SECOND OPINION:The HSE needs to be told what it is doing wrong and right, writes JACKY JONES
IRISH PEOPLE are known for their lack of assertiveness. We are reluctant to complain about services and we are poor at giving and receiving compliments – particularly about health services. Two recent reports highlight our diffident behaviour. The Health Service Executive’s annual report shows that 8,434 complaints were made about HSE services while 6,181 complaints were recorded in voluntary hospitals and agencies.
Most of the complaints related to delays or waiting times, treatment or service delivery, staff attitudes or manner, and communication. Details of the 7,050 compliments are not broken down, which is a pity because we all learn more from praise than censure.
The numbers of complaints and compliments are tiny in comparison to the levels of services provided, with only 0.2 per cent of service users making a complaint and one in 1,000 giving a compliment. Can we assume from these figures that more than 99 per cent had no complaints or that 99.9 per cent had nothing good to say about the services they received? Well no, we cannot.
A 2011 survey from the Irish Society for Quality and Safety in Healthcare (ISQSH), Measuring the Patient’s Experience of Hospital Services, shows that almost 16 per cent of respondents wanted to complain but didn’t, and one in 12 patients was dissatisfied with the hospital services received. These findings mean that the number of complaints would be much higher if service users behaved assertively.
Irish hospitals provided services to more than six million people last year but the survey findings mean that one million patients wanted to make a complaint and did not do so. Almost one-third were dissatisfied with levels of patient participation and involvement, which translates into nearly two million possible complainants. On the other hand, the ISQSH report shows very high levels of overall satisfaction with the services, so the HSE should be getting thousands of compliments every day, but this does not happen.
Nearly half of patients surveyed were unaware of the patient’s charter and almost two-thirds did not know about the complaints procedure.
These documents are supposed to be actively promoted by healthcare workers. In fact, 39 per cent of respondents said hospital staff did not encourage them to voice their opinions about services.
Knowing how to make a complaint is one thing, feeling assertive enough to do so is another. Irish people are unable to be assertive in many aspects of their lives, such as saying no, asking for what they want, and making and receiving criticisms and compliments because they didn’t learn how to be assertive in childhood. Most people tend to be passive, manipulative or aggressive.
When they are complimented, they may feel they don’t deserve it, or are suspicious of the person’s motives. On the other hand, people get so used to being criticised in childhood they spend a great deal of time and energy as adults trying to measure up to others. This results in both patients and healthcare staff being unassertive when receiving or delivering services.
Another reason people may not complain is because they believe it will be ignored or that their future services will be affected. They may dread authority figures or feel intimidated by professionals. They may fear being labelled a “complainer” or a difficult patient. This should not happen.
The Health Act (2004) puts the management of complaints on a statutory footing so they are taken very seriously. There is a specific procedure to be followed and 98 per cent of complainants last year were satisfied with the response from the HSE. It is possible that staff in some settings may be unable to deal with criticism assertively so persist until you get your complaint resolved.
The Commission on Patient Safety and Quality Assurance (2008) stresses the need for knowledgeable patients in developing a culture of patient safety, so speak up, get empowered, give credit where credit is due, and make a complaint when you are not satisfied. This is the only way we will get the health services we deserve.
My most recent experience of the HSE was when I wanted to renew my European Health Insurance Card. It took less than five minutes and I received my card within a few working days. So thanks for being so efficient.
Jacky Jones is a former regional manager of health promotion with the HSE