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From the VCMS mediations it was clear to see that the impact of Covid-19 and restrictions continued to exacerbate complaint situations throughout 2021. The restrictions themselves were rarely the cause of the complaint; as outlined by Nockolds Resolution in their latest annual report, the ‘Covid Impact’ was as much around societal tensions, team fatigue and unfortunately encouraged earlier escalation and entrenched positions, with an ‘all or nothing’ mindsets that lead to:
- Dismissal of other person’s perspective
- Mistrust
- Unwillingness to see the ‘human’ impact of an escalating complaint on the others involved.
The VCMS also saw an increase in referrals of situations which escalated and became increasingly contentious because of the timescales in complaint responses by stretched practice teams. Wider Covid pressures also made complaint handling at a local level more complex – furloughed staff, team shift rotations and the fatigue within the practice team all compounded the complaint process. The impact, however, is an escalating complaint which may have been resolved far earlier and with less tension for all concerned. The balance comes in deciding how much time practices can invest in dealing swiftly with grumbles or misunderstandings to avoid the time and emotional cost of situations where they escalate into concerns.
While mediations have been more challenging, it continues to be a very effective approach, particularly where acknowledging and exploring the basis of differing views and beliefs are key aspects of the complaint. Indeed there is a resolution rate of +80% in diagnostic complaints and communication/consent issues (which are the top 5 most frequent complaint issues referred to the VCMS).
Another reason that mediations have been more challenging has been the financial pressures on practices and clients. Although more than 55% of resolutions are non-financial, the VCMS did see a decrease in the average goodwill gestures agreed in resolutions and average fee payments made by animal owners from £ in 201-20 to £ in 2020-21.
The increased reliance and focus on online interactions (which was present before the pandemic, but is now much greater) coupled with societal tensions and reduced access to the practice team, have all contributed to a greater prominence and impact of social media and online reviews. While some clients may be frustrated that they have not been able to speak to someone in the practice, others will take this route before, during or after the complaint discussion with the practice, and can include personal and unjustified criticism. Mediation is a confidential process, and the parties sign an Agreement to Mediate which confirms they will abide by this during the course of the mediation. We have also seen mediations achieving a client’s agreement to remove or rectify an unreasonable or unfair social media/online review as part of the resolution. There can be learnings for a practice around why a client took that route initially, but it is also recognised that unfair and unwarranted online reviews are not unique to veterinary practices, and this is the modus operandi for some consumers. A practice strategy for managing these situations and supporting the practice staff are now fundamentally important to protect the reputation of the practice and the wellbeing of the team.
Reflected in the data, the VCMS has identified how the most common scenarios referred to the VCMS ahead of the summer were:
- The client believing that the practice did not undertake sufficient diagnostic assessments
- The client believing the practice made an incorrect diagnosis
- Communication and explanations around consent and treatment decisions
- Unexpected outcomes and complications.
Evidently, the difficulty of vet and pet owners meeting to discuss owner worries or dissatisfaction early has contributed to complaints escalating earlier and a greater number of clients contacting the VCMS to assist with their complaint.
Looking more closely at the nature of such complaints, there appears to be a theme linked to the owner’s engagement in decision making, and preparedness for unexpected or less favourable outcomes. This can also include the appreciation or awareness of a range of available options, particularly when this element of the consultation took place at a distance or not face to face. This can arise in complaints where the owner believes they did not consent to all the veterinary care administered, and were not fully aware of the likely cost. Mediation has been particularly effective where there is a disparity of understanding and recollection.
In both cases, the challenges around effective communication do not help. Clients may feel they have to refer their complaint as they are unable to speak to someone in the practice or obtain a detailed response in the timescale they expect. Of course, as an impartial third-party service, the VCMS recognises that misunderstanding occurs between two parties and can escalate no matter how hard either party works to diffuse the frustrations and focus on how the complaint can be resolved locally or in the most effective way. The VCMS approach the complaint in a non-adversarial way which is both fair and transparent, and mediation can start to bring down those barriers. This a two-way approach as there are, of course, instances where one party may not have clearly expressed the options or their views as clearly as they recall, and this contributes or triggers the breakdown in communication.
Building into the consultation
- Check-ins to give the client a chance to open up about particular worries or the opportunity to identify any misunderstanding
- Stand in their shoes – what will the client be worried about, what should the client be prepared for?
- Don’t brush over those ‘amber warnings’ – if something hints that the client has not fully appreciated the position, or the response seems ‘surprising’ then explore it
- Assumptions don’t save time in the end! Ask questions, check understanding even if you think the owner has the knowledge or understanding from their own experience
- Annotate the consent form with any specific issues discussed or decisions made by the client (ie not opting for additional tests, where a range of options were given), and consider providing the client with a copy. If it’s not an emergency situation, can the consent discussion take place a day or so prior to the admission so the client can take it away and digest.
- Discharge appointments are critical – they may be busy parts of the day, but think of how owners can be prepared and provided with more information in advance or to take away. What can you provide online via hidden links on your website?
With this in mind, it is worth reflecting on how we can apply the motto, ‘prevention is better than cure’ to complaints as well as animal care. Where we can make the time early on when first becoming aware of potential issues, it will often save the disproportionate amount of time needed to address an escalating complaint in the long term, and may also re-affirm the relationship with the client.
