Investigating Complaints Training Session PALS & Complaints Team Sara Chaudhry & Nadine Lipscombe PALS & Complaints Manager

Your objectives

“an expression of dissatisfaction” What is a complaint? “an expression of dissatisfaction”

PALS Concern or Complaint? On the spot or quick resolution Generally less serious concerns - Requires little investigation Often a verbal response (but can also be a written response) Generally responded to by the department/ward/consultant directly

Complaint Requires investigation Generally more serious concerns Must be handled in line with the NHS Regulations Requires a written response from the CEO

NHS Complaints Regulations The aim of the NHS Complaints Regulations is to resolve issues at a local level, known as ‘Local Resolution’ To listen to, investigate and respond to complaints in full and use the findings to influence service improvement If, at the end of local resolution, the complainant remains dissatisfied they have the right to take their complaint to the Parliamentary & Health Service Ombudsman Note: As a general rule the Ombudsman will only accept a case after local resolution has been exhausted.

What do complainants want? Resolution? Retribution? Revolution? Compensation?

Why do people complain? They are angry / frightened / worried They want someone to blame…. They require an explanation – honest They want an apology They want to prevent someone else having the same experience – the Trust to learn lessons Financial gain NB The majority do NOT seek financial compensation

Francis Report (Mid Staffordshire NHS Foundation Trust) Why bother….? Recent National reports: Francis Report (Mid Staffordshire NHS Foundation Trust) Serious failings at the Trust, suffering of patients, failed to listen to complaints and concerns, failed to act on poor standards, poor leadership, unacceptable standards of care Keogh Report High levels of patient mortality identified at various hospitals, highlighted issues around Liverpool Care Pathway, concerns regarding quality of care & treatment provided – patient experience and safety . Lack of engagement with patients and staff. Imbalance around accountability & blame rather than support and improvement

Think of two instances where you Personal experiences Think of two instances where you have made a complaint One where the outcome was positive and why One where the outcome was negative and why

NHS Complaints Regulations Who may complain? Any patient, current or former, using the Trust’s services Any relative can act on behalf of existing or former patient, as long as they have the patient’s explicit consent If the patient is deceased or unable to act for themselves, in most cases consent is required from the registered next-of-kin

Dealing with complaints as a member of staff – How do complaints affect you? Can be stressful Can be emotionally draining Can be very time consuming Routine work does not get done Pressure increases Can be rewarding

The Complaints Process: Local Resolution Acknowledge within 3 working days (in line with national regulations) Action investigation within 24 hours (from PALS & Complaints to Division) Investigating Officer appointed (by Division) to investigate and complete investigation (approx 12 days) Approval of Investigation Report required with ‘sign off’ for recommendations Response sent from CEO (normally between 25-40 working days. Timeframe agreed by PALS & Complaints Staff at start of investigation)

Investigating Officer Sent allocation e-mail (appointed by Division – normally ACN/CD) Sent copy of complaint, blank investigation report (IR), any other information Medical records need to be ordered (liaise within Division to identify who is arranging this) Carry out investigation – if investigation covers more than one Division, liaise with other IO’s Complete IR, identify learning/recommendations and obtain approval for these Send IR back to Division Lead for approval Approved IR sent back to PALS & Complaints CEO letter and report checked & sent

The report/response to complaint a summary of the complaint result of investigation (including explanations of what went wrong / what is the normal process etc) an apology (if relevant) what actions will be taken, by when who is responsible for making this happen what steps have been taken to prevent the same thing happening to other people the report/response should be balanced, factual and impartial, as well as clear and easy to understand (do not become defensive) response also needs to include advice on what the complainant should do if they remain unhappy

Managing your time Ensure medical records are requested Begin to do the background work immediately on receipt of the complaint Don’t avoid it…it won’t go away……. Set up meetings with all key personnel Gather information, including statements, relevant policies, supporting documents etc Complete Investigation Report – be factual, use Layman’s terms (reflect language in complaints letter) Ensure learning/recommendations identified are discussed with and agreed with all relevant senior staff/managers

Feedback – result of a good investigation & response

What happens if the investigation and response is not adequate? Re-opened Complaints Audit carried out reviewing complaints re-opened between 01/01/12 to 31/12/12. Our Trust received 444 complaints, of which 119 (27%) were re-opened

Re-Opened Complaints

Main findings of the Audit

Examples of complainants’ issues No sincere apology No sense that the complaint had been taken seriously No process of informing the complainant that the changes had been initiated Superficial or inadequate recommendations (e.g. nurse will be spoken to, memo will be sent out to inform staff members) Lack of assurance that anything had changed or processes will be improved in future. The response did not address the concerns at all

Examples of complainants’ issues continued… The responses were standard and not personal Response answered some concerns but also contained inaccurate information. (often basic information re: name, initial diagnosis or incorrect dates) First response raised new information leading to further concerns which resulted in a second complaint. Hospitals versions of events were incorrect Basic information was incorrect Inadequate remedies being offered

Parliamentary & Health Service Ombudsman (PHSO) In 2011-12 there were 16,337 complaints received by the PHSO about NHS 7,403 of these were regarding NHS Hospitals, Specialist & Teaching Trusts In 2011-12 the PHSO received 82 contacts regarding Mid Essex Hospital Services NHS Trust (we sent 23 files to PHSO) Of these, 4 complaints accepted for investigation

Identifying recommendations/learning Root Cause Analysis (RCA) What was the root cause? (there may be more than one issue and more than one root cause) Could this have been prevented? If so, how? (i.e. new policy / review of process / staff training) Is this wider than this Department / Ward? (does this learning need to be shared Directorate wide / Trust wide?) Is there a cost implication? All recommendations must be ‘SMART’ (Specific ; Measurable ; Achievable ; Realistic ; Timely) All recommendations must be agreed and “signed off” by relevant senior staff (i.e. Lead Nurse / Head of Nursing / Clinical Director / Department Manager)

Recommendations cont… - Some recommendations may be specific to an individual complaint - Some may be due to a number of complaints about the same or similar incidents (obvious trend)

System for logging and monitoring Recommendations Approved/agreed by key senior staff Logged by Complaints & PALS Team onto Datix Database as a new “action” Lead person receives email from Datix alerting them to the new action assigned to them Lead person to update Datix on progress of recommendation Lead person to close action on Datix by deadline (6 weeks)

Practical Exercise Investigating a complaint…. Review complaint example What are the main issues and who do you need to speak to during the investigation? What information do you need to enable you to complete the investigation report?

Review of objectives Have we been able to cover all objectives during the session? Are there any outstanding questions / issues?

Sara Chaudhry & Nadine Lipscombe PALS & Complaints Managers Thank you Sara Chaudhry & Nadine Lipscombe PALS & Complaints Managers