The real reason people complain about healthcare

It is important to determine the reason behind a complaint, because the actual content is not always a true representation of what is at play. Complaining might be a sign of powerlessness. Paying attention and providing an explanation might then be more important than actually remedying the complaint.

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The press really knows how to focus on inadequacies in the healthcare sector. Clients and family members complain about lack of care, insufficient care or care that is provided too late. “Urine running down the legs” is a recent example of this. Despite this, clients in the healthcare sector, extramural or intramural, generally praise the care provided. A stay in a nursing home or convalescent home is considered a real luxury, for the most part. But even these institutions are subject to problems: being cared for or cleaned up too late, being showered too infrequently, water that is too hot, food that is too cold, et cetera. The fact that such incidents occur is not good, but it is unavoidable. We must seriously take into consideration that these types of healthcare-related incidents are going to increase.

The professional healthcare sector is shifting towards informal caregivers (mantelzorg), budgets are being trimmed, and a substantial restructuring is taking place (decentralization of responsibilities). And all of this is happening at the same time. Regardless of how great (informal) healthcare may be or how good the intentions, mistakes and inadequacies are unavoidable. Also, consider that the many rules, regulations and guidelines in professional healthcare, do not apply to informal healthcare. In other words, a great deal more will go wrong and complaints will happen more frequently.This is one more reason why a complaint must be accorded its due value.

Complaining is a form of influence

When people are unable to control certain aspects in their environment, it leads to learned helplessness (Seligman, 1975). This, in turn, has negative consequences on motivational, cognitive and emotional levels (Kalma, 1989). This is why it is important for the health and well-being of people that they are able to gain influence or retain their level of influence over their immediate surroundings. When a person isn't able to do much on their own, when direct influence is not quite as possible, it might help to have an influence on the people who can help. But this is often limited. People want to help, but are not always able or are unable to help when help is actually needed. For example, the client receives food at the scheduled time, but not when he or she is actually hungry. Or perhaps he or she cannot be taken to the bathroom when the need arises, et cetera. When people are unable to influence their surroundings, the last thing left for them to do is to complain.

Because we (luckily) have no influence over the weather, we complain about it. The same applies for many things that are beyond our control: politics, the system, traffic, the boss. Complaining gives us the idea that we can at least still say something about it. If someone in a nursing home complains about the food, it might mean that there is something wrong with the food. But this does not have to be the case. It might also mean that it is not possible for the relevant person to influence the food. “Even though the beans are tasty and healthy, I would cook them differently.” Being unable to influence these things leads to a sense of helplessness, and this can be compensated for to a certain extent by complaining.

Determine the actual reason behind the complaint

A complaints does not have to sound justified to other parties, such as healthcare professionals. But this does not mean they should not be taken seriously. On the contrary. It is certainly important to determine the actual reason behind the complaint. The content is not always a true representation of what is really at play. Paying attention and providing an explanation might be more important than actually remedying the complaint. Let people know that something has been done, because of their complaint. If it is impossible to do something about the matter, explain why. This will allow the client to better judge why something can or cannot be done, in future situations.

People want to able to influence quality

Having to wait becomes less bothersome if one knows why one has to wait so long, and how long the wait will be. This knowledge gives people a sense of control and prevents complaints. This principle doesn't just apply in Disney World, but also in the healthcare sector. Public opinion, press and politics often zoom in on the content of a complaint, unjustifiably so, without actually considering it in context. Rules, protocols and supervision are pretty much exclusively aimed at quality on paper.

Although these measures are aimed at achieving improvements in daily practice, they often don't consider the most important aspect, which is that people want to have an influence on quality. "I am receiving proper assistance because people are helping me in the way that I would like to be helped, and not because of what is stated in the guidelines." Guidelines actually undermine the sense of control and competence, rather than reinforcing these feelings. This applies for clients and healthcare workers.

Guidelines are fine as long as they allow the healthcare worker and the client to do things in the manner they deem most fitting, within a global framework. Allow for the fact that mistakes will sometimes be made and pay sufficient attention to the – legitimate – complaints. Listen to them, show clients what their remarks are doing, and most definitely do not convert these complaints into yet another rule.

Considerable attention was paid to client satisfaction in the healthcare sector during recent years.We are actually starting to understand this concept better, to refine it and to put it into perspective. Things are not always what they appear to be. Just because a client fills out a questionnaire, stating that he or she is satisfied, does not necessarily mean they are. Likewise, we must be careful not to take healthcare-related complaints at face value. Instead, we should try to understand their true meaning. Sometimes complaints can be solved by getting rid of the cause; sometimes complaints can be lessened by explaining that there really is no alternative. Or merely by giving people the opportunity to control the effect, if possible.