Why affiliation matters: A conversation analysis of complaints calls to the NHS

Bethan Benwell, Maria Erofeeva, Catrin S Rhys

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Callers making a complaint share their negative experience in complaint narratives that make relevant affiliation from an operator. We examined how call handlers' language choices affect both the progress of the call and the stance of the caller. We identified episodes where affiliation is displayed or noticeably absent in a dataset of 95 complaints calls to the NHS. Two single cases were closely examined using conversation analysis. Affiliation at sequentially relevant moments in conversation helps progress the call and de-escalate the complaint while the absence or misplacement of affiliation may lead to escalation. The latter recurringly involves blaming whilst de-escalation includes practices that diffuse blame. Early intervention in the form of affiliation to the 'hurt' component and the reasoning of the complaint is essential to de-escalation. Our analysis revealed three key functions of affiliation in complaints calls: 1) ratifying the reasonableness of the complaint; 2) progressing the institutional requirements of the call; 3) de-escalating the complaint. Call handlers should listen for callers' cues for legitimization of the complainability of their concerns and seek to provide responses that express affiliation. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.]
Original languageEnglish
Article number108077
Pages (from-to)1-11
Number of pages11
JournalPatient education and counseling
Early online date21 Nov 2023
Publication statusPublished online - 21 Nov 2023

Bibliographical note

Funding Information:
This work was supported by the UK National Institute for Health and Care Research [NIHR 127367 ].

Publisher Copyright:
© 2023 The Authors


  • Complaints calls
  • Healthcare
  • Conversation Analysis


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