Suki Singh talks to dentist and Head of Indemnity at the BDA, Len D’Cruz, about the inevitability of complaints and how to prevent them from escalating.
SS: Thanks for giving us your time, Len. Please explain what are the triggers for a complaint?
LDC: Problems don't automatically lead to a complaint. You'll know yourself if you think about complaining about a service, it may be the existing good relationship you have with the person, as well as the nature of the organisation, that stops you from actually complaining. And many of the complaints you and I make are not actually directed against individual people. They tend to be against faceless organisations that provide a less personal service.
As healthcare professionals, we deliver a very personal service, so we’re bound to get occasional complaints. The volume of patients we see also mean they're inevitable. In our practice we have six surgeries. That's about 15 patients a day, five to six days a week, 12 months of the year, which is about 22,000 patient contacts. It's inevitable things will sometimes go wrong in terms of systems and processes. Appointment scheduling is going to go wrong, lab work’s not going to come back on time or doesn’t fit. All sorts of different things. With that volume, you've got to expect that complaints are going to happen, so let's not be too alarmed by them. It’s obviously not pleasant to receive a complaint of any description but we have to accept that, in a service industry where money is changing hands, some form of dissatisfaction is bound to happen in some situations.
SS: Why do some patients choose to make a complaint?
LDC: Trust is important, and I think a lot of complaints arise because of a lack of trust. The trust equation is well-known. In it, there are three positives and one undermining factor.
The first one is credibility. Do you know your stuff? Do you speak with authority? Do you look and sound credible?
Next: reliability: you're dependable. When you say you're going to get the job done, you do it. When you say the denture will fit, it fits. When you say it's going to hurt, it hurts!
Then: intimacy: it refers to safety and security. ‘I feel safe giving this information to the dentist about my bad breath, my teeth’. ‘They won't embarrass me’. ‘They'll keep the information confidential’.
This can all, of course, be undermined by self-orientation. The patient thinking, ‘is this person doing the best for me or is it just self-serving’. ‘I think they’re doing this for their own benefit’. ‘They're offering me this private treatment because it is more profitable. This will undermine that feeling of trust.
For example, with ‘reliable’: you may not be as reliable as you were before. We're having to cancel entire groups of patients because their dentist has COVID and is now isolating. Patients think ‘Well, I'm starting to lose trust in this particular organisation.’ Or they're wondering: ‘Why are you using a waiting list? Are you getting paid and still not seeing us?’ Any perception of self-orientation will undermine their trust.
It is interesting how people perceive us. When we talk about a person’s ability to understand how we operate, patients also use interpersonal competence as a proxy marker. How likeable are you as a person? Because they've got no real way of judging your clinical skills. They can't look in their own mouth and check for three-point contact when you have done a restoration. They have no real ability to do that or to see the margins of their crowns. All they know is, ‘Do I like this person? Can I get on with them?’ That's the de facto stamp of clinical competence.
I'm not suggesting you should become incompetent in order to be more likeable, that's not the answer. But likeability matters more to patients than competence. And you'll know yourself that every time you consult a new professional person you will consider if you can get on with them and whether you can trust their advice?
SS: Are there some ways you can help become more likeable to patients?
LDC: Body language during communications needs careful consideration: facing each other, open body language, maintaining eye contact, conveying positive body language, listening attentively, verbal and non-verbal encouragement and follow-up questions, all help. This is a real challenge for us as dentists, hygienists and therapists, because we are doers. We want to get on with treatment.
Stopping to listen to somebody for any period of time is actually quite challenging for us and certainly listening to somebody for five minutes, let alone 10 minutes, is a challenge particularly without interrupting with our own views. And we're not usually taught about it as an undergraduate. In dental school, we're taught a whole lot of other stuff, but communication skills and active listening is something you must do for yourself later.
We're not so good at active listening. And when we actively listen, we reduce complaints. We increase the trust that we have from our patients. There is a lovely book by Kate Murphy, ‘You're Not Listening’, which explains a lot of these things, and the fact that you can't really teach listening skills. You've got to be genuinely interested in people. You can't just nod your head and pretend to listen.
SS: How do patients react if something goes wrong? What can we do to prevent a bad situation from getting worse?
LDC: Well, you might think they go straight to lawyers. The reality is, they don't. Around 88% want to be offered a solution to fix the problem, 36% want an apology and 69% want a refund. There are just three things they want: sort the problem out, apologise, and give them some money back. Those are pretty straightforward things to do. Sometimes, we're very reluctant to do that because our ego gets in the way or we see it as a sign of weakness. The challenge for us is to manage our pride and solve the problem quite quickly. Because often these complaints can escalate themselves, particularly if the patient feels they are not being listened to or taken seriously.
My advice is: deal with complaints quickly. Acknowledge them within three working days as required by the NHS complaint process. Your practice manager should be empowered to send an acknowledgement quickly. Then investigate with input from the staff involved and follow up with a detailed response. Apologise. Remember, an apology is not an admission of liability.
I think dentistry is an amazing profession. We're privileged to provide care for our patients. When you consider the many pressures that can arise during the working day, fear of litigation shouldn't be one of them. Keep calm and love dentistry.
Len D’Cruz is a general dental practitioner, foundation trainer and practice owner and Head of BDA Indemnity. He has 21 years’ experience as a dento-legal advisor supporting dentists with complaints, clinical and regulatory issues, and clinical negligence claims. He is lead lecturer at the University of Bedfordshire teaching on the MA in Dental Law and Ethics. He has authored and co-authored two books: “Understanding NHS dentistry” and “Legal aspects of general dental practice” (Churchill Livingstone) and has contributed legal and ethical content to a number of textbooks, and journals and websites.
Suki Singh is an Area Sales Manager who has been at Practice Plan for 14 years and has 18 years’ experience in the dental industry. Practice Plan is the UK’s leading provider of practice-branded patient membership plans, partnering with over 1,800 dental practices and offering a wide range of business support services.