Complaints, Suggestions and Compliments Policy and Procedure The Senior Management Team hereby formally recognises the adoption of this policy for use by staff at St Michael s Hospice, Hastings. This document replaces all previous policies relating to this area and will be reviewed in accordance with the hospice audit and review timetables If any member of staff has any questions, or needs further clarification with regards to this policy, please discuss this with your line manager immediately Author: Approved by: Celia Pyke-Lees Senior Management Team Date issued: April 2008 Next Review date: Review lead: August 2014 Senior Management Team Past review April 2008 dates May 2010 July 2011 Reviewed July 2012 Approved by SMT/Registered Manager Signature July 2012 Complaints, Suggestions and Compliments Page 1
Contents 1. Policy Statement... 3 2. Applicability... 3 3. Responsibilities... 3 4. Policy details... 4 Complaints... 4 Suggestions... 6 Compliments... 6 5. Education and dissemination of complaints handling... 6 6. Further guidance... 6 7. Related Hospice policies... 7 8. Complaints procedure... 7 9. Appendices... 10 Appendix 1... 10 Appendix 2... 11 July 2012 Complaints, Suggestions and Compliments Page 2
1. Policy Statement St Michael's Hospice aims to provide a high standard of care and support for patients and their families and friends. It is our policy to seek, in a variety of ways, the views of those who use our services and to learn from the comments we receive. An open culture exists which we hope will enable patients, families and visitors to feel confident about putting forward their views so that we can learn from them. This policy provides one of the ways in which we try to ensure that we listen to and learn from users of our services. We consider that complaints, criticism or suggestions, whether oral or written, made by patients or their representative, should be taken seriously, handled appropriately and sensitively. Patients should feel able to approach the staff who provide the services so that every attempt can be made to resolve any concerns at an early stage. We seek to promote a process that is fair, open, flexible and conciliatory and that is easy to access. Our overall aim is to ensure that we can continue to improve the quality of the services that we provide and learn from any mistakes that may have occurred. St Michael s maintains the same standards of openness in relation to all its activities, for example fundraising, trading and lottery. This policy, therefore, covers both clinical and non-clinical areas of our work. The Chief Executive has overall responsibility for complaints management. 2. Applicability This policy covers both clinical and non-clinical areas of the work of the Hospice and is applicable to all staff and volunteers. 3. Responsibilities All volunteers should pass any complaints, comments and criticisms received to a member of staff. All employees are responsible for considering and acting on an informal complaint and for passing any written complaints to the relevant Senior Manager or line manager. All managers have a responsibility for ensuring complaints are considered in a constructive and proactive way. Details of complaints received should be sent to a Senior Manager and copied to the Chief Executive s office. The Senior Management Team is responsible for ensuring the investigation of complaints in a fair and impartial way within the timescales laid down. Senior Managers are also responsible for reporting a summary of complaints to the Care Quality Commission, Fundraising Standards Board and Gambling Commission, as appropriate. The Chief Executive s office is responsible for logging and tracking any complaints and suggestions and for reporting on these, and all compliments received, to the Senior Management Team and the Board of Trustees. July 2012 Complaints, Suggestions and Compliments Page 3
4. Policy details Complaints Aims The aims of the complaints policy and its accompanying procedure are: To provide a straightforward means for patients (or those acting on their behalf) or others who use our services to make a complaint to St Michael's Hospice. To ensure complaints are investigated within a reasonable time and in a courteous and efficient manner. To provide a means of keeping a complainant informed about progress as well as the eventual outcome, so that they feel that the complaint is being treated seriously even if the answer is not to their satisfaction. To provide a means of ensuring that action is taken to resolve an issue and/or to prevent a recurrence of identified problems. To enable the Hospice continually to learn and improve. To ensure feedback is given to the Board of Trustees. Definition A complaint is an expression of dissatisfaction about the standard of our service, from patients, relatives or concerned members of the public that has not been resolved on initial contact with any member of our staff. Time limitations A complaint should be made in writing, within six months of the incident that caused the problem or within six months of the complainant discovering that there was a problem, provided this is within 12 months of the incident. Confidentiality It is recognised that confidentiality must be maintained throughout the implementation of these procedures. It is important, therefore, that complaints made on behalf of someone else are made with the permission, given in writing, of the individual. The only exception to this would be where a patient is incapable of giving permission. In these circumstances, the Hospice is required to notify the patient s next of kin of any complaints made by anyone other than the patient and his/her next of kin. Litigation Where a complainant has explicitly expressed, either orally or in writing, an intention to take legal action, a view would then be taken as to whether progressing the investigation of the complaint could prejudice any legal process. If this was considered to be the position, the complaint would be put on hold and the complainant advised of this. However, if there were no legal impediment, investigations into the issue would continue. July 2012 Complaints, Suggestions and Compliments Page 4
Investigation All complaints will be carefully investigated by a Senior Manager. The aim of the investigation is to: Find out what happened. Make it possible for the complainant to discuss the problem with those concerned where this is appropriate. Make sure an apology is given, where this is appropriate. Explore what both parties can do to make sure the problem does not happen again. Advocacy If a complainant requires support in presenting a clinical complaint, assistance should be provided in line with the Hospice s Advocacy Policy. Staff and volunteer complaints/grievances Employment issues, including harassment, bullying, whistleblowing, will be handled through the relevant employment policies and procedures, rather than through this policy. These policies are available electronically and on paper versions throughout the Hospice or obtainable from managers. Similarly, issues raised by volunteers will be managed through the procedures detailed in the Volunteers Handbook. Complaints from students will be managed as set out in the Students Policy. Disciplinary procedures The main focus of this policy is to resolve complaints without apportioning blame and to learn any lessons for the improvement of service delivery. It is, therefore, not the role of this complaints policy to deal with issues relating to disciplinary matters. However, the circumstances of some complaints may lead to the recommendation that further action should be considered under the disciplinary procedures. Record keeping All written complaints will be logged and tracked by the Chief Executive s office to ensure that they are managed in a timely way, in accordance with this policy. Records will be kept for seven years. Monitoring and review A review of complaints received and action taken will be undertaken every six months. Summary reports will be made to the Senior Management Team and to the Board of Trustees. As required, summary reports are forwarded to the Care Quality Commission, Fundraising Standards Board and Gambling Commission Complaints relating to another healthcare organisation or other providers In the event that St Michael s Hospice may be required to contribute to an overall complaint made to another healthcare organisation or other provider, the Hospice will comply with the timescales appropriate to that organisation. July 2012 Complaints, Suggestions and Compliments Page 5
Suggestions Suggestions about ways in which we can improve our services are welcomed and encouraged. These can be made to a member of staff or a note can be put in the suggestion box, which is available in St Michael s Reception. It is the responsibility of the Chief Executive s office to ensure that these boxes are emptied regularly. All suggestions will be considered by the Senior Management Team on a monthly basis. Responses will be posted in reception. Compliments All letters and cards expressing a compliment about a service received are sent to the appropriate area of service. All accompanying donations will be promptly acknowledged. Letters which single out a particular member of staff should be passed to that person by their manager, with recognition of the good quality service they have provided, as it is important that the relevant staff and managers know their services have been appreciated. On a six monthly basis, copies of all compliments should be sent to the Chief Executive s office, where they will be analysed and a report sent to the Senior Management Team and to the Board of Trustees. 5. Education and dissemination of complaints handling During the induction programme, staff will be made aware of the commitment of the Hospice to an open and constructive response to complaints and criticism and to the policy and procedure. Staff and volunteers will be supported by the managers in understanding and managing the complaints process. 6. Further guidance NHS Constitution (Dept. of Health 2009) Listening, improving, responding: a guide to better customer care (Dept. of Health 2009) Being open communicating patient safety incidents with patients and their carers (NPSA 2009) References: Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 July 2012 Complaints, Suggestions and Compliments Page 6
7. Related Hospice policies Advocacy policy Whistle blowing policy Disciplinary and grievance policies Staff and Volunteers Handbooks 8. Complaints procedure Verbal comments Complaints can be made directly to staff, in person or over the telephone. They should be made as soon as possible after the event that gave rise to the concern. All comments, however minor, will be taken seriously and investigated. A senior member of staff will deal with the initial issue raised and seek to resolve concerns. If the matter cannot be resolved, the complainant should be given the relevant complaints leaflet (copy attached as Appendix 2) and/or advised to write to the relevant member of the Senior Management Team, as indicated below. Written complaints A flow chart detailing the procedure for written complaints is set out in Appendix 1. Clinical: All written clinical complaints should be sent to the Head of Clinical Services. Fundraising: All written complaints in relation to fundraising should be sent to the Head of Fundraising. Shops and Trading: Complaints concerning trading activities and shops should be sent to the Head of Trading Lottery: complaints relating to the Hospice Lottery should be sent to the Lottery Manager. Other complaints: Written complaints about any other service should be forwarded to the member of the Senior Management Team who manages the relevant area. All complaints should be acknowledged within 3 working days, giving an indication of when a reply can be expected and who is dealing with the matter. A copy of all complaints correspondence should be sent by the manager to the Chief Executive for recording and tracking. A full reply should be given to the complainant within 20 working days; otherwise the complainant should be given further information about when a reply could be expected. The full reply to the complainant should advise that, if complainants are unhappy with the outcome of the investigation into their complaint and do not feel that the matter has been satisfactorily resolved, they can write to the Chief Executive within 20 days of receipt of the response. The Chief Executive will ensure that a further review of the original complaint is made. Similar standards apply: a letter of acknowledgement within 3 working days with the aim of a full reply within 20 working days. July 2012 Complaints, Suggestions and Compliments Page 7
Unresolved complaints Complainants who continue to be concerned at the outcome of the investigation into their complaint should be advised of the appropriate organisation they can contact, as follows: Care Services The care services we provide are mainly commissioned by: Hastings and Rother Primary Care Trust Bexhill Hospital Holliers Hill Bexhill-on-Sea East Sussex TN40 2DZ Tel: 01424 735600 The Hospice is inspected by: Care Quality Commission National Correspondence Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 Email: enquiries@cqc.org.uk Fundraising Fundraising Standards Board 61 London Fruit Exchange Brushfield Street London E1 6EP Tel: 0845 402 5442 Email: info@frsb.org.uk Lottery Any continuing concerns about the outcome of a complaints investigation relating to the Hospice Lottery can be referred within two months of the Hospice s decision on the complaint to: The Independent Betting Adjudication Service PO Box 62639 London EC3P 3AS July 2012 Complaints, Suggestions and Compliments Page 8
Tel: 020 7347 5883 Email: adjudication@ibas-uk.co.uk Our Lottery is licensed by: Gambling Commission Victoria Square House Victoria Square Birmingham B2 4BP Tel: 0121 230 6666 Email: info@gamblingcommission.gov.uk July 2012 Complaints, Suggestions and Compliments Page 9
9. Appendices Appendix 1 FLOW CHART OF COMPLAINTS PROCEDURE In first instance, complaint to staff member Complaint not resolved and is confirmed in writing Complaint resolved immediately Referred to Senior Manager Complaint acknowledged within 3 working days Full reply in 20 working days (or information given on timescale) Complaint resolved Complaint not resolved and further letter is sent to Chief Executive within 20 days of receipt of the response Letter of acknowledgement within 3 working days Full reply in 20 working days (or information given on timescale) Complaint resolved Complaint not resolved Complainant advised to whom they could take their complaint for further review. July 2012 Complaints, Suggestions and Compliments Page 10
Appendix 2 Complaints, comments and compliments Your views are welcome and we recognise that they can help us improve the quality of our services The Board of Trustees and Staff at St Michael s Hospice aim to provide a high standard of care and support for patients and their families and friends. We take seriously the views of those who use our services, whether comments, compliments or complaints as we recognise that these can help us improve the quality of our service provision. An open culture exists which we hope will enable patients, families and visitors to feel confident about putting forward their views so that we can learn from them. We value both praise and constructive criticism which will help us in develop and improve our care. St Michael s Hospice Company will follow up any comments by: Investigating any complaints swiftly and impartially, using the complaints procedure set out in this leaflet Where possible, implementing any suggestions for improvement Passing on praise to staff members where this is due. Suggestions, Comments and Compliments Please put your comments and compliments in writing to the Chief Executive. You can either put these in the Suggestion Box located in the Reception area and Arthur Easton Centre or send them to the address on the reverse of this leaflet. Informal Complaints We recognise that, from time to time, our services may be the subject of a complaint. We hope that the majority of complaints can be dealt with swiftly and informally, to your satisfaction, by senior staff on duty. Please do feel able to talk to the staff concerned (face to face or over the telephone), as this is often the best way to get the issue resolved, easily and quickly. Continued overleaf... July 2012 Complaints, Suggestions and Compliments Page 11
Comments, compliments & complaints continued: Formal Complaints A complaint should be made within six months of the incident that caused the problem or within six months of discovering that you have a problem, provided this is within 12 months of the incident. If you are not satisfied with the outcome of the informal discussion, or if a more detailed investigation is needed, you will need to confirm the details in writing to: Head of Clinical Services (for all clinical complaints) Head of Fundraising (for all fundraising complaints) Head of Trading (for all complaints about shops or trading activities) Lottery Manager (for all Lottery complaints) A member of the Senior Management Team (for any other complaints) We aim to acknowledge your complaint within 3 working days, giving an indication of when a full reply can be expected and who is dealing with the matter. A full reply should be given within 20 working days; otherwise a further acknowledgment will be sent giving an indication about when a reply can be expected. When we look into the complaint we aim to: Find out what happened Make it possible for you to discuss the problem with those concerned where this is appropriate Make sure you receive an apology where this is appropriate Explore what both parties can do to make sure the problem does not happen again Complaints about medical treatment Please note that we keep strictly to the rules of medical confidentiality. If, therefore, you are complaining on behalf of someone else, we have to know that you have their permission to do so. This means we need a letter signed by that person giving their permission. The only exception to this is when that person is incapable of providing such a letter. The Hospice is required to notify the patient s next of kin of any complaints made by anyone other than the patient or his/her next of kin. Taking your complaint further If you are dissatisfied with the result of the initial investigation into your complaint you may write within 20 days to our Chief Executive, Celia Pyke-Lees, at the address below. The timescale for responding is the same as detailed above. If you continue to be concerned as to the outcome of the investigation, you will be advised of the appropriate regulatory body whom you can contact. A copy of our complaints policy is available on request. St Michael s Hospice: 25 Upper Maze Hill, St Leonards-on-Sea, East Sussex, TN38 0LB. Telephone: 01424 445177. Registered Charity No. 228462 www.stmichaelshospice.com July 2012 Complaints, Suggestions and Compliments Page 12