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

2. 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

3. 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

4. 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 hindsight

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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!

22. 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