Managing complaints in chiropractic

Receiving a complaint is often an unexpected part of running any business, including a chiropractic practice.  No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are.  There can be a tendency to see a complaint as a personal criticism rather than constructive feedback.  However, there can be positive outcomes when the situation is managed appropriately. 

Why do people complain? 

There are many reasons why patients might complain about your practice and the treatment or service they’ve received.  Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise.  Understanding why people may complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.  The following are some of the reasons why people may feel the need to complain.

High expectations – consumer expectations are increasingly high when engaging professional services.  Your patients pay for your service and will most likely see you as a highly trained and qualified professional.  This view can influence their expectations about the service and outcomes they anticipate. 

Unrealistic expectations – it’s possible that patients may have unrealistic expectations about what they can reasonably expect from chiropractic treatment.  Their high expectations may at times surprise you.  It’s therefore important to remember that most patients will not have the clinical knowledge you do and what’s obvious or common sense to you may not be to them.  A practice must assist patients to be clear and fully informed about the treatment being provided and the outcomes they can realistically expect.  This requires ongoing discussions with patients and, where possible, written information to assist their understanding. 

To inform and be heard – patients may wish to make a complaint about an incident or poor outcome just so they are sure you and your staff are aware of what’s occurred and how they feel.  They may wish to complain simply to be listened to and acknowledged, especially if they have been adversely impacted.  Not all complaints will lead to a formal demand for compensation. 

Belief that someone is responsible – when something goes wrong we often try to determine who’s responsible.  Sometimes someone is obviously responsible, sometimes it’s hard to determine who’s responsible and other times there is no one person responsible but it’s just an unfortunate set of circumstances.  If a patient thought something had gone wrong and this led to them being harmed, it’s quite possible they may complain with the intention of holding someone responsible and possibly liable. 

The importance of managing complaints 

There may sometimes be a temptation to ignore a complaint and hope it’ll just go away.  Maybe the patient won’t follow up.  Maybe the incident won’t occur again.  This is a very short-sighted way to run any business as there are clear benefits when complaints are managed appropriately. 

  • Patients will generally expect to see their complaint dealt with quickly and fairly.  When this doesn’t happen it’s possible that further complaints will follow and the issue or concern could become a much greater one.  Complaints may also escalate to AHPRA or another regulatory body. 
  • Managing complaints should be seen as good ‘customer service’.  You rely on patients to keep your business afloat.  When patients are unhappy with a service they’ve received, they can talk with their feet by not returning to the practice.  Keeping patients happy and satisfied is more likely to see them continue to use your service and recommend your practice to others. 
  • Complaints can provide a practice with an opportunity to review and improve their service.  Receiving a complaint may highlight an issue which the practice had not been aware of.  When investigating and dealing with the complaint, the practice may wish to consider a change in a procedure to avoid that issue arising again in the future. 

How to manage complaints

It’s advisable that every chiropractic practice has a complaints policy.  This means that the practice will have an agreed-to process which allows for all complaints to be dealt with in a fair and consistent manner.  It also means staff know what to do which is important as managing complaints can be challenging.

A key aspect in dealing with any complaint is listening to the person.  Where possible, make time to sit down in a quiet space and give them time to express their concerns.  Make the effort to hear what they have to say and take on board what they have told you.  You may not agree with all they are saying, however it helps if you can try to understand the situation from their perspective.  You may wish to ask them to document their concerns so you both have an accurate record of the matter.  Avoid being defensive or taking the complaint personally as this may inflame the situation.

With low level complaints you may be able to offer a solution there and then.  However, this won’t always be the case.  With more serious complaints you should provide the person with an assurance that you’ll investigate the matter and get back to them with a response at a later date.

Guild Insurance expects those insured with us not to admit liability (or name someone else as being at fault), or to offer any compensation without contacting us first.  However, this doesn’t prevent you from apologising or showing sympathy for any pain or inconvenience the person may be experiencing.  Contact Guild Insurance on 1800 810 213 as soon as you’ve received a complaint; don’t wait till it escalates to a claim for compensation.  We will provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation.  This support can be the difference between sorting a problem quickly and it escalating to a serious claim.  

Managing complaints in Chiropractic

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    Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them    .

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    Learning from chiropractic claims

    Guild Insurance spends a significant amount of time analysing the chiropractic claims reported to us. This analysis helps us to understand what patients complain about, factors which might make some patients more likely to complain and what actions from practitioners make it challenging to defend these complaints. Following this analysis, Guild, in conjunction with the Australian Chiropractors Association, creates risk messages and learnings to share with and educate chiropractors, with the aim of reducing complaints. The following details Guild’s key learnings for the chiropractic profession based on this claims analysis.

    Record keeping

    All chiropractors would be aware of their requirement to keep detailed clinical records. Yet, unfortunately, Guild’s claims experience tells us that too many chiropractors aren’t keeping these records to the detailed level required. 

    To better understand the level of detail required, it helps to consider the reasons, beyond the regulatory requirement, for detailed records. One commonly understood reason for keeping detailed records is the defence of a complaint. When there’s been an allegation of harm or wrongdoing, the clinical records serve as evidence of what took place and why. Unfortunately, Guild’s ability to defend against these allegations becomes quite challenging when there are vital details missing from the clinical record. And a repercussion from this is that the cost of managing and settling claims can increase. 

    The other key reason for keeping detailed records, which seems to be overlooked at times, is the role they play in providing quality treatment. Without the detailed history of the patient’s presentation, assessment outcomes, treatment provided and the response to treatment, the chiropractor is relying on their memory as they provide further treatment at each consultation. Yet we know no one’s memory is perfect and these gaps in the clinical record can lead to poor clinical decision making and inappropriate treatment.

    All chiropractors should make themselves familiar with the record keeping resources available on the Ahpra website which can be found at www.ahpra.gov.au/resources/managing-health-records.

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    To understand what’s required for a patient to give their informed consent, practitioners should focus on the key word – informed. If a patient isn’t informed, they can only give their consent, and this is not enough.

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    It’s not enough to have a patient sign an informed consent form. This form, if used, is there to support the conversation, it can’t replace it.

    Communication

    Breakdowns in communication feature in almost all complaints from patients. Sometimes the patient will complain about how they were communicated with, while other times communication may not be mentioned in the complaint yet when the matter is investigated, it’s found to have been a factor. Therefore, the importance of appropriate and professional communication can’t be overlooked.

    When communicating with patients, it’s important to use language they’ll likely understand, so avoid overly clinical terms and acronyms. And don’t rely on just verbal communication, tools such as diagrams and models can assist greatly.

    When communicating with patients, be sure to keep the conversation professional and appropriate. While it’s important to form a good working relationship with your patients, there also needs to be a professional boundary. Chiropractors must ensure that topics discussed, and language used, don’t blur this boundary.

    Professional conduct

    Guild Insurance has seen an increasing trend in complaints from patients that focus less on the clinical outcome and more on how the patient viewed the professional behaviour of the practitioner. It’s becoming very clear that patients have high expectations regarding how health professionals conduct themselves and are willing to complain about this conduct.

    A new shared Code of Conduct (shared between 12 health professions) was released in 2022. Chiropractors need to be sure they’re familiar with this Code of Conduct as it details what Ahpra, and the Chiropractic Board of Australia expect regarding professional behaviour. This can be found at www.ahpra.gov.au/resources/code-of-conduct/shared-code-of-conduct.

    As mentioned earlier, maintaining professional boundaries is incredibly important. Chiropractors need to be sure their behaviour, as well as communication, maintains these boundaries. They shouldn’t become too familiar or casual with their patients or take advantage of the power imbalance between a health professional and patient.

    Clinical decision making

    Chiropractors need to be sure their decisions regarding when and how to treat are always in the best interests of their patients.

    No health professional can be the answer to every patient’s needs. It’s therefore vital to be sure you’re only treating when it’s appropriate to do so. When chiropractors see patients who should be treated by a different health professional, they need to refer that patient to someone more suitable, explaining the reasons for this to the patient. Chiropractors should also be sure they don’t allow themselves to be convinced by the patient to treat when it’s not appropriate.

    Chiropractors need to ensure that any treatment or clinical advice they provide is within their scope of practice and something they’ve been suitably trained for. While all chiropractors will develop their skills over time, this development needs to happen while keeping in line with the chiropractic scope of practice.

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