Managing Complaints Using Complaints to Improve the Patient Experience Nick Nurden – The Ridge Medical Practice

Introduction Hearing the Patient Voice is important to help us improve Recognising the value of Complaints Influencing quality Improvement What culture does your directorate have Supporting your staff Complaints We all find them a bit of a bind, they take a lot of time to deal with, and very often we find that we have done little if anything wrong – except perhaps failed to manage expectations, or communicate effectively with the patient! Depending on the size of your organisation you may also not really come into much contact with the process of dealing with complaints – you will have a system and process in place. This session does not plan to look at those aspects – CMG run a whole day conference most years to look at. What I want to look at today is the following: Firstly , how can we capture from the complaints an aspect of patient feedback we would not otherwise do – and how can we distil this to make meaningful improvements for those in our care Secondly, ensuring that we value the complaints that we get and how we handle them – this is where I start to talk about organisational culture and how this will affect our ability to learn. Then – taking this information how can we use it to influence change in our organisation. Finally we will again look at the culture of your organisation and how you value your nursing team as this is crucial to any change

6 principles of complaint handling Getting it right in the first place Being customer focused Being open & accountable Acting fairly and proportionately Putting things right Seeing continuous improvement

Root causes of complaints Administrative mistakes Poor customer service Poor communication between clinician and Patient Lack of connection with the patient Misdiagnosis or wrong treatment Failure to have 20-20 hindsight

Capturing the Feedback Always keen to improve the patient experience Number of sources of feedback available Survey Direct patient feedback Thank you letters Family feedback Staff feedback Complaints Complaints is a potentially rich source of feedback

Encourage Feedback Make complaints an integral part of the feedback mechanism Work hard to encourage positive feedback regularly Make sure that success is regularly celebrated in your organisation Make sure that this comes from “the top” Set this off against the complaints – it is far less negative

Organisational Culture Is the general approach to complaints A blame culture that seeks to find scapegoats and excuses and sees complaints as a chore A learning culture that seeks to support staff in helping the organisation to learn and improve, Here is our starter for ten on top tips for successful co-production (there are lots of others!): Remember, we can’t get it right without the people who use our services. Think about who to involve and invite them to take part as early as possibly in the process. Before you start, think about how you are going to work together and what will make it a success. For example, set up briefing calls, explain terminology and be sensitive to the perspectives and difficult experiences that people might bring. Work together to identify a clear purpose. Start small and build up to more ambitious projects – hand over the reins and let others lead (not just professionals). This can feel risky at first but if carefully planned can provide much better results. People like to share their experiences of care and service improvement, so allow time for this. Cut out the jargon and don’t use TLAs (three letter abbreviations) or any acronyms. Think about the practicalities such as lots of notice for meetings, accessibility, user-friendly venues, travel arrangements and costs etc. Many co-production members have carer responsibilities. The time they take out in reading papers, contributing to meetings and events can sometimes add day-to-day pressures for them. And finally – provide feedback! People put a lot of time and effort into getting involved – they want to know what difference their contribution is making.

Developing an open culture Avoid a blame culture – it disengages the workforce and will lead to cover ups Staff must be accountable for their actions, but no one set out to come to work today to make a mistake Need to understand the underlying causes for the behaviour that leads to complaints This forms part of the accepted behaviours in your organisation

Local Complaints Processes How and where are complaints managed in your organisation? From “on high” Locally within departments Encourage local ownership Local departments investigate and respond to the complaint With help and support from the complaints “department” Have efficient systems in place

Accountability & Ownership Individual departments should own their own complaints Support with the process and the learning facilitated by the specialists This will help increase learning from the process and help to change behaviour This makes it clear that accountability for behaviour lies with everyone

Creating Frontline Resolutions Better for the operational team to deal with and respond Encourage direct contact between the frontline team and the complainant Will help learning and reflection Has better impact on the patient

Organisational Challenges Ongoing Board Challenges Resource/Money Workforce Doing “More for Less” Keeping the regulator happy You are caught in the middle Have board responsibilities Want to be seen as champion of your Nurses

Stress for staff complained about Most staff are very conscientious and get distressed about complaints against them (whether reasonable or unreasonable) Staff may over react initially to a complaint against them May lead to competent or excellent staff questioning their own capability Could adversely affect their working life whilst the situation is resolved

Support Mechanism for Staff Complaints are stressful for staff They worry about the implications of their actions They worry about the security of their jobs Make sure the process doesn't make this worse Have in place a system that supports staff When required this needs to be robust – including counselling support where applicable

Staff wellbeing will aid learning Staff welfare process embedded in the culture of the organisation Need management awareness of what is happening on a daily basis Simple established responsive mechanism in place for immediate needs Ongoing periodic review of processes

Support staff in addressing complaints Ensure that communication with them is effective Timely Detailed Supportive Using the chain of command where appropriate Guide them through the process of responding Flag up to others any signs of stress

How can we maximise the learning Have developed the right culture The staff know you will support them Be their champion at the board Be visible to them regularly Stick up for them when the organisation lets them down Take opportunities to really learn – get beyond a defensive reaction Build a planned proactive quality improvement programme

Co-Production Co-production is a way of working – its about equal partnerships. Services and organisations working together with patients, carers, families and service users to co-design care & support Recognise the vital contribution of people and communities to shape services People like to share their experiences – allow plenty of time for this

What is great about co-production Services will improve as we focus on using lived experience rather than just data Everyone is equal You are likely to see new perspectives that you may not have expected It can be fun & the outcomes are meaningful It’s a positive way to live out the values of a care organisation Built on the principle that people using the service are best placed to design & improve it

Experienced based co-design Gathering experiences from patients and staff (interviews, observations, group discussion) and assigning positive and negative feelings Create a short edited film of the material Show this to staff and patients conveying how patients experience the service - storytelling Work together in small groups to find ways of improving the service or care pathway Focus is on staff and patient experience and emotions rather than attitude or opinion

Reflecting & Learning Key aspect of complaints management Look for common themes in the complaints Facilitate the right forums for this to occur Encourage learning and sharing Need time to reflect and learn Have structure and support in place Make sure any learning is implemented Needs time!

Summary Let us embrace complaints and their potential in an environment of learning from feedback Have in place the right culture that will promote learning Involve the patient – listen in detail to the patient experience Use that to influence changes to care pathways