Have you heard the saying: From a little spark a great fire can be kindled.
I’m going to use sparks as a metaphor for feedback. You can recognise those sparks of feedback and deal with them in different ways. You don’t know where that spark might lead but you can direct it’s course by taking appropriate action.
We’re going to look at different types of sparks, recognising the sparks – both positive and negative and then handling sparks and conclude with a few warnings.
Where is your spark leading?
Often feedback does start as a small spark. You need to be able to recognise these sparks and handle them appropriately.
You want the sparks that come from your practice to be positive sparks that light candles or beacons that shine in your community telling everyone your message. Recognising these sparks and handling them well will enable your practice to grow it’s reputation. Ideally you want to make sure a candle is lit from patients compliments and even turning those candles into a beacon for your clinic in your community giving you a reputation for brilliant care.
Negative sparks can spread quite rapidly and may ignite fireworks or worse a raging fire. If you can recognise these sparks at an early stage you may be able to deal with them appropriately. An osteopath who is a skilled communicator and handles sparks well may be able to turn the sparks that look like they are going to light a raging fire into sparks that light a beacon for your clinic. Patients will become raving fans if you handle their concerns or complaints well. You might be asking why I’ve referred to sparks that light fireworks or a fire. I am differentiating between a spark that causes a small local explosion that draws attention to your clinic compared to a spark that lights a fire which potentially can cause significant damage to your clinic.
First of all osteopaths need to be skilled at recognising sparks. You need to identify a spark of positive feedback that could be used to promote your practice. You also need to recognise the first spark of negativity in terms of a concern or complaint.
In your practice you need a process for making the most of positive sparks. Patients won’t necessarily think of recommending your practice unless you tell them. If a patient starts giving compliments about any aspect of your practice think about how you would like to make the most of that and be prepared. Perhaps you could have testimonial forms available, maybe you want to invite them to leave feedback on google or social media, some clinics like to collect video testimonials. However you decide to handle positive feedback, make sure you have the patient’s permission to use their words – be clear about how the information will be used and how they would like it attributed – anonymous or using part of their name or fully claimed. Make sure all your staff know your procedures for dealing with positive sparks so you can either light lots of small candles shining in families or work places or even better make your clinic a bright beacon in your area. Try to learn from these positive sparks – what made them, so your practice can create even more positive sparks.
You also will benefit from being skilled at recognising negative sparks. There is some research to help in this area. In this section we are just going to talk about identifying the sparks but don’t be alarmed because the next section will discuss how to prevent the sparks and what to do about them. From concern and complaint patterns we know that negative sparks most often arise from:
Treatment reactions, poor response to treatment, worse symptoms, additional symptoms, no change – you could summarise that these are all unexpected outcomes from treatment. A patient comes with symptoms and expects them to improve when something different happens there is potential for sparks to occur. Of course it is extremely common for patients not to improve immediately and other symptoms or adverse responses to occur but it is how you handle the sparks that makes all the difference.
Insurers list these as signs of potentially unhappy patients:
- Verbal complaint from someone dissatisfied with a threat of taking things further
- Letter of complaint alleging dissatisfaction, neglect, error or omission
- Not attending for subsequent treatment without explanation or further contact
- Refusing to settle or delaying payment of fees
- Request for refund of fees
They identify the receipt of a complaint verbal or written, disappearing patients and money issues as clear warning signals.
My advice is that if you are subject to any of the five items on the insurers list you should speak to your insurers or the iO before you respond.
Fire risks from particular patients:
Just as certain substances are more flammable, there are certain patient interactions and situations that are potentially flammable. You need to be aware of these so you can be more alert to prevent sparks and identify any sparks early.
- New Patient
- Vulnerable patient
- Patient new to you
- Adverse reactions
- Lack of improvement
- Prolonged treatment
Now we’ve identified the potential risks for sparks we need to learn how to handle those sparks and reduce the fire risks.
Handling the sparks
The most important factor in handling the sparks is communication.
|Prevention||Proactive Response to Spark|
|Treatment reactions |
Poor response to treatment
Worse symptoms Additional symptoms
|Inform patients about potential adverse reactions Make sure patients know how to contact you if they are worried Make sure patient has realistic expectations of treatment Agree a treatment plan with your patients||Reassess the patient Reassurance as appropriate Informed, shared decision making about ongoing treatment plan Provide with contact details if concerned Have appropriate referral routes Communicate well about the referral – with the patient and healthcare practitioner|
|Prolonged treatment||Make sure your patient has realistic expectations of treatment Have an agreed treatment plan with patients Reassess and review at intervals to agree ongoing treatment||Reassess and review progress Discuss alternative treatment options Refer if appropriate Agree an ongoing treatment plan with timeframe with reassessment|
|New patient Vulnerable patient Patient new to you||Have brilliant consent procedures – informed consent, shared decision making, treatment planning Understand patients’ expectations, preferences and values Communicate well throughout the session Have a consistent, comprehensive procedure for transferring over patients between practitioners – allow additional treatment time if appropriate Make sure patients know how to contact you with any feedback or concerns||If the patient seems dissatisfied: Review the assessment and diagnostic reasoning and reassess Manage expectations Review patients’ preferences and values Discuss alternative care options Agree an ongoing treatment plan Refer, if appropriate, with good referral procedures|
At some point you will receive negative feedback – what should you do?
Consult the master firefighters
You may need to take advice from your insurers or the iO. Your experience and instinct will often tell you whether this is a usual response to an adverse treatment reaction or if the patient seems particularly irritated and volatile. If in doubt, make the call to get advice – don’t take any chances. There are no negative effects from you taking advice – you may need to submit some written reports but it will be worth your time if it prevents a fire.
The iO and your insurers are master firefighters and just like the regular fire service they are experts in fire prevention advice. It is in their interest to prevent fires and they are more than happy to advise you on preventative and proactive responses to prevent sparks from escalating. In fact, if you haven’t told them about a spark such as a verbal or written complaint or request for a refund and it escalates to a fire you may find that they are not willing to come and help you once you have a blazing fire in the form of a complaint to GOsC. Insurers want you to involve them at the earliest opportunity.
You are probably thinking about how you respond to a significant complaint that leads to you fearing the future. I would urge you though to apply this advice to even the smallest sparks in your practice. Perhaps someone complains about the parking or difficulty making an appointment or a slippery floor. All concerns and complaints need to be responded to appropriately. Any spark can lead to a bigger issue and several sparks for one person may escalate quickly. Show you care about the small things as well as the big. Your aim is to be a brilliant practitioner with an outstanding clinic.
Every spark happens for a reason and you need to be alert to those sparks and respond appropriately.
There are several different acronyms and systems which you may come across for receiving feedback. One thing they all have in common is the word LISTEN. Never forget that listen is an anagram of silent – a lesson to be applied.
Make sure you acknowledge your patients concern or complaint – however it is received. Tell them you have received it or heard what they have said and that you will investigate. If the patient is expressing negative comments directly to you acknowledge that they have some concerns. Reassure them that you are taking those seriously and that you will investigate if appropriate or you will reflect and respond. Tell the patient when you will respond and how. Make sure you do respond, even if it is just to say you are still looking into things and you will respond by.
If you say you will do something do it. Try not to fan the spark into something bigger.
Try to avoid being defensive. This is something seen a lot in complaints reports. The practitioner responds out of fear and does not listen appropriately to the patients concerns. This then leads to an escalation of the problem. Patients want you to hear their concerns and respond appropriately. If a patient asks a question make sure you respond. If you don’t know the answer, find out and send them the information afterwards. Don’t blag or simply ignore your patient’s needs.
Nobody likes to receive criticism. Take a deep breath to remain in a right frame of mind. Listening carefully to the patients concerns and allowing them to fully express their concerns. Wait until they run out of steam before you ask any questions or make any response.
Patient’s are always right
If your patient is expressing dissatisfaction it is for a reason. Patients do not usually set out to find fault with a practice or a practitioner. Always try to see things from the patient’s perspective.
When your patient comes in with pain I don’t think there is any osteopath that would simply say to their patient – don’t be so silly, that’s nonsense, you can’t feel like that. We believe the story the patient comes in with and try to make sense of it.
If a patient is expressing that you have caused them pain physically, mentally or emotionally you must believe that is how they feel and respond appropriately whether you agree with their point of view or not. You cannot deny the patient the way they feel – anger, annoyance, irritation etc. It is their point of view and their feelings. Identify what the patient would consider an appropriate response or outcome.
Always take the time to investigate on why the situation has arisen – was it poor communication, has the practitioner neglected self-care and not been at their best. Even if you don’t agree with the patient’s opinion it is important to reflect on how that opinion arose.
Put things right
Take the action necessary to put things right and inform the patient about what you have done. This may need to be done through your insurers depending on the nature of the complaint.
If it is an internal domestic issue tell your patient what you have done. They will be pleased to see you have listened and responded. This is your potential to take that spark and light another positivity candle for the clinic. You might want to thank them for their feedback and tell other patients about the experience in your newsletter.
You should reflect on any situation that has led to a concern. Try to look at it from your perspective, an aerial view and the patients perspective. Consider all three of these points of view and reflect.
We are going to look more at reflecting and learning later in this series.
Three final points:
Some sparks are entirely appropriate
Positive sparks should be recognised. Osteopathic success is to be celebrated and we want the word to spread.
There are some negative sparks that I feel very happy they end up in front of the investigating and professional conduct committee. Osteopaths who value the reputation of their profession will want the complaints system to work to protect the public. Professional misconduct taints the reputation of osteopaths and we want the public to know that if their care is not up to standard there will be repercussions.
Don’t ignore the spark
Never ignore negative sparks. You don’t know where they might lead in terms of damaging your reputation and at what point they may ignite into a fire.
Always acknowledge feedback and never be dismissive of a patient’s questions or concerns.
Don’t just quench the spark
Be careful not to just quench the spark. You need to respond appropriately to the patient and reflect and learn. Just stemming one spark may mean you have not dealt with the underlying issues
Glowing embers can reignite – learn from the situation and take preventative action to prevent further sparks from arising. If you don’t make changes you are at risk of more sparks and escalating problems.
Complaints that escalate are very few so do keep things in perspective. Value feedback as a means of developing and improving your practice. Good communication is key to positive outcomes from feedback.