Not upheld and partially upheld complaints: Getting to grips with complicated situations
Not upheld and partially upheld complaints usually occur when dealing with complicated situations. How can boards and staff ensure that the process is fit for purpose and built around the complainant? Dyfrig Williams and Ena Lloyd reflect on learning from the Good Practice Exchange’s Complaints Seminar.
Back in June we held a seminar on Embracing Complaints. The reason why we wanted to hold the seminar in the first instance was following a discussion with Nick Bennett, the Public Services Ombudsman for Wales. We got talking about the increasing number of complaints that they have been receiving, which led to Nick making a great presentation at the event on the cause of this and why the number of complaints are set to rise even further. It’s well worth having a look at the Storify for an overview of Nick’s points.
Jane Dale, Head of Organisational Learning at Aneurin Bevan University Health Board raised an interesting question at the event about not upheld and partially upheld complaints. Where a Health body believes that the correct care has been delivered but the patient feels that they had a bad experience, feeding the information back to a disappointed complainant can be challenging. It can also be difficult to present the information effectively to Board members to encourage strategic improvement. Do boards find it difficult to deliver improvement when the learning may be around soft skills instead of hard processes? It can be difficult to apply that learning and put it into practice across an organisation when it’s not in a binary context of right and wrong.
For example following an investigation it may be found that the correct clinical course was followed however the patient may feel that the communication / explanations were poor. Staff on interview may state that they made every effort to explain the situation however the patient remains unhappy. The challenge is whether to classify this as a complaint that is not not upheld and to explain why or to classify it as partially upheld. If it is classified as not upheld the patient continues to feel aggrieved and not listened to. To uphold it implies something was wrong and staff find that difficult if they have made every effort to communicate with the patient.
Nick Bennett added, ‘if in doubt go for the learning point rather than the tick in the box’
Complex and complicated situations
Public services are delivered in complex environments. Simple processes may work for relatively straightforward issues, however when feelings and viewpoints are brought into the equation, no process can give simply black or white answers when there are shades of grey.
The Good Practice Exchange’s work fits with the rationale of the Cynefin Framework. You may notice that we never use the term ‘Best Practice’. That’s because it implies that there’s one right way of doing things that will work for every situation. This may work in a manufacturing environment, but when the relationship between cause and effect is muddy like it is in complicated environments like public service provision, a simple one size fits all response is unlikely to work.
So how does an organisation develop and manage a complaints process when feelings and viewpoints need to be taken into account? The danger with any policy or process is that once it’s formed, it sits on the shelf without being put into practice. So success lies in making the document a living, breathing thing that is continuously updated and improved based on practice and experience. There may be lessons that can be learnt from Digital Design principles in terms of working iteratively. Principle five of the Government Digital Service Design Principles says:
“The best way to build good services is to start small and iterate wildly. Release Minimum Viable Products early, test them with actual users, move from Alpha to Beta to Live adding features, deleting things that don’t work and making refinements based on feedback. Iteration reduces risk. It makes big failures unlikely and turns small failures into lessons. If a prototype isn’t working, don’t be afraid to scrap it and start again.”
Has the process been designed with the complainant in mind?
As Alan Morris said at the event, the Wellbeing of Future Generations Act gives organisations the opportunity to look again at their culture. It gives them the chance to look again at old processes and to question whether they’re still fit for purpose. Does the process focus on the needs of the organisation instead of the needs of the complainant?
Participation Cymru’s National Principles for Public Engagement in Wales may help organisations to think about how they might make the process focused on the complainant. They can provide prompts for useful questions. For instance, is the process effectively designed to make a difference? How do you feedback to people and how will you learn and share the lessons to improve the process of engagement?
By blogging on this, we’d really like to get some responses on social media so that we can share ideas and approaches with Jane and all interested parties to help public services improve. And by recognising that a person’s emotional response is at the centre of such complicated situations, organisations can help to ensure that they’re on the right path of public service improvement.