2.  Gloria Clark, Patients Association Project Manager  Tanya Tofts, University Hospitals Bristol Patient Support and Complaints Manager  Paul Cresswell, North Bristol Associate Director of Quality Governance

3.  Long established, independent charity–51 years  Non-disease specific  Our motto.... ‘listening to patients, speaking up for change’

4. How the Patients Association listens to patients, finds solutions and speaks up for change National independent, non-disease specific health and social care campaigning charity working nationally and locally to improve experience of care: Help influence service improvement Working with patients, families, carers, public and staff Spreading good practice Our independence is very important

5. “A complaints system that does not respond flexibly, promptly and effectively to the justifiable concerns of complainants not only allows unacceptable practice to persist, it aggravates the grievance and suffering of the patient and those associated with the complaint, and undermines the public’s trust in the service.” (Sir Robert Francis QC, 2013) Quote from Sir Robert Francis QC

6. Pilgrim Projects Speaking Up Project 2011-2013

7. Complainants truly listened to, and understood, emphasis would not be upon robust adjudication: it would be on a) Understanding what went wrong b) Understanding how it went wrong c) Understanding why it went wrong d) MOST IMPORTANTLY e) Learning how to avoid the same thing happening again and sharing the learning throughout the NHS

8.  A recent patient complaint

9.  Complaints are like gold dust  Listen and encourage  Identify direct links to safety breaches  Recognise areas of concern and risk to patients in all complaints  Link, learn and take action to prevent further mistakes.

10.  Good practice standards  Complaints survey  Peer review  Staff training  Digital stories  Complaints Board Game  Tools for CQC inspections and CQUINs  Projects to talk to patients 

11.  Standard 1: The Complainant has single point of contact and is placed at centre of process.  Standard 2: The complaint undergoes initial assessment and any necessary immediate action taken. A lead investigator is identified.  Standard 3: Investigations are thorough, obtain independent evidence/opinion, in accordance with local procedures, national guidance and within legal frameworks. Copies available today or on our website - The Patient Association Good Practice Standards in Complaints Handling

12.  Standard 4: The investigator reviews, organises and evaluates the investigative findings.  Standard 5: The judgement reached by the decision maker is transparent, reasonable and based on the evidence available.  Standard 6: The complaint documentation is accurate and complete.  Standard 7: Both the complainant and those complained about are responded to adequately.  Standard 8: The investigation of the complaint is complete, impartial and fair.

13. Standard 9: The organisation records, analyses and reports complaints information throughout the organisation and to external audiences. Standard 10: Learning lessons from complaints occurs throughout the organisation. Standard 11: Governance arrangements regarding complaints handling are robust Standard 12: Individuals assigned to play a part in a complaint investigation have the necessary competencies.

14.  Panel members –patients, clinicians, complaints managers, expert lay members  Low, medium and high categories  5-10 case files per organisation  Use of score card against standards  Highlight good and poor practice  Report with action plan  Support with implementation  Improvements seen and positive feedback

15.  Questionnaire about the quality of the complaints process after complaint closed  Developed with patients and staff  Partnership with NHS Benchmarking  Value in being independent  Offered to all NHS trusts  Web based toolkit  www.nhsbenchmarking.nhs.uk www.nhsbenchmarking.nhs.uk

16. Complaints survey – on line toolkit  Monthly and quarterly results- Trust see own results  Chart shows total of all results for Q3 (Sept to Dec 2014)  52% consider complaint not resolved although only sent to closed cases

17. UH Bristol NHS Foundation Trust 2014  Nine hospitals in central and south Bristol – acute, community and specialist services  1,600 formal complaints per year  Seeking improvements in service quality and complaints handling, through hearing from patients Independent qualitative work with people who have complained by the PA

18.  Method: random selection of people who complained in previous six months – 18 participants in focus groups and depth interviews  Reasons for complaining  Motivations  Experience  Suggestions for change

19. Motivations ‘ The reason I complained was that I don’t want others to go through that too’

20. Patient Accessibility You will listen and understand Investigation You will look into my complaint thoroughly and honestly Accountability You will respond positively

21. Recommendations  Maintain good practice  Accessibility: welcome concerns; explore and offer options for handling  Investigation: develop timeliness and independent rigour, especially complex cases  Accountability: action plans, communication, ensuring the whole organisation uses complaints to improve service delivery

22. Outcomes  Feedback to staff to develop understanding of patient perspective  Increased numbers in complaints team to ensure initial contact and patient focus  Investigation: develop processes especially for complex cases  Accountability: renewed focus on action plans, communicated to person who complained and to other patients  Continued commitment to using complaints to guide patient service improvements  Feedback to participants

23. North Bristol NHS Trust 2015  1 million population – acute, community and specialist services  Site move to combine Frenchay and Southmead  1,200 formal complaints  Complaint delays and inconsistencies  Lack of formal training (<20%) Initiative to improve complaints handling – including Patients Association training

24. ‘The Art and Science of handling concerns and complaints’  Three one day courses  74 participants – variety complaint handling roles  Hearts and Minds  Interactive with case studies  Stages of complaint resolution: ◦ Accessibility - putting the patient at the centre ◦ Investigation – full and fair using the PA standards ◦ Positive response – accountability, learning, action

25. Outcomes Skills Tools and Policy

26. Built staff interest, skills and confidence  ‘Excellent course, very useful’  ‘Breathed new life into complaints and resolutions processes’  I have learnt come useful tips, I will approach my next complaint differently’

28. Developed policies, processes and toolkit  New lines of responsibility  Common process  Triage system for risk and timescales  Acting on concerns; early phone call to patient  Resolution meetings  More to do: further skills training, e.g. in developing investigation skills

29.  To be listened to and treated with genuine care and good communication  To be able to comment, raise concerns or complain without fear  To have their complaint fully and fairly explored  That staff hear what is being said and act upon it – to improve service and safety

30.  Any questions?  Feedback on:  How do organisations learn from complaints to increase safety?  How could organisations learn from complaints to increase safety?

31. Contact details gloria@patients-association.com Paul.Cresswell@nbt.nhs.uk Tanya.Tofts@UHBristol.nhs.ukk www.patients-association.com