NHS Ayrshire and Arran. Annual Report on Feedback, Comments, Concerns and Complaints ( )

Transcription

1 NHS Ayrshire and Arran Annual Report on Feedback, Comments, Concerns and Complaints ( ) Version no: 1 Prepared by: Professor Craig White and Andrew Moore, Executive Nurse Directorate Effective from: 11 th July 2013 Review date: June 2014 Lead reviewer: Professor Fiona McQueen, Executive Nurse Director Dissemination arrangements: Internal and External

2 INDEX PAGE 1.0 Introduction Summary of formal complaints data Summary of feedback (comments/concerns) data Listening, learning and responding Priorities for

3 1.0 Introduction The purpose of this report is to present an overview of Feedback, Comments, Concerns and Complaints ( ) received during financial year 01 April March 2013 and to ensure that people who use NHS Ayrshire and Arran services can see what action is being taken to improve the patient experience and empower staff and patients to contribute to this. NHS Ayrshire and Arran is committed to delivering person centred care and the requirements of the the Patients Right (Scotland) Act 2011 by ensuring feedback structures and processes are: encouraging, welcoming and viewing feedback as opportunities for ensuring the NHS provides person centred care promoting learning and improvement from all forms of feedback received credible, independent, transparent and easy to use for members of the public and staff effective, fair and consistently applied well publicised and accessible to all and that information is available in other formats where this is appropriate ensuring that everyone, regardless of their race, age, religion, sexual orientation, gender or any disability or sensory impairment, has the support they need in order to access the services providing staff with the training and support to consistently display sensitivity and understanding to everyone who uses the NHS and in particular to understand that people may feel vulnerable and stressed empowering staff to listen to and act upon and resolve feedback, comments, concerns and complaints given NHS Ayrshire and Arran is also taking forward a number of actions to support progress toward an improved and more person centred approach to receiving concerns, complaints and handling feedback. 2

4 2.0 Summary of complaints data formal complaints were recorded during 2012/2013, compared with 472 for the previous year, an increase of 71 (13%). 2.2 The percentage of complaints acknowledged within 3 working days for 2012/2013 was 88% compared with 90% the previous year. 2.3 The percentage of complaints responded to within 20 working days was 59% for 2012/13 compared with 58% for the previous year. This demonstrates 1% more complaints were responded to within the timescales verbal complaints were dealt with during 2012/2013, compared with 536 verbal complaints the previous year, an increase of 11(2 %). 2.5 The Scottish Public Services Ombudsman (SPSO) requested information on 27 complaints from which 26 proceeded to investigation (One waiting to be reported on at the time of writing). During the year, NHS Ayrshire and Arran received 2 published investigation reports outlining recommendations and 13 Decision Letters also outlining recommendations which NHS Ayrshire and Arran has implemented or is currently acting upon. Following review the SPSO recommended that three complaints NHS Ayrshire considered not upheld should be changed to fully upheld and one complaint that NHS Ayrshire and Arran recorded as partly upheld should now be changed to not upheld. The SPSO agreed with all other outcomes of complaints reviewed. 2.6 The majority of complaints (80%) involve four main issues clinical treatment, attitude and behaviour, dates for appointments and communication (oral). These issues remain the same as the previous year. 2.7 The ISD annual report on complaints for 2012/2013 will be published later in the year, at which time NHS Ayrshire and Arran will be able to compare its performance in more detail against the picture across NHS Scotland. Complaints Team will produce a report at that time. 2.8 Figure 1 - NHS Ayrshire and Arran Formal Complaints last 5 years ( ): Table 1 - Complaints received by directorate 2012/13: 3

5 FORMAL INFORMAL Total Finance Integrated Care and Emergency Services Integrated Care and Partner Services Information & Clinical Support Services Medical Executive Mental Health Services Nursing Executive Pharmacy and Prescribing Public Health Totals: Table 2 - Overall outcome of local resolution: Overall Outcome of Local Resolution 2012/2013 TOTAL Overall Complaints Resolved: - Complaints Upheld Complaints Partly Upheld Complaints Not Upheld 143 Ongoing 4 Complaints referred to other Area 3 Consent not received 14 Unreasonable complaint * 2 Complaint resulted in internal review (ongoing) 1 Complaints withdrawn 23 Total 543 * 2 anonymous complaints received 2.11 Table 3 - Performance against national standards: 2011/ /13 % of complaints acknowledged within 3 working days 90% 88% Written response within 20 working days. Average Resolution Time (days) 58% 59% 24 days 25 days 4

6 2.12 Table 4 - Staff Groups Involved In complaints: Staff Groups Involved in Complaints & Outcome 2012/2013 Total Number of Staff Involved Upheld Partly Upheld Outcome Not upheld Withdraw n /Other Medical Staff Nursing & Midwifery Ancillary Other* Allied Health Professionals Administration Total Includes Ambulance staff, GP (ADOC), Pharmacists 2.13 Table 5 - Issues raised by complainants (all complaints): Comparison 2012/ /12 Issue Total Number 11/12 % of all issues Raised 11/12 Total Number 12/13 % of all issues Raised 12/13 Clinical treatment % % Attitude and behaviour % % Date for appointment 57 9% 71 10% Communication (oral) 49 8% 56 8% Communication (written) 21 3% 24 3% Patient property / expenses 10 2% 18 2% Premises 6 1% 17 2% Test results 10 2% 14 2% Admissions / transfers / discharge procedure 4 0.4% 12 2% Outpatient and other clinics 12 2% 12 2% Personal records 7 1% 11 2% Aids / appliances / equipment 8 1% 7 1% Consent to treatment 0 0% 6 1% Patient privacy / dignity 8 1% 5 1% Mixed accommodation 1 0.1% 4 1% Transport 6 1% 4 1% Cleanliness / laundry 3 0.3% 3 0.3% Competence 4 0.4% 2 0.2% Date of admission / attendance 7 1% 2 0.2% Complaint Handling 1 0.1% 1 0.1% Patient status 3 0.3% 1 0.1% Hospital acquired infection 1 0.1% 1 0.1% Policy and Commercial Decision of NHS Board 5 0.5% 0 Shortage / Availability 4 0.4% 0 Catering 3 0.3% 0 Failure to agree procedures 1 0.1% 0 Totals: % 2.14 Table 6 - Issues raised by complainants (all UPHELD complaints): 5

7 Issue Number % of all issues raised Clinical treatment 93 13% Attitude and behaviour 45 6% Date for appointment 36 5% Communication (oral) 20 3% Communication (written) 17 2% Premises 14 2% Test results 11 2% Patient property / expenses 9 1% Admissions / transfers / discharge procedure 8 1% Outpatient and other clinics 6 1% Personal records 6 1% Aids / appliances / equipment 4 1% Patient privacy / dignity 4 1% Consent to treatment 4 1% Cleanliness / laundry 2.3% Mixed accommodation 2.3% Complaint Handling 1.1% Date of admission / attendance 1.1% Transport 1.1% Totals: % 2.15 Table 7 - Issues raised by complainants (all Partly Upheld complaints): Issues Number % of all issues raised Clinical treatment 98 14% Attitude and behaviour 36 5% Date for appointment 19 3% Communication (oral) 13 2% Communication (written) 3 0.4% Outpatient and other clinics 3 0.4% Aids / appliances / equipment 3 0.4% Premises 2 0.2% Patient property / expenses 2 0.2% Admissions / transfers / discharge procedure 2 0.2% Personal records 2 0.2% Consent to treatment 1 0.1% Mixed accommodation 1 0.1% Transport 1 0.1% Competence 1 0.1% Total % 6

8 3.0 Feedback, Comments and Concerns Feedback discussed within this report has been drawn from the following corporately managed feedback methods, and also includes an independent feedback source*: Care to Comment Postcard Our Customer Care What do you think? (feedback leaflet) Customer Care mailbox (Public website quick feedback link is also linked to this mailbox) Annual Customer Care Survey *Patient Opinion (independent feedback website) During the reporting period, 251 items of feedback were received through the above mentioned feedback methods. This has been themed below 3.1 Table 8 - Feedback themes Broad Theme Tone of feedback Negative Neutral Positive Total Items Appointments Attitude of staff Caring and compassionate staff Corporate communication Communication between health care staff 4 4 Communication with families and carers Communication with patients Courtesy and respect Environmental 3 3 Environmental cleanliness Environmental comfort Food Medication Parking 5 5 Providing information Staff helpfulness Sunday service 1 1 Treatment and service Waiting 7 7 Welcome and friendliness Total The tone of most feedback received has been positive, with the largest number of positive feedback being received for the themes of caring and compassionate staff (21%) and staff attitude (13%). Most negative comments received were also around staff attitude (9%) together with environment cleanliness (5%), where comments most often related to smoking on hospital grounds. 3.2 The source of feedback that has generated most responses is the relatively new feedback form Our Customer Service what do you think? (39%). This is closely followed by the annual customer service survey (34%) and customer care inbox (17%). 7

9 Figure 2 - Sources of data Feedback Source Our Customer Service - what do you think? 39% Patient Opinion website 7% Care to comment card 3% Customer care inbox 17% Customer Care Survey 34% Source Table 9 - Sources of feedback Care to comment card Customer care inbox Customer Care Survey Our Customer Service - what do you think? Patient Opinion website Total Tone Negative neutral Positive Total Items

10 4.0 Listening, learning and responding 4.1 NHS Ayrshire & Arran is committed to ensuring that all feedback, comments and concerns are considered and, where improvement is possible, that action is taken. Where possible, items of feedback, comments and concerns have been directed to the services they relate to so that these can be shared with the staff concerned and help improve services. The following are some examples of specific improvement activities undertaken as a direct result of feedback (Table 10 below). Patient/Public said: Switchboard staff should be pleasant at all times and give helpful advice or transfer calls to someone who can help. Why does the NHS spend money on posting out an appointment letter following a clinic visit rather than giving it to patients before they leave? Improvement activity: All telephonists have received a written reminder of the telephone standards required by NHS Staff Caring, Courteous, Polite, Efficient, and most of all Helpful. Extracts from the feedback, which were made anonymous, was used to illustrate what was inappropriate about the way this call was handled. As part of the new Transforming Outpatients Programme, our approach to arranging appointments at Outpatient (OP) Clinics is being reviewed. We are also actively exploring the use of and text for communicating appointments as part of the process of continuously improving the way this is managed. Patient/Public said: It is not good that people continue to smoke near entrances/exits at hospital. Cigarette butts litter the ground at doors and non-smokers have to hold their breath when passing. Not very good for health promotion. Public transport to some health locations can be limited and very expensive for some patients depending on where they live. If clinic appointments could be held in the community or by telehealth it might avoid patients who do not drive wasting so much time trying to get to clinic appointments. Improvement activity: We have now taken steps to ensure that cigarette bins / containers are regularly emptied and similarly, will be regularly cleaning out areas of shrubbery and other garden areas, where cigarette ends are thrown by smokers. We are looking at the possibilities of upgrading the front door entrances at University Hospital Ayr and University Hospital Crosshouse. This will include looking at the option of relocating the smoking shelters. All of this work will support the move to all NHS Scotland premises being smoke free by March As part of the new Transforming Outpatient Services Programme we are exploring opportunities to increase the use of tele-consultation to reduce the need for people to attend busy district general hospital sites, where appropriate. This work is at an early stage but we are working closely with members of the public, who are users of local outpatient services, to ensure that the views of 9

11 Where possible, people should receive the information they need at the time it is needed. patients and the public are fully considered. We have been routinely reminding our staff of how important it is to provide the information people need at the time they need it and will continue to work at improving on this. In addition, we have been working with patients and the public to develop a patient held information logbook that provides relevant information for their discharge and allows patients to ask about information that is important to them and record it during a stay in hospital. This resource is now finalised and will be launched over the next couple of months in all in-patient areas. Appointments have been cancelled at the last minute (and sometimes on several occasions) due to consultants taking annual leave and departmental meetings. Healthcare and medical managers have introduced several improvements to ensure that requests for leave and planning for meetings are factored into clinic planning - specifically to avoid what happened in this case. Patient/Public said: NHS staff should consistently demonstrate caring behaviours (good customer service) Switchboards, wards and departments need to become more responsive to incoming telephone calls. NHS staff should always wear visible and legible identification at all times, so that people know who they are taking too. NHS staff should consistently provide a welcome that promotes trust and good communication between NHS staff and patients or their families/carers. NHS staff need to feel that being as helpful as possible is a priority Improvement activity: We have been working with our staff to agree a set of values for all NHS staff and the values of safe, caring, and respectful were agreed in June 2013 along with associated behaviours and corporate commitments to our communities, our workforce and our partners. During Annual Customer Care Survey 2013 we plan to embed these across NHS Ayrshire & Arran services. Switchboards, wards and departments have been working to meet the telephone call handling standard within our Customer Care Commitments. They have been testing different approaches to delivering a greeting that feels person-centred to callers. This team now check how well they are doing by carrying out an audit of their service twice a year along with all other operational services. Wearing visible identification has been made a priority for all staff and is monitored in an organisational customer care audit twice a year. We are delivering a range of training and awareness programmes that cover good communication and good customer service, including an online induction programme for all our new staff. We aim to embed our set of values and behaviours that have been agreed with our 10

12 responsibility and part of everyone s role. staff into organisational culture over the coming few years. 4.2 Feedback from other routes Other feedback routes include patient and public groups and lay representation on NHS led groups and committees. In Ayrshire and Arran approximately 630 patients and members of the public provide direct feedback by participating in around 80 NHS decision making and service development groups. NHS Ayrshire & Arran also consults routinely with independent patient/public groups, such as the Public Partnership Forums in East, North and South Ayrshire, the Hospital Patients Council and the Mental Health Services Public Reference Group. Issues raised by these groups over the last year have included: Table 11 Improvement activities from issues raised by public groups Issue raised: Continued use of Chartermark Signage following the organisation that provides the accreditation winding up. Condition of the male public toilets Promotion of hand washing in NHS toilets Information needs of older people on discharge from hospital Improvement activity: As a result of concerns raised about continuing to publicise the organisation s chartermark status, signs at both University Hospitals Ayr and Crosshouse hospital were removed. As a result of concerns raised about the smell in the male public toilets at University Hospital Crosshouse further work was carried out on the flushing system to improve performance and planned preventative maintenance has been arranged for the extractor fan to improve the ventilator system. As a result of concerns raised that there should be more done to promote hand washing the Infection Control Team and Scottish Health Council worked with members of the public to create an information poster that is now located within NHS toilets and some have also been provided to local organisations by the public members for their use. As a result of this issue, members of the public worked with NHS staff and Social Work staff to develop a new patient information resource with useful information for people on discharge. 4.3 Improvement through feedback - Case studies Case 1 Community Feedback Information needs on discharge The South Ayrshire Public Partnership Forum (PPF) raised a topic about the information needs of older people at the time of discharge with NHS Ayrshire & 11

13 Arran. This PPF then went on to carry out a survey in the local community to find out more about what people felt were their information needs on discharge and other information they felt was important to them. A small working group was formed that included the public members from the Public Partnership Forums, Social Workers, Hospital Discharge Co-ordinators and other relevant stakeholders. This group started work on a leaflet that would provide the information about the discharge process that people said they wanted and within the leaflet a logbook that would allow people to record other information that was important to them. Following an extensive consultation period and testing of a number of early drafts the Leaving hospital - your personal logbook was designed and will be ready for implementation across NHS in-patient services during August Case 2 Patient Story - Equalities Pauline has cerebral palsy which she has had all her life. As she became older the condition progressed leaving her less able to mobilise. Pauline also suffered a stroke which has left her with limited use of one side of her body, and with limited ability to lift both arms, her limitation means that she is unable to move her arms above shoulder height. As she lives in sheltered accommodation Pauline has a reasonable amount of independence due to various adaptations and equipment within her home. Although, Pauline also has support from carers and family members on a daily basis. Following a serious nose bleed, Pauline was admitted to hospital for one week. During that time Pauline was asked not to bring her own lifting equipment or wheelchair into the ward for a number of lifting and handling reasons, however she then experienced some challenges around her mobility and self-care in the ward as the nursing staff found moving her difficult. This meant that she was frequently left until last to receive her personal care and some staff openly complained that they needed more staff to move her. This causes a Pauline a great deal of distress. On hearing of Pauline s experience, the NHS Ayrshire & Arran Moving and Handling Team are now using Pauline s story to highlight the importance of asking them for advice when caring for a patient who has specific moving and handling needs. In this case Pauline s own equipment could have been brought into the hospital. The moving and handling team have also commenced training and competency assessments to ensure nurses are trained to be sensitive to the needs of people with mobility problems. Case 3 Patient and Staff Solicited Feedback Food in hospital A person centred review was commenced in 2012 following a proposal to change the menu offered to in-patients in the acute and community hospital setting. In order to understand the impact of these changes on a number of different patient population s informal interviews were carried out with patients and nursing staff within a range of care settings. The feedback from this review helped to form a picture of the challenges and positives of delivering quality nutritional care process across NHS Ayrshire & Arran. This information helped to inform the development of a set of person centred proposals for a new comprehensive food in hospital programme. It also helped to identify the aspects of the current menu that were of most 12

14 importance to patients and their families. These aspects have been incorporated into the new proposals, these include maintaining scrambled egg as part of the continental breakfast menu, as well as soup and ice-cream as standard menu items for lunch and evening meals. Following consultation with patients, the public and NHS staff we will be implementing these proposals during 2013/14. Case 4 Patient Story Night time Renal Dialysis Diane has been receiving dialysis for kidney failure for three years. She received her dialysis during the day for the first two years and has been undertaking night time dialysis for the last year. Having dialysis this way has allowed her to feel much better and to reduce her medication due to the dialysis happening over a longer period of time. Due to recent reductions to catering budgets it was proposed to the patients on night time dialysis that toast and tea in the mornings might not be provided. Diane spoke with the other patients on Night Dialysis within the Renal Unit and compiled their views on their needs as patients and about equity with day time services and presented this to the unit s management team. As a result of the concerns raised by this group of patients, the unit decided to maintain the level of snack provision at the end of their dialysis for night time dialysis patients. 13

15 5.0 Priorities for 2013/14 A range of immediate actions will support progress toward an improved and more person centred approach to handling feedback during , this includes: Increasing the focus on early personal engagement with people who provide feedback or submit complaints, emphasising the focus on early resolution of concerns by clinical teams. Ensuring that enquiries, requests for information and/or concerns in respect of ongoing clinical care, management, decision-support or navigation of services are directed to clinical teams If concerns are already known to be issues requiring improvement, consider the value of applying same standardised approach to review Develop guidance that outlines roles and supports clarity of process for a person centred approach to dealing with feedback More active engagement with people who might wish to work with staff on improvements Routine feedback offered to staff reviewing concerns and complaints in respect of the approach taken to resolution and response. As part of the Person Centred Health and Care Programme ensure spread of person centred approaches (including Caring Behaviours Assurance System, Customer Care Commitments, Schwartz rounds) Explore and share the leadership practices of ward departments of wards/teams that consistently have low numbers of negative feedback Test the above actions through an identified network of key opinion leaders to who will be supported to identify and evaluate changes in approach, to be used to inform construction of new guidance and supporting process. 14