Complaints handling- Can this be a positive experience? David Hall Clinical Director NHS Dumfries & Galloway

Complaints handling- Can this be a positive experience? David Hall Clinical Director NHS Dumfries & Galloway

A positive experience? Not immediately if you re the one being complained about! Has to be regarded as an important opportunity to receive feedback Rarely results in serious consequences (unless you deserve them!)

Why do people complain?

Common reasons To avoid the problem occurring again To learn lessons To be given a full explanation To receive feedback They feel humilated, betrayed and hurt They want to know what happens next To receive a meaningful apology

How many people complain? 162,000 complaints re NHS care 2012/13 Around 3000 per week ISD Scotland figures 2012/13 9161 complaints 76% Acute Hospital Care Treatment issues 38% Staff 32 % Medical & Dental 37% 28% Fully upheld 35% Partially upheld 36% Not upheld

35 Number of Complaints - 1 April 2013-31 March 2014 33 30 25 26 24 26 26 23 20 15 14 17 19 17 20 16 10 5 0 1 1 4 2 2 2 1 0 0 0 0 0 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 NHS D & G Mental Health

How to handle complaints?

NHS DUMFRIES & GALLOWAY COMPLAINTS PROCEDURE Patient feedback comes into NHS Dumfries and Galloway via several methods; letter, e-mail, telephone and in person. All staff are encouraged to deal with patient feedback at a local level (INFORMAL CONCERN) prior to progressing through the FORMAL COMPLAINTS PROCEDURE FORMAL COMPLAINT All formal complaints received to be passed to Patient Services Co-ordinator (this should include complaints sent direct to staff members). Record on DATIX Acknowledgement letter sent within 3 working days Send to General Manager for investigation. General Manager or designated investigator will contact complainant by telephone to clarify issues and discuss appropriate resolution. General Manager to send out for comments to be returned to GM within 5 working days. Response not received follow-up as priority (days 5-7) Comments/Statements received General Manager will draft response and let staff involved have sight of draft response Draft sent to Patient Services Co-ordinator for formatting and passed to Nurse Director for signing. * INFORMAL (CONCERN) To be dealt with by most appropriate member of staff using the most appropriate low level response (ie phone call, face to face meeting). Patient may also request a follow up letter, which can be sent from the member of staff involved or the head of service as appropriate. Keep a record of all conversations/actions taken and send to the Patient Services Coordinator along with the outcome If complainant is dissatisfied with outcome progress through FORMAL COMPLAINTS PROCESS * * MEETING Meetings should be held at every opportunity to benefit patient experience and organisational learning Date for meeting confirmed and agreed prior to 20 working day target. TIMELINE ON HOLD MEETING HELD Further enquiry/follow-up letter from chair of meeting or Nurse Director (if required) Do you have a policy or procedure for complaints? Copy of signed response letter sent to General Manager for completion of action plan. Satisfactory outcome confirmed CLOSED Learning Recorded in Action Plan Database and DATIX. NURSING COMPLAINT Senior Charge Nurse cc Clinical Nurse Manager Associate Nurse Director NURSING COMPLAINT Senior Charge Nurse cc Clinical Nurse Manager Associate Nurse Director When sent out complaints should go to General Manager and: When sent out complaints should go to General Manager and: MEDICAL COMPLAINT Clinician cc Clinical Director Acute/Medical Director MEDICAL COMPLAINT Clinician cc Clinical Director Acute/Medical Director

Six stages of a complaint 1) Receiving & defining the complaint 2) Investigation planning / gathering evidence 3) Decision Upheld / not upheld 4) Communicating the decision 5) Resolution / Redress 6) Learning lessons - feedback

Who can complain? Had or having care or treatment from the organisation Visited or used the services or facilities What about? Care or treatment facilities / place of work staff organisation of services (private costs) When can they not? Something they are taking legal action about (Based on NHS D&G Policy)

What s your job if someone is complaining? Keep calm & professional (more detail later) Get as much detail as possible Understand the complaint Be mindful of confidentiality Try to resolve the issue at the lowest possible level

What should I not do? Panic; it s just a conversation Be: Defensive Flippant Sarcastic Make a promise you can t keep Take sides Provide personal opinions Don t panic, don t panic! Give advice or information which you are not qualified to do so

Governance / Data Protection Data protection is a major consideration, this is private & personal health record data When dealing with a complaint, verify with ID you are speaking with the right person Complaint on behalf of someone else / not made by the patient: If relates to an under 18, must be parent or legal guardian Over 18, must have permission (confirmed by you) verbally or preferably a written mandate Legal power of attorney Relative of a deceased person Advocate My advice: If they can t prove identity or permission, do not divulge any information

Expectation? Confirm what the service user wants as a result of their complaint: What do they want to happen? What is it they want you to look into Are they just telling you this for information

Following an investigation / Learning Must decide if the complaint is upheld / not upheld Take action Learning (even if not upheld) Education Change of practice etc Demonstrate that learning has been put into place Respond to the complainer

If a person is unhappy with the outcome of a complaint or how it was handled they can appeal to: Scottish Public Services Ombudsman or GMC / GDC

Apologising Apology: a written or spoken expression of one's regret, remorse, or sorrow for having insulted, failed, injured, or wronged another.

Where it is justified, an apology is the most important aspect of resolving a complaint, why: Its an acknowledgement of truth Confirmation the complainer was correct It shows understanding of where things went wrong An acceptance of responsibility A reassurance that the problem has been addressed and will not happen again A reconciliation of a relationship A restoration of reputations

Complaints v Feedback No mistake or harm- no reason to complain? Mistake with/ without harm- but no complaint - a narrow escape? Or a missed opportunity to learn? Mistake with/ without harm- a justifiable complaint? Or an opportunity to learn?

Feedback Complaints are more likely if it s the only way to give feedback Seek feedback from everyone? After each encounter? Patient/ visitor feedback Patient surveys Go looking for errors so they can be minimised

Patient Safety Climate Tool

Patient Safety Climate Tool How safe do patients feel in Scotland s adult inpatient mental health wards? As part of the SPSP-Mental Health programme there is a strong commitment to deliver a Safety Climate Tool for patients in a mental health setting. If you could ask a patient 3 questions about how safe they feel whilst in hospital what would they be and why?

Complaints and feedback Most clinicians attract some complaints Very few clinicians get into serious trouble The more we develop systems to encourage feedback (positive and negative)- The easier it is to put complaints into context -for individuals and the organisation