other customers.

Handling a complaint badly can cost time and money. A defensive and negative wrangle can tie up a business – usually, in the case of private dentistry, a small business – for years. It is hard to see how this is a profitable use of time.

One of the most useful aspects of the new Dental Complaints Service, then, from the point of view of dental professionals, is that it provides a ‘next step’ for an unsatisfied complainant, who otherwise might take their business elsewhere (if they decide not to pursue the complaint), or take their complaint to the GDC's fitness to practise procedures, or to the courts – a ‘next step’ before meltdown or showdown.

In that sense, the Dental Complaints Service can help dental practices to manage complaints more positively, and more effectively, allowing them to maintain and improve their relationships with patients. In turn, patients no longer need to pursue other, more daunting avenues of complaint, such as legal proceedings, which can be prolonged, adversarial and expensive, for the dental practice as well as the patient.

Many dental practices already appreciate this. Dental professionals can – and do – seek the help of the DCS to resolve complaints that they are finding intractable.

How the service works

The GDC, in its Principles of complaints handling, gives ethical and practical guidance on how to set up an effective complaints handling procedure. All dental practices are expected to have such a procedure and most dental professionals, through it, can and do successfully resolve any complaint that they receive from a patient swiftly and effectively. The Dental Complaints Service builds on that success, supplementing practices' own complaints procedures with a common-sense, three-stage approach to resolution:

First, complainants are encouraged to return to their dental practice and give staff there a chance to resolve matters;

If the first stage of attempted resolution proves unsuccessful, and the dental practice cannot resolve the matter to the complainant's satisfaction, then the Dental Complaints Service's advisers try to sort out the complaint informally with the practice and the patient. Resolution may include explaining to a patient that there is no complaint to answer.

At this stage (or the next), resolving complaints may involve an apology, a refund of fees and/or a contribution by a dental practice towards the costs of remedial treatment. So far, the service knows of £350,000 repaid by dental practices to patients who contacted the DCS – there may be more as a result of private arrangements. The DCS cannot recommend compensation – that is a matter for the courts. Neither can it bind dental professionals to follow its suggestions.

At the third stage, if DCS advisers are unable to reach a resolution, and if appropriate, the service convenes a local complaints panel. This is the last step in the Service's attempts to resolve a complaint. A panel consists of three trained volunteers – two lay and one dental professional. It is convened as locally as possible to the practice and patient, and as soon as possible, because delay can hinder resolution. (One panel was convened within a week of the complainant's first call to the DCS hotline.) In more than two years, fewer than 50 complaints have reached this final stage of the DCS's complaints handling process. Considering the number of complaints received, this is notable, and a measure of the success of the service.

Other aspects of ‘the DCS way’ may be worth noting. The service does not insist on receiving complaints in writing; most enquiries and complaints came through the service's local rate ‘complaints hotline’, and are made directly to a DCS adviser. Patients with a complaint who want to write can email the service through its website, or fill in a form online. One useful aspect of this form is that it can be printed and despatched as a letter raising the correspondent's concerns directly with the dental practitioner. Through the website, users – dental patients and professionals – can also give feedback on how the service is performing.

The majority of complaints are successfully closed. Very occasionally, the complainant has remained unsatisfied, despite the best efforts of the service, and in some cases, the efforts of the dental professional, too.

Despite its name, of the thousands of calls the service has received since it was launched, not all have been complaints, and not all have been about private dental care. Half the calls have been from NHS patients, who were re-directed to the appropriate local NHS contact. (This ‘advisory’ role was perceived as important from the beginning, and perhaps demonstrates limits to the NHS's efforts to make its own complaints procedures transparent and accessible.) Other calls were for advice, and it is for this reason that the service was given a generic title, rather than one that referred only to complaints about private dental care. Interestingly, one in 14 contacting the DCS were directed to it by their dental professional or practice. Indeed, a number of dentists and practice staff have contacted it directly themselves.

Who and what have complaints been about?

Launched in May 2006, the DCS has now seen two full years of operation. In its second year of operation, the service took 19,500 calls – initial contacts or follow-up calls – compared to 16,800 for the previous year. Some 12,800 of those calls (compared to 9700 in its first year) came through its local rate complaints hotline. The service's website www.dentalcomplaints.org.uk received some 144,890 ‘hits’ from more than 11,900 users; a year-on-year increase of more than 50%. As a result of these contacts, the service logged 1623 complaints, equivalent to over 31 a week. More than two-thirds of these complaints were resolved in less than a week. The average time taken to resolve complaints was 13 days.

So far, most complaints have been about dentists. A few have been about other dental professionals, including practice receptionists, dental hygienists, dental technicians and a dental nurse. Most concerned private treatment, but a few were about mixed NHS/private treatment, which the service can usually consider. Boxes 1 and 2 show sample cases.

The top three areas of complaint for treatment have been restorations, dentures and crowns, and for service issues, pain, cost and rudeness. Issues of ‘pain’ or ‘cost’ were cited in some four out of five complaints generally.

Most of the dental professionals who have replied with feedback have considered the performance of the DCS to be ‘excellent’ or ‘good’. Patient feedback has been equally positive.

The Dental Complaints Service arguably shows other UK public and professional services, particularly those in healthcare, how to handle complaints quickly, sensitively and cost-effectively. It demonstrates not just best practice, but a world-class standard.

The Dental Complaints Service may be contacted on 08456 120540 (local rate), or visit www.dentalcomplaints.org.uk, or email info@dentalcomplaints.org.uk.