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Working in patient relations for more than 13 years, Dr. Amie Liddle, MN’05, PhD’20, has spoken to thousands of patients and their families to resolve concerns about disappointing health-care experiences.

“Sadly, I also engaged with countless people who remained unsatisfied despite all efforts to resolve their concerns,” she says. “These complainants become labeled as difficult, frivolous and vexatious.”

Liddle was challenged by the labels and applied the term querulous to describe the behaviour of complainants who did not benefit from generalized complaint management processes and cannot reach resolution. “This term does not specifically label any one characteristic of an individual; it allows for the consideration of a multiplicity of behaviours and actions,” Liddle explains.

Passionate about concerns management and driven to understand those who could not achieve resolution, Liddle decided to explore, using a hermeneutic inquiry method, nurses’ experiences managing querulous complaints. Hermeneutics is an interpretive research method that is focused on understanding rather than explanation. Liddle found that, in the efforts to resolve concerns, there is a significant misuse of resources and more importantly emotional distress to the heath-care staff attempting the resolution.

"A unique management process is necessary, not your standard approach,” says Liddle. “Health care tends to rationalize abusive behaviours in the context of a person’s health and the stresses associated. Unfortunately, accepting aggressive behaviour has been normalized as the standard when managing querulous complaints."

Liddle’s supervisor, Dr. Nancy Moules, PhD, says research of this type addresses both patients’ grievances and the impact of working with them for health-care professionals.

Amie’s research is a critical examination of the complexity of the relationships between people who experience something that they deeply believe requires attention and resolution and the health team.

“Understanding what underlies such grievances and knowing how to navigate them is an artful and often difficult skill," says Moules.

Now more than ever, the importance of bringing forward concerns about the provision of health care must be acknowledged. Going forward, Liddle believes her results create a platform for further research related to managing health-care complaints.  

“Understanding querulous complainants, early identification, implementation of strategies and processes to effectively support staff will institute a professional standard that will reduce abuse and misuse of resources. It will also provide a fair and concise approach to concerns management.”

Liddle will continue as provincial director of patient relations for AHS doing the work she loves — supporting patients and families — but says the current pandemic has drawn heightened attention to the ways the public relies on health services.

"In order to meet the demand for education related to managing complaints across Canada, I am in the final development phase to bring an online platform for complaints management education to health-care providers. I have also engaged with Innovate Calgary to bring forward the Querulous Complaint Assessment Instrument that was designed to pre-identify querulous complainants in health and non-health organizations."  

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