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Planning systemic investigations
Tom Morgan and Emer Doyle
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Systemic investigations – a general overview
Tom Morgan Senior Investigator Office of the Ombudsman
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How do we unearth systemic issues?
Training caseworkers to be alert to issues Trends from Complaint Examination System (CES) Close monitoring by Heads of Units Sectoral leads – “scanning the horizon”, Dáil and Committee debates, newspapers, specialist publications, NGOs, other regulatory bodies Quality Assessment audits “Own initiative” powers
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Deciding whether to investigate or not
Is it likely to impact on a large number of people, complainants and non-complainants? What is the likely scale of the adverse affect? Can the Ombudsman make a meaningful impact? Are there other sources that could potentially resolve the matter? Resource requirements
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Deciding whether to investigate or not
Is the matter attracting a lot of public attention? Is there any urgency about the matter which requires a quick intervention? The timing may be right Reputation – think about it – don’t bite off more than you can chew!
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How do systemic difficulties arise?
Periods of austerity leading to inflexible administration and fettering of discretion New organisations / units not properly prepared to administer the tasks Local delivery of central policy/schemes – inconsistency, incorrect interpretations Transfer of local delivery to centralised delivery Lack of communication between different service providers
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Previous investigations / systemic issues
“A Good Death” – end of life care Thematic “look back” High impact but low level resource Importance of launch and design
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Previous investigations / systemic issues
Local Authority loans – one case – widespread impact Long Term Illness Care investigation – localised administration – countrywide solution Social Work investigation – a partial “look back” – timing – High Court judgment JR Student Universal Support Ireland (SUSI) – widespread adverse affect Treatment Abroad Scheme – centralised administration – serious adverse affect Homelessness
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Learning to Get Better – a practical example
Emer Doyle Investigator Office of the Ombudsman
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into how public hospitals handle complaints
Learning to Get Better An investigation by the Ombudsman into how public hospitals handle complaints
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This investigation looked at
How well the HSE and public hospitals listen to feedback and concerns Whether the HSE and public hospitals are learning from complaints to improve services
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Why investigate? Despite the high number of interactions with public hospitals, relatively few complain to this Office about the service received 20% of complaints to this Office are about the health service (including public hospitals) – over 60% in Northern Ireland We wanted to find out why this was and We wanted to make sure that the complaints system available was effective
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This report A constructive report
We wanted to highlight good practice in complaint handling where it exists Bright spots so hospitals can learn from each other
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Methodology An “own initiative” investigation
Three strands - involved reaching out to members of the public including focus groups Surveyed all public hospitals on their complaints processes and visited 8 hospitals across the country for a more in-depth look at their processes Engaged with a wide range of stakeholders including advocacy groups, regulators and representative organisations
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Engagement with public
Investigation announced in June 2014 Public invited to make submissions using specially designed form Freepost address Also set up designated address – Just over 30% used form to make submission Majority of submissions (57%) were from relatives and/or carers
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Engagement with public
All submissions were responded to – some were set up as valid complaints with consent 16 people were chosen to take part in focus groups (run by outside company following a tendering process) Two focus groups held – one in the afternoon and one in the evening
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Engagement with public
Participants in focus groups included those who had considered making a complaint to the hospital but did not made a complaint informally to the hospital made a complaint to the hospital Complaints Officer but did not pursue the matter further after that made a complaint to the hospital Complaints Officer and subsequently requested a review of the matter from either the HSE or this Office
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Engagement with hospitals / HSE
Issued a survey to all public hospitals re: complaints processes and level of signposting 100% response although some needed reminding! Asked to supply examples of patient information booklets, posters, etc.
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Engagement with hospitals / HSE
Chose 8 hospitals to visit – at least one from each hospital group including a maternity hospital and a mental health facility. Asked them to complete a more detailed survey prior to our visit. Spent one day in each of the hospitals meeting senior management, Complaints Officers and frontline staff and walking around hospital Randomly selected 6 hospital complaint files from each hospital for examination
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Engagement with hospitals / HSE
Met with Senior Management from the HSE including Acute Hospitals Division and the Quality and Patient Safety Division Met with senior officials from the Department of Health
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Engagement with others
Issued a survey to a wide range of advocacy groups via SurveyMonkey. Wrote to representative organisations and medical / nursing schools looking for their views on the complaints process. Met with health sector regulator (HIQA) and main professional regulators (Medical Council and Nursing and Midwifery Board).
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Resources Staff – 3 person investigation team
Lead investigator – average 75% of time Caseworker – average 35% of time Retired staff member – 25 days
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Resources Freepost address Focus groups
Costs associated with launch, including printing of report and short film.
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Short film: experiences when making complaints
/Investigation-Reports/Health-Service- Executive/Learning-to-Get-Better/Short-film- about-making-complaints.html
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