Supporting staff involved in a stressful or traumatic incident, complaint or claim.

Supporting staff involved in a stressful or traumatic incident, complaint or claim. Version: V2.00 Ratified by: Date ratified: October 2010 Name of originator/author/job title Name of responsible committee Name of responsible individual Date issued: October 2010 Review date: May 2011 Target audience: Healthcare Governance Committee Ms A Bromley, Deputy Director of Human Resources Healthcare Governance Committee Ms A Bromley, Deputy Director of Human Resources & Mrs K Hingley, Inteirm Head of Clinical Governance Trust wide EQUALITY IMPACT The Trust strives to ensure equality of opportunity for all both as a major employer and as a provider of health care. This policy has therefore been equality impact assessed to ensure fairness and consistency for all those covered by it regardless of their individual differences (see appendix 4). Page 1 of 17

VERSION CONTROL SHEET Version number Issue Date Revisions from previous issue 2 Overall and complete review of the previous policy DOCUMENT CONTROL Summary of consultation process Control arrangements Reviews shall generally be undertaken every 2-3 years or more frequently to take account of organisational learning Shared with Joint TU for comments. The initial implementation of the policy will be monitored by the Head of Patient Safety & Quality through reporting to the Healthcare Governance Committee. These will triangulate numbers of incidents, complaints and claims against staff support checklists received by Occupational Health. All non-compliance will be followed up with managers by the Occupational Health Department any manager who has failed to submit a Staff Support Checklist will be sent a follow-up letter requiring them to submit the form within 14 days. At the end of December 2010, a random sample of 5% of cases will be followed up this will involve the employees being contacted directly by Occupational Health Department and asked a series of questions to assess whether or not the support offered/provided was timely and met their needs. The results of this sample survey will be included in the report submitted to the Health Care Governance Committee/Health and Safety Committee. The Policy will be reviewed in 6 months time with the Joint TU to assess it s effectiveness. Associated documentation references and Page 2 of 17

TABLE OF CONTENTS 1. Introduction 4 2. Policy Statement 4 3. Scope of Policy 4 4. Roles & Responsibilities 4 5. Process For Providing Support For Staff Involved in a 7 Traumatic/Stressful Incident, Complaint or Claim 6. Specific Support for Staff Required To Attend Court Or Tribunal 8 as a Witness 7. Policy Implementation Plan 8 8. Monitoring 9 9. Review 9 10. References 9 Page Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Guidance to Managers Staff Support Checklist Summary Report Form EIA form Plan for Dissemination Page 3 of 17

1. INTRODUCTION 1.1 This policy establishes the responsibilties and arrangements for the provision of support to staff involved in potenitally traumatic or stressful incidents, complaints or claims and is aimed at minimising the effect on staff. 1.2 The principles of providing support to staff detailed in this document also extend to staff who may experience challenging situations when appearing as a witness, be it as a result of a Serious Untoward Incident (SUI), Divisional Root Cause Analysis (RCA s) or in a court of law or Coroners Court. 2. POLICY STATEMENT 2.1 The University Hospital of South Manchester NHS Foundation Trust (UHSM) recognises the need to ensure that formal arrangements are in place to support staff and therefore minimise the risk of staff suffering from adverse effects following an incident complaint or claim. 3. SCOPE OF POLICY 3.1 This policy applies to all staff directly employed by UHSM. 3.2 This policy provides processes to ensure the provision on immediate and ongoing support for staff involved in potentially traumatic or stressful incidents, complaints and claims, as well as for staff who may be required to appear as a witness. 3.3 Separate arrangements will apply to support offered to staff in relation to (and through) the following policies: Bullying and Harassment Policy; Raising Concerns at Work(Whistleblowing policy); Violence and Aggression Policy; Disciplinary Policy; Inoculation Injury Prevention and Management Policy. 3.4 Definitions A traumatic or stressful incident, complaint or claim is defined as an incident, complaint or claim that invokes unusually strong emotions, overcoming normal coping abilities. Examples of traumatic incidents, complaints and claims may include the following (though not exhaustively): Serious Untoward Incidents Serious (untoward) medication errors; Unexpected patient death; Allegations of gross negligence; Dealing with a major incident; Any other situation that the member of staff considers to be of a traumatic nature. Page 4 of 17

4. DUTIES 4.1 EXECUTIVE DIRECTORS The Executive Directors are accountable for ensuring that systems and arrangements for staff support are in place and provided for staff who are involved in an incident complaint or claim and for staff who may be required to appear as a witness. The Executive Directors are also responsible for ensuring that arrangements are in place to ensure that the support provided is effective and that a counselling service is available. 4.2 Director of Human Resources The Director of Human Resources is responsible for ensuring that support is provided to safeguard the health and mental wellbeing of employees who fall within the scope of this policy through the provision of counseling services and critical incident debriefing. The Director of Human Resources will ensure that the Occupational Health Services Department monitor the implementation of the policy and ensure that an annual report is provided to Healthcare Governance Committee. 4.3 Line Managers Line managers are responsible for providing immediate and ongoing support to staff who are involved in a stressful or traumatic incident, complaint or claim. They will: Work through the staff support checklist (see Appendix 2) with any employee covered under the scope of this policy, offering support and assistance as required; Provide the support and advice required by staff directly and/or take action to refer those to the Staff Counselling Service (as appropriate and necessary); Facilitate staff attendance at appointments with Staff Counselling Services; Ensure that any recommendations from Occupational Health Department and Staff Counselling services are considered and followed through in relation to individuals and their workplace environment; Arrange for the de-briefing of staff following traumatic incidents and deal with any subsequent absence in a compassionate manner; Further guidance is provided for managers in Appendix 1. 4.4 All Staff Staff involved in a stressful or traumatic incident, complaint or claim should: Page 5 of 17

Inform their manager if they are experiencing difficulties associated with a complaint incident or claim or as a result of the requirement to act as a witness, to enable their line manager to support them directly; Inform their manager so that they can facilitate time away from the workplace when attending the Staff Counselling Service; Self-refer to the Staff Counselling Service if experiencing difficulties associated with an event in relation to this policy. 4.5 Occupational Health Services Manager The Occupational Health Services Manager will be responsible for providing support, advice and guidance as appropriate to safeguard the health and mental wellbeing of employees falling under the scope of this policy, including the provision of counseling services and onward referral to specialist external support such as Critical Incident Debriefing, etc. The Occupational Health Department will collate and monitor the staff support checklists as detailed in Section 8. 4.6 Patient Safety & Quality Team The Patient Safety & Quality Team will ensure that managers of staff involved in an incident graded moderate or red (high) are aware of both the need to complete the staff support checklist and to submit it upon completion to Occupational Health. The Patient Safety & Quality Teamwill also send the Occupational Health Manager a monthly summary of the forms sent out to support the performance monitoring processes(see appendix 3). The incident will not be closed off by the Patient Safety & Quality Administrator until receipt of the staff support checklist is confirmed by the Occupational Health Department. 4.7 Legal Services Department The Legal Services Department will ensure that managers of staff involved in a moderate or red claim are aware of both the need to complete the staff support checklist and to submit it upon completion to Occupational Health. The Legal Services Department will also send the Occupational Health Manager a monthly summary of the forms sent out to support the performance monitoring processes(see appendix 3). 4.8 Patient Experience Department The Patient Experience Department will ensure that managers of staff involved in a complaint are aware of both the need to complete the staff support checklist and to submit it upon completion to Occupational Health. Page 6 of 17

The Patient Experience Department will also send the Occupational Health Manager a monthly summary of the forms sent out to support the performance monitoring processes (see appendix 3). 5. PROCESS FOR PROVIDING SUPPORT FOR STAFF INVOLVED IN A TRAUMATIC/STRESSFUL INCIDENT, COMPLAINTS OR CLAIMS 5.1 In all cases, as soon as managers become aware that one of their employees has been involved in a potentially traumatic or stressful incident, complaints and claims, including being required to appear as a witness, they should offer immediate support and re-assurance to the staff member. 5.2 The manager should work through the Staff Support Checklist (see Appendix 2) with the employee and give them the opportunity to access specialist support (e.g. Chaplaincy Team, Trade Unions, Counselling services, Occupational Health, etc). The intention is to ensure that staff are provided with timely, appropriate support. 5.2 Triggers which should prompt managers providing support to staff Following an incident If a member of staff has been involved in a incident, the Patient Safety & Quality Administrator will contact the relevant line manager and advise them of the need to complete the staff support checklist (if not already done so) and onward submission to Occupational Health. Following receipt of a complaint If a member of staff is involved in the investigation of a serious moderate or red complaint or allegation of clinical negligence, the Patient Experience Department will contact the relevant line manager and advise them of the need to complete the staff support checklist (if not already done so) and onward submission to Occupational Health. Following receipt of a claim (including requirement to appear as a witness) If a member of staff is involved in a claim, including appearing as a witness for any proceedings, the Claims Admintrator or Bereavement Services Manager will contact the relevant line manager and advise them of the need to complete the staff support checklist (if not already done so) and onward submission to Occupational Health. The Staff Support Checklist will prompt specific management action for the provision of both immediate and ongoing support. 5.3 If specialist support is required, this should be brought to the attention of the Occupational Health Department as soon as possible to ensure that there are the resources in place to deal with the staff concerned. 5.4 It is recognised that ongoing as well as immediate support may be required and this ongoing support will be provided in the first instance by the line manager, but may require support through the Occupational Health Team. It is also recognised that staff Page 7 of 17

may have other support mechanisms that they choose to access and also that some staff may require time away from the workplace following such an incident. Managers are expected to deal with such absences in a compassionate manner. 5.5 On occasions staff may not wish to access support services at the time but it may become apparent at some time in the future that they have been affected by an incident. Where this becomes apparent the manager should refer the individual to Occupational Health Department. 6. SPECIFIC SUPPORT FOR STAFF REQUIRED TO ATTEND COURT OR TRIBUNAL AS A WITNESS 6.1 Where a member of staff is required to attend a court or tribunal as a witness for the Trust then the Trust will ensure time off without loss of earnings and the payment of reasonable expenses. 6.2 They will also be offered the following support: Prior to the event This will include a full briefing of the process with further advice and support given by the Legal Services Manager and the Trust s Solicitors (as appropriate). During the event This will include senior-level support on the actual day where staff are appearing as a formal witness. After the event This will include a debrief meeting with an opportunity for staff to discuss the events and the outcome of the case and support given. 7. POLICY IMPLEMENTATION 7.1 The policy will be launched by being published on the Trust s intranet and circulated to all managers via Patient Safety & Quality Team and the Occupational Health Department. The policy will have immediate effect. 8. MONITORING OF COMPLIANCE OF THIS POLICY 8.1 The initial implementation of the policy will be monitored by the Head of Patient Safety & Quality through reporting to the Healthcare Governance Committee. These will triangulate numbers of incidents, complaints and claims against staff support checklists received by Occupational Health. All non-compliance will be followed up with managers by the Occupational Health Department any manager who has failed to submit a Staff Support Checklist will be sent a follow-up letter requiring them to submit the form within 14 days. Page 8 of 17

8.2 At the end of December 2010, a random sample of 5% of cases will be followed up this will involve the employees being contacted directly by Occupational Health Department and asked a series of questions to assess whether or not the support offered/provided was timely and met their needs. The results of this sample survey will be included in the report submitted to the Health Care Governance Committee/Health and Safety Committee. 8.3 A retrospective audit will be undertaken by the Patient Safety & Quality Team of all incidents for vember/december 2010 to assess the level of support provided to employees by line managers prior to the re-launch of the policy. This will be presented to (and reviewed by) the Healthcare Governance Committee. 8.4 The Patient Safety & Quality Team and Occupational Health Department will jointly submit monitoring/audit report with an action plan to (and to be reviewed by) the Health Care Governance Committee on an annual basis. This report will include monitoring of the performance of duty holders in the policy. The monitoring will include the following elements: Duties of those involved in the process immediate support offered to staff (internally and, if necessary, externally) ongoing support offered to staff (internally and, if necessary, externally) advice available to staff in the event of their being called as a witness (internally and, if necessary, externally) action for managers or individuals to take if the staff member is experiencing difficulties associated with the event 8.5 The role of Occupational Health in supporting staff involved in stressful or traumatic incidents, complaints or claims will be monitored through an annual report to the HR Divisional Management Team. 9. REVIEW 9.1 The Health Care Governance Committee will review the Policy every two years or sooner depending on the results of monitoring or as a result of recommendations from internal staff feedback or by external recommendations from approved bodies. 10. REFERENCES NHSLA Risk Management Standards, April 2008 Page 9 of 17

APPENDIX 1 GUIDANCE TO MANAGERS GUIDANCE FOR MANAGERS When a staff member is involved in an incident, complaint or claim they may require support as they may find it either traumatic, stressful or both. This is often caused by fear or the unknown or feeling that they are alone. WHEN SUPPORT NEEDS TO BE GIVEN The first line for that support is the line manager who should be involved as soon as possible. Much of the reassurance required by the staff member can be given by the manager informing the staff member of the process and referring them to appropriate resources. Dependent on the nature of the incident it may be possible for the Manager to provide support to staff during the incident for example where patients or relatives may be getting increasingly disruptive or be unwilling to listen to or cooperate with immediate staff but for most incidents the manager will be required to provide support following a moderate or significant incident. If the event concerned is a complaint or claim then the support for the staff member is following the event and the staff member will need to be informed of the content of the complaint or claim as they may be unaware and they will also need to be informed of the possible actions that need to follow For staff appearing as a witness, the support needs to be given before, during and after the appearance. In all cases support must be documented on the Staff Support Checklist (see Appendix 2) with the form sent to the Occupational Health Department. GIVING SUPPORT - FACTORS TO CONSIDER Immediate support 1. In all cases the manager should ensure that the initial appraisal of the incident takes place in a confidential manner and in a suitable environment. 2. The staff member should be given time to talk and the manager should listen to them and reassure staff that they are committed to ensuring that they are supported. 3. The initial debrief should allow the manager to assess the level of support required and the types of intervention which may be useful to the staff member immediately following the event. 4. Any arrangements for the staff member for medical assessment or attention (if the staff member is distraught or in shock, suffers from pre existing medical or mental conditions which could be exacerbated) should be made. 5. The fitness of staff to undertake or continue their full range of duties should be Page 10 of 17

APPENDIX 1 GUIDANCE TO MANAGERS assessed, with temporary adjustments to duties/responsibilities considered. A discussion needs to be held with the staff member about their feelings and an assessment of the risks needs to be undertaken by the manager which must include consideration of staff competence. 6. Where the staff member would find it challenging to work in the same environment or with others who may have been involved in the incident complaint or claim, consideration should be given to temporary redeployment or to restriction of duties. 7. Where staff feel that they would benefit from support through the Occupational Health Department and/or Counseling service, the manager make the referral to Occupational Health as required. 8. Where an individual is required to provide a written statement, assistance with statement writing will be offered to the employee. Ongoing support 1. Staff may need further time on a one-to-one basis, and a further debrief once they have had time to reflect. If this is the case, then the manager should make this available. 2. Staff may require some phasing back to their full duties after a significant event and communication with the member of staff may be required to assess progress and discuss any further support. 3. Where staff members continue to feel the effects of the event, consideration should be given to engaging further support from external sources. Page 11 of 17

APPENDIX 2 STAFF SUPPORT CHECKLIST STAFF SUPPORT CHECKLIST Please see section 2 for staff support for witness appearances Employee name Job title Manager name Date completed Is the support being provided due to a: Incident Complaint Claim Section 1 all staff 1. What immediate support was offered to the employee? 2. Was a copy of the policy provided to the employee? 3. Was a referral to occupational health discussed with the employee? 4. Was a referral to occupational health made? If not, why not? /self 5. Was counselling support discussed with the employee? 6. Was a referral to counselling support made? If not, why not? Page 12 of 17

APPENDIX 2 STAFF SUPPORT CHECKLIST 7. Have temporary role adjustments, redeployment or reassignment of duties been considered? 8. If yes, please detail any changes made 9. Has a debriefing session been held with the employee? 10. If yes, please detail key learning points 11. Has other support been offered to the employee (e.g. Supervisor of midwives chaplaincy, trade unions, etc)? 12. If yes, please detail support taken up 13. Has the need for ongoing or long term support been discussed? 14. If yes, please detail support agreed 15. Have any training needs been identified? If so please give details Section 2 witness appearances only Page 13 of 17

APPENDIX 2 STAFF SUPPORT CHECKLIST 16. If required to act as a witness, has employee been briefed about the process? 17. Has employee been offered support in statement writing? 18. Has employee been offered support in preparation for appearing as a witness? 19. Have arrangements been made to ensure that the member of staff will be supported on the day of the hearing? 20. If the case has concluded, was the employee debriefed? 21. Any other comments MANAGER SIGNATURE DATE EMPLOYEE SIGNATURE DATE ACTIONS Original Form to be filed in staff member s personnel file Copy of completed form sent to Occupational Health Department Copy of completed form given to employee Page 14 of 17

APPENDIX 3 SUMMARY REPORT FORM Summary report of Staff support forms sent to Managers following a Moderate / red incident/ complaint /claim Reporting department Legal Services Patient S&Q Complaints Summary of forms sent to managers for the month of Incident/ complaint claim no. Date of Event Date of letter Ward /Department Manager involved Staff members name if known Completed by Date Page 15 of 17

Appendix 4 - EQUALITY IMPACT ASSESSMENT TOOL Yes/ Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? n\a 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? n\a n\a If you have identified that this document could have a negative discriminatory impact, please refer it to the Information Governance Department, together with any suggestions as to the action required to avoid/reduce this impact. Page 16 of 17

Appendix 5 Plan for Dissemination of Policy or procedural documents To be completed and attached to any document which guides practice when submitted to the appropriate committee for consideration and approval. Title of document: Date finalised: October 2010 Previous document already being used? Supporting staff involved in a stressful or traumatic incident, complaint or claim. Yes Dissemination lead: Print name and contact details A Bromley/K Hingley If yes, in what format and where? Proposed action to retrieve out-of-date copies of the document: Intranet to be archived. Remove form the intranet and archive previous copy. To be disseminated to: How will it be disseminated, who will do it and when? Paper or Electronic Comments All DM s.heads of Nursing/Matrons and Ward Managers Email, global bulletin Electronic Dissemination Record - to be used once document is approved. Date put on register / library of policy or procedural documents Date due to be reviewed Disseminated to: (either directly or via meetings, etc) Format (i.e. paper or electronic) Date Disseminated. of Copies Sent Contact Details / Comments Page 17 of 17