22 January 2014

Feedback, concerns and complaints: designing good togetherPatient Experience conference

Dame Julie Mellor, Parliamentary and Health Service Ombudsman

Staff experience and patient experience

• Actively engaging staff results in better outcomes for patients

• Patient satisfaction significantly higher in trusts with higher levels of employee engagement.

Source: Michael A West and Jeremy F Dawson, ‘Employee engagement and NHS performance’ (2012)

Action Area 2

• The NHS provides great care, but when something goes wrong, how it is dealt with is important

• This determines whether the individual receives justice and whether the organisation learns.

Action Area 2:

• Treating patients’ with dignity, empathy and respect

• Listening to patient feedback and acting on it.

This presentation is about

• What is your experience of dealing with concerns and complaints

• What is experience of patients when they receive poor care and express concerns and complaints

• What can you do and what can your board do

• What can we do to support you.

The case of Mrs L

Small things can make a difference:

Mrs L:

•Hospital staff did not contact her son to tell him she was there

•Nurses not compassionate and sensitive to her needs

Our recommendation:

•Trust give full and sincere apology

•Learn lessons with action plan

The case of Ms D

• During pregnancy, she told GP her bump was smaller than at 34-week check

• GP dismissed her concerns

• Distress that baby not given every chance to survive

• Resulted in learning:

GP practice told us what they had learned

Developed actions to avoid repeat

What is the problem?

The problem:

•The ‘toxic cocktail’

•This matters because: complaints are not addressed and opportunities to learn and improve services are lost

Reasons for defensive response by staff

1. Do not have the authority or resources to resolve complaints

2. They are on their own when dealing with a complaint

3. Fear of disciplinary action, blame and consequences

4. Perception of disloyalty to team or the organisation by listening to/addressing a patient’s concerns

5. Frightened by patient/carer/family behaviour and/or accusations

Reasons for reluctance to raise concerns and complain

64% of those that do

complain say it doesn’t make a

difference

54% of those who want to

complain don’t do so

26% do not want to be

seen as ‘troublemaker

’

11% feared adverse effect on their care

‘The NHS aspires to put patients at the heart of everything it

does’.

The NHS Constitution

When things go wrong

People want:

•a decent explanation

•any mistakes/failures to be acknowledged

•an apology, which is meaningful

•action to follow to prevent same happening to others

Action Area 2 and concerns and complaints

So what can be done to deliver Action Area 2 in the area of concerns and complaints?

On the ward and other service settings

• Addressing concerns and resolving problems on the ward

• On the frontline – patients’ primary contact point

• Putting things right immediately would help to reduce formal complaints

• Staff need training to deal with complaints

• and to know process for complaint handling.

By the board

• Need to lead culture change

• ‘Who’s fault is it?’ to ‘how can we learn and improve’?

• Should ask questions about trends/themes, not just number of complaints

• Nurses and other healthcare workers cannot deliver the right care if Boards are not leading the way.

How can we help?

• Taking on more investigations – more feedback and learning

• Working with Department of Health and HealthWatch England on patient-led vision and expectations for complaints handling in the NHS

• Working with boards through Foundation Trust Network and NHS Trust Development Authority

What other support would you like from us and your boards?

• How else could we support you?

• How could your board support you in your role?