Healthcare complaints in a pressured health system: why the first response matters
New Zealand’s healthcare sector continues to operate under considerable pressure, with workforce shortages, capacity constraints and increasing demand challenging providers across the motu.
Against that backdrop, Health and Disability Commissioner Morag McDowell and Simone Tune, a medico-legal specialist at Duncan Cotterill, discussed at the firm’s June 2026 healthcare conference how health providers should respond when care does not go as expected in order to manage complaints effectively and maintain trust with patients and whānau.
The discussion highlighted a simple but important point: effective complaint handling should be viewed as part of good care, rather than simply a regulatory or administrative process.
Complaints are often about more than clinical care
Communication issues feature in a significant proportion of complaints to the Health and Disability Commissioner, with around 60% raising communication concerns alongside issues relating to clinical care.
At Duncan Cotterill, we increasingly assist healthcare providers at an earlier stage, when concerns are first raised and before they develop into formal complaints, investigations or regulatory scrutiny. We also continue to support providers once matters have escalated. At that point, the focus is often no longer solely on the underlying clinical issue. Questions are also asked about how the provider responded after concerns were raised, whether communication was adequate, and whether appropriate steps were taken to investigate the event and learn from it.
This underscores an important point: the way concerns are addressed after an event can be just as important as the event itself. Done well, complaint handling can help preserve relationships, identify opportunities for improvement and reduce the risk of concerns becoming more adversarial.
The discussion with the Commissioner reinforced the value of addressing concerns early, before positions become entrenched and trust begins to erode. That, in turn, requires organisations to have robust internal complaint processes in place. Clear escalation pathways, timely investigation procedures and staff who are trained to recognise and respond appropriately to concerns can all play an important role in resolving issues constructively and supporting ongoing quality improvement.
What complainants are often looking for
Many complainants are seeking an acknowledgement of their concerns, an explanation of what happened and reassurance that lessons have been learned.
One of the strongest motivations behind a complaint is the desire to ensure that no one else goes through the same experience. That’s why quality improvement and evidence of change are so important in responding well.
Importantly, formally responding to a complaint does not generally require lengthy or legalistic correspondence. Clear communication, genuine engagement and plain language are often more effective.
Many complainants are not primarily motivated by compensation or punishment. Rather, they want to understand what happened, know that their concerns have been heard, and be reassured that steps have been taken to reduce the risk of the same thing happening again.
Open disclosure helps preserve trust
Open disclosure means being transparent with patients when something has gone wrong and explaining what it means for their care and next steps. This allows them to make informed decisions, including accessing support or entitlements such as ACC for a treatment injury. An appropriate apology can also go a long way towards acknowledging the patient’s experience and preventing a complaint from escalating. In New Zealand, concerns about civil liability should not generally prevent a provider from offering an appropriate apology, particularly given the limited scope for civil claims for compensatory damages arising from personal injury covered by ACC.
By contrast, if an adverse event is not disclosed and the patient later discovers it, trust in both the provider and the wider health system can be seriously undermined.
In some cases, what is needed is not simply a written response but a genuine opportunity for patients, whānau and providers to speak directly. As discussed during the conference, restorative and tikanga-based approaches can sometimes achieve outcomes that formal correspondence cannot, particularly where trust has been damaged and relationships need to be rebuilt.
From a risk management perspective, providers should ensure staff are equipped to have these conversations confidently and appropriately. The quality of those early interactions can significantly influence how a matter progresses.
A good internal review can make a difference
Providers can be understandably cautious about internal investigations and adverse-event reviews, particularly where a review identifies shortcomings.
However, a thoughtful review can demonstrate that the provider has taken the event seriously, established what happened and introduced appropriate improvements. The Commissioner noted that, depending on the circumstances, a well-conducted adverse-event review may assist HDC in concluding that appropriate steps have been taken and that further intervention is unnecessary.
The focus should be on learning rather than producing a document merely to defend a position.
While the appropriate approach will depend on the circumstances, effective adverse-event reviews commonly:
- identify the issues that have been raised
- involve the right people in the review process
- consider both individual and wider systems factors where relevant
- reach evidence-based conclusions
- identify practical improvement actions
- record how those actions will be implemented and monitored
Maintaining good care under pressure
During the discussion, the Commissioner acknowledged the significant pressures currently facing the health sector. Workforce shortages, increasing demand and resource constraints form part of the context in which care is delivered. However, the Commissioner was clear that those pressures do not diminish the importance of communication, informed consent or responding appropriately when concerns are raised.
Workforce and infrastructure pressures form part of the context HDC considers when dealing with a complaint. However, pressure can also cause the very safeguards that protect patients and providers to fall away.
Conversations become shorter. Documentation is deferred. Complaint responses are delayed. Informed consent becomes a form to complete rather than an ongoing conversation. In fact, as highlighted during the discussion, informed consent remains a recurring theme in complaints received by HDC.
Despite being a fundamental aspect of clinical practice, concerns continue to arise where patients believe they were not provided with sufficient information about treatment options, risks, potential outcomes or alternatives. The Commissioner emphasised that consent is not a one-off exercise or tick-box process. It needs to be modelled by senior clinicians and reinforced through practical training.
Policies are important, but a policy sitting on an intranet will not by itself create consistent practice. Providers should ensure their staff understand how the policy applies in real situations, including when services are busy, patients have additional communication needs, or there is uncertainty about capacity and decision-making. This requires practical training, not simply written policies.
Five questions for health providers
As services continue to work under pressure, leadership teams may find it useful to ask:
- Is our complaints process easy for patients and whānau to understand and use?
- Are staff equipped to hold difficult conversations following an adverse event?
- Do our responses address the person’s actual concerns, in plain language?
- When did we last test our informed-consent practices, rather than simply review the policy?
- Could we demonstrate that learning from complaints has led to meaningful change?
Complaints as an opportunity
While complaints are often stressful for those involved, they can also be a valuable source of insight. Organisations that approach complaints with curiosity and a genuine willingness to learn are often better placed to strengthen care, improve patient experience and maintain trust. Importantly, patients and whānau are often more reassured when they can see that their concerns have led to reflection, improvement and meaningful change.
When something goes wrong, responding early, listening carefully and communicating openly can help preserve trust, even when the outcome itself cannot be changed.
Disclaimer: The content of this article is general in nature and not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose.
