From transformative learning to social change? Using action research to explore and im- prove informal complaints management in an NHS trust

Background: The number of complaints from patients and/or carers concerning aspects of care has increased over time. Yet, in spite of a growing body of national and international literature on healthcare complaints, there is a lack of knowledge around how nurses and midwives manage informal complaints at ward level, or staff needs in relation to this. Aim: Using an action research approach with mixed methods, four phases and four cycles, the aim was to explore informal complaints management by nurses and midwives at ward level. We discuss the action research process primarily in connection with learning and service change, drawing from the qualitative data in this paper. Findings: The analysis of the collected qualitative data resulted in three main themes, related to the complexities of complaints and complaints management, staff support needs and the existing ambiguous complaints systems, which are hard for staff and service users to negotiate. The action research approach facilitated learning and change in participants in relation to complaints management, in the collaborating trust. Conclusions: The extant body of research on complaints does not sufficiently recognise the complexity of complaints and informal complaints management, or the complaints systems that are in place. Needs-based staff training can help support staff to manage informal complaints more effectively. Implications for practice: • There needs to be recognition of the complexities involved in complaints management • Complaints systems need to be clearer for the benefit of service users and staff • Staff need training and support that is tailored to their needs to improve their response to complaints, leading to a better patient experience • Limited interventions, informed by staff needs, can lead to change and act as a catalyst for a wider change in informal complaints management