Feedback and complaints toolkit

NHS AYRSHIRE & ARRAN FEEDBACK & COMPLAINTS TOOLKIT INTRODUCTION TO TOOLKIT This toolkit has been developed to assist all staff in the complaints process and the actions expected following successful complaint resolution It will also outline details of new feedback processes, and how to capture not only negative, but positive feedback For an organisation to achieve high performance, any opportunity for learning must be vigorously pursued Learning from complaints is therefore essential throughout NHS Ayrshire & Arran to shape our services and uphold the values of caring, safe and respectful that places the person at the centre of all we The toolkit will detail some changes to our complaint process that are designed to improve our organisational response to poor or negative experiences and make improvement an integral part of the process Throughout the toolkit, key information is highlighted to assist those involved in complaints We hope to move away from the traditional model of often complex, clinical letters to a more personal approach that reaches out to our complainant in order to reach resolution at the earliest stage possible, and to engage the complainant in the improvement process where applicable Details of training for all staff groups in our new approach to complaint handling are also included, and also details of how the complaints team can be of assistance to you This tool will be available in paper format, and online It will be regularly updated and maintained to ensure it is a valuable resource for all staff involved in any part of the complaint process As you deal with concerns and complaints, bear in mind these six easy principles to ensure both the complaints and staff can turn a negative experience into a positive learning one Get it right Be person centred Be open and accountable Act fairly and proportionately Put it right Seek continuous improvement To discuss any aspect of the toolkit, or if you have any feedback/complaint related queries, please contact me direct Laura Harvey - Quality Improvement Lead Person Centred and Customer Care Eglinton House, Ailsa Hospital Tel: 01292 513610 Laura.harvey@aaaht.scot.nhs.uk 1|Page CONTENTS • Receiving Negative Feedback as an Opportunity for Improvement o The Power of Apology o Apologies (Scotland) Bill • The Feedback and Complaints Process • Complaint Handling & Resolution o Assigning Lead Investigator o Role of the Lead Investigator o Making Contact with Complainants o Informal Complaint Handling by Clinicians o Guidance for Staff Writing Statements o Meeting with Complainants o Written Responses o Guidance for written responses o Useful Phrases for written responses o Examples Complaint Letters and responses o Classification of complaint outcome o ISD Reporting 10 10 11 14 14 15 16 17 19 20 21 23 24 • Complex Complaint Handling o Directorate Reviews o Significant Event Analysis o Choosing your review format o The role of the SPSO 26 26 29 32 34 • Learning from Complaints o Quality Improvement Plans o Learning Summaries/Notes 35 36 36 • Supporting Staff Involved in Complaints 37 • The Role of the Complaint Team o Quality Improvement Lead – Customer Care o Patient Feedback Manager o Complaint Team Leader o Complaint Officers 39 39 39 40 41 2|Page • Feedback 43 • Patient Opinion 44 • Training & Resources o Complaint Process Awareness Sessions o Complaint Training for Family Health Services o Valuing Complaints o Dealing with Difficult Conversations o Learning from Complaints 46 46 47 47 48 48 • Useful Documents & Resources o Early Resolution: Filenote o Notification of Complaint – Sample Email to Service o Complaints Checklist o Statement Template o Minutes of Meeting Template (Complaints Meeting Template) o Written Response Template (Complaint Response Template) o Timeline of Events Template o SBAR Report Template o Significant Event Analysis Report Template o Quality Improvement Plan Template o Learning Note Summary Template o Completed Learning Summary Example 49 50 52 54 56 58 60 61 62 64 65 66 67 • Glossary 69 • References & Useful Resources 70 3|Page Receiving Negative Feedback as an Opportunity for Improvement The Patient Rights (Scotland) Act 2011 aims to improve patient experiences of using health services and to support people to become more involved in their health and health care The Act raises the status and focus of patients rights and, together with supporting legislation, provides for the encouragement of feedback, comments, concerns and complaints on health care services and also clarifies the responsibilities of relevant NHS bodies and their health service providers in Scotland The delivery of healthcare is wholly reliant on people Working for NHS Ayrshire and Arran puts all members of the healthcare team in a privileged position of caring for patients and their families at some of the most intimate and vulnerable times of their lives The vast majority of patients who we care for have a good experience (about 90% from local/national data), which reflects the hard work and ethos of all staff We cannot underestimate the emotional (and sometimes physical) impact on patients and families who have a less positive experience It is therefore essential that there is a compassionate response to negative feedback that offers answers to questions, an authentic apology (where appropriate) and action that demonstrates learning in the spirit of improvement Research undertaken by the Scottish Health Council in 2009, highlighted that almost 70% of people who wish to give negative feedback feel unable to so As a learning organisation, it is important that we actively encourage and listen to feedback as an opportunity to improve Successful organisations constantly seek feedback from people using their services It is only a natural human response to take negative feedback personally (it demonstrates that you care about your work/practice) Healthcare staff have a responsibility to be professional and compassionate in their response to receiving negative feedback (This may be face to face, in written form or via a third party) It is important to process feedback from the perspective of the patient and/or family (i.e someone I have been caring for has had a poor experience) rather than a self focused response (how dare someone complain about me or my service) Reflection is the tool to processing negative feedback and working through the emotional response (shock, anger, denial, and acceptance) As individuals we use different approaches and can take a varying amount of time to complete this process It is important not to immediately respond to negative feedback until you have had time to understand and reflect on your emotional response (if at all possible) Perception is reality for patients/families providing the negative feedback and it can be challenging not to be defensive, when you feel you have done your best for the patient and/or family There are almost always learning points when we reflect on the experience of a patient and/or family Some key reflective questions include: • Have I truly listened to and understood the issues contained in the poor experience described by the patient/family? 4|Page • • • • • Are there systems and process issues that have negatively impacted on the experience of the patient and/or family? Reflecting on my practice and in hindsight would I anything differently? Were opportunities to engage and resolve the issues raised earlier missed? Would I have done anything different if a loved one of mine had a similar experience? What can I improve and differently in the future? Very occasionally negative feedback is vexatious in nature It is important to engage and listen to the patient and/or family to try and understand the strength of feeling e.g cumulative impact of previous experiences, mental health issues, and demands that feel unreasonable Engagement must be framed in balancing the duty of care to the patient with the duty of care we have to staff The impact of the emotional impact of caring cannot be underestimated It is important that staff find space and time to reflect and recharge the empathy ‘batteries’ in order to be consistently person centred Psychological ‘first aid’ is available to individuals and teams via the Staff Care Team who are involved in complex and/or highly emotive complaints The Power of Apology An apology is almost always an essential element of the resolution process for patient and families who have formally raised their poor experience Most complainants are looking for a meaningful apology regardless of the complaint being upheld by the organisation Very often a specific time can be pinpointed when an apology might have been given by frontline staff, which may have resulted in a complaint being avoided An authentic apology, along with an explanation of why their experience was poor and proposed actions to support improvement and learning together can secure resolution Litigation is usually not on the ‘radar’ of complainants and an apology is not an admission of liability An apology is a way of communicating a message which includes a number of components: a meaningful apology requires all parts to be present The apology should first of all express regret and sympathy as well as an acknowledgement of fault, shortcoming or failing Omission of one part is a partial apology and is much less powerful than a meaningful apology Many people find it difficult to apologise People not like to admit they were wrong for a number of reasons, including hurt, denial, avoidance, fear of rejection and inability to accept responsibility An authentic apology is given in the context of accepting the patient and/or their family have had a poor experience (even if there complaint is not upheld) 5|Page According to the Scottish Public Services Ombudsman (2006), the elements of a meaningful apology are: • • • • • An acknowledgement of the wrong doing Whether or not this was intentional, an apology must correctly describe the offending action or behaviour The description must be specific to demonstrate an understanding of the element of care fell below the standard expected It must also acknowledge the resulting impact on the person(s) who had the poor experience Accepting responsibility for the experience and the harm done This includes identifying who was responsible A clear explanation as to why the poor experience happened This should show that the experience was not intentional or personal Although most people will want an explanation, this is not always the case Also if there is no valid explanation, then one should not be offered The responsible officer may wish to say that there is no excuse for the poor experience or behaviour Expressing sincere regret This demonstrates that the officer(s) involved recognises the stress and impact on the person(s) who have had a poor experience An assurance that any actions or omissions will not be repeated This includes an explanation of the steps that will or have been taken to put things right We all know what an authentic apology feels like Timing, tone of voice as well as content and body language for verbal communication is important Ensuring that both you and the complainant are as calm as possible is important to ensure the situation does not escalate However, the very act of saying ‘I’m sorry’ is often enough to calm everyone down and move on towards reaching a solution to the problem which has been identified Apologies should be given by the right person That is either the person who is responsible for the mistake or the person who is seen as speaking on behalf of the organisation Apologies (Scotland) Bill A recently passed bill, it aims to encourage the use of apologies by providing that an apology is inadmissible in certain civil proceedings This means an apology cannot be used as evidence of anything relevant to the determination of liability and cannot otherwise be used to the prejudice of the person making the apology (or on whose behalf it is made) As well as encouraging a change in social and cultural attitudes towards apologising, it is hoped that the Bill will not only help give closure to a complainant but will also potentially have huge preventative spend implications, given the length of time and cost, in what can often be a lengthy complaints procedure The Bill will therefore cover complaints in the public, private and voluntary sectors and between individuals 6|Page The Feedback and Complaints Process All poor experience – concerns and complaints Complaints Team Classify - Determine Communication Mode Log onto Datix Pass to nominee for early resolution within working days Nominee to contact Patient/Carer/Family Confirm key issue(s) and provide indicative timescale for resolution/agree timescale for further contact (If patient/carer/family wishes concerns to be treated formally then move to 20 day response) Nominee seeks information from ALL relevant stakeholders*¹ (using most timely communication method) Resolution focused contact with Patient/Carer/Family Resolving simple *² issues Telephone call or face to face meeting with nominee (service manager) or most relevant clinician Resolving complex *³ issues Face to face meeting involving nominee, clinicians*⁴ +/- complaints team Resolution meeting – action focused: • Explanation • Improvement actions • Authentic apology • Further care and treatment Resolution Achieved N O YES File note (including agreed actions) to complaints team Written acknowledgement *4 only required if asked for QIP completed Datix closed 7|Page CONSIDER A Further meeting with nominee to resolve outstanding concerns *5 B Escalation to next line management level C Refer to Improvement Lead for consideration of directorate review or Significant Event Analysis Resolution Achieved *⁶ No Y E S Response within 20 working days outlining response to issues within complaint, actions and any QIP’s included and options i.e SPSO Datix closed File note to complaints (including agreed actions) written acknowledgement only if asked for Feedback on outcome to ALL stakeholders involved * (offer debrief) QIP actions implemented by action owners Learning identified and shared Shared learning discussed/tabled at team meetings/governance group Stakeholders Simple Complex Clinicians Consider Options Resolution Feedback All clinicians named and those with overall responsibility for care – consultant/senior charge nurse Remember emotional impact for those directly named or involved Remembering concerns are not SIMPLE for those providing feedback Simple resolvable issues not involving multiple services or clinicians or issues Multiple issues/involving more than one service/end of life care/sudden death Judgment is required about who to involve, meetings should involve no more than three people without (there will be exceptions) Judgment is required regarding next steps – A, B, C – can all be used and repeated if required Any follow up actions included in file note including timescale for further Patient/Carer/Family contact ALL involved should receive file note/response letter and verbal feedback Debrief should be routinely offered 8|Page The ethos behind the new complaints process as outlined in the flow chart is a focus on early engagement to support action focused local resolution The Feedback and Complaint process outlined previously fulfils the requirements of the Patients Rights Act (2011), including a working days target for early resolution of concerns and the 20 working day target for a formal response There are numerous potential risks to the organisation if complaints are not handled well or fairly, resulting is criticism not only by service users, but by government organisations, public service ombudsman, media and other organisations It is therefore a priority for all service leads to ensure that complaints are handled in an effective, timeous manner and that where possible; we uphold the values of the organisation in an honest and transparent manner However, all service staff must remember that effective complaint handling does not end at resolution – indeed that may be considered the start of the learning period Improvement and learning resulting from complaints is an integral part of any high performing organisation and details of how to ensure effective learning occurs is shared and is discussed more fully within the toolkit Remember – think of the positive value of complaints;       They are a measure of quality They can be a catalyst for positive change They assist future planning They reflect opinions and views of our users They project the image of the organisation They can be an early warning system of service issues 9|Page NHS AYRSHIRE & ARRAN STAFF STATEMENT Patient Name: Complaint / Datix Reference: Statement Note Form Name: Post Title / Qualifications: Date of Incident: Name of Clinician: GMC/NMC/Pin Number: Details/Comments: 56 | P a g e Name (Please Print) Signature: Date: 57 | P a g e COMPLAINTS MEETING TEMPLATE This template must be completed at all meetings by a member of the Complaints team Meeting notes must be completed and filed within the complaints file within 48 hours of the meeting taking place COMPLAINT REFERENCE DATE OF MEETING PRESENT AT MEETING (Identify Meeting Lead) MAIN POINTS OF COMPLAINT (May be useful to complete prior to meeting ) MEETING DISCUSSION 58 | P a g e AGREED POST MEETING ACTIONS &PERSON/S RESPONSIBLE OUTCOME Can the Complaint be closed? Does the complainant wish a written meeting summary? Comments MEETINGS NOTES TYPED AND ADDED TO COMPLAINT FILE DATE: SIGNATURE: Must be signed by Manager/Clinician present 59 | P a g e Eglinton House PO Box 13 Ailsa Hospital Dalmellington Road AYR Ayrshire, KA6 6AB Tel: (01292) 513600 www.nhsaaa.net Private & Confidential Date Your Ref Our Ref 1506C Enquiries to: Complaints Department Direct Line 01292 513620 Fax 01292 513665 Email Dear Ms , Free Text If you require any further information or advice regarding your complaint, please not hesitate to contact: You also have the right to ask the Scottish Public Services Ombudsman (SPSO) to consider your complaint The ombudsman is the final stage for complaints about most organisations providing public services in Scotland Their service is independent, free and confidential You may contact the SPSO directly and I enclose a leaflet about their services Yours sincerely, Service Lead Enc 60 | P a g e TIMELINE TEMPLATE DEMOGRAPHICS Age BMI Smoker Past Medical History Special Features Date/Time Use this to detail social history Details of inpatient/outpatient care Details of complaint if relevant Event/Details Issues/Concerns comments This should be used to detail clinical care during admission and should be gained from medical and nursing notes, results etc The level of detail required will depend on the issues and the facilitator should determine that prior to completing Once completed it should be shared with the review team and any additional material needed should be identified by the team 61 | P a g e Directorate Review SBAR Report ID Number: Datix Author(s): Situation 1.0 Background 2.0 Process of Review The review Team was led and chaired by The review team consisted of: • The review involved: (add / remove as appropriate) • • • • • 2.1 Creation and consideration of timeline Review of case records Staff statements Two meetings of the review group Application of root cause methodology Background Information Regarding the Patient Assessment 3.0 3.1 3.2 62 | P a g e 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 Identified Clinical/Service Delivery Issues Clinical Care/Communication Issues: 3.11 The review group were of the opinion that Learning Points 4.0 4.1 Recommendations 5.0 5.1 5.2 Wider sharing and Learning 6.0 This case should be presented to the Clinical Governance Groups and disseminated for the purposes of learning/reflective practice 63 | P a g e Significant Event Analysis Title: Lead Reviewer: Members of Review: Outcome: (See guidance on outcome categories) What Happened? Why Did It Happen? What Has Been Learned? What Learning Needs to Be Shared? (Document type of learning) If you have any comments about this, please contact; Laura Harvey – Quality Improvement Lead Laura.harvey@aaaht.scot.nhs.uk 64 | P a g e Quality Improvement Plan for Complaints - Please ensure a copy is sent to the Complaints Team in order to close the complaint Date Plan Actioned: Owner: Date Actions Completed: Action Required Complaint & Full Response has been shared with the appropriate team Person Responsible for Action Management Lead To be completed by Status (provide some detail of progress) The complaint can only be closed when there is evidence it has been shared with the team involved so learning can take place 65 | P a g e ACUTE SERVICES LEARNING NOTE CATEGORY: TARGET AUDIENCE: KEY WORDS: DATE OF DISTRIBUTION: WHAT HAPPENED? WHAT WENT WELL? WHAT CAN WE IMPROVE? WHAT HAVE WE LEARNED? ADDITIONAL INFORMATION 66 | P a g e ACUTE SERVICES LEARNING NOTE CATEGORY: Failure to recognise deterioration/Communication failures TARGET AUDIENCE: Acute Nursing & Medical Staff KEY WORDS: AKI, Communication, Fluid Balance DATE OF DISTRIBUTION: August 2015 WHAT HAPPENED? The patient was a 73 year old female who lived at home with home care support Whilst mainly independent with support, she was being investigated for memory problems Patient was admitted on 3rd April 2014 with a provisional diagnosis of transient ischaemic attack (TIA), with day history of increasing confusion, weakness, lack of appetite, intermittent slurred speech, and facial asymmetry She was admitted for the emergency department (ED) directly to an acute medical bed and was treated for Acute Kidney Injury (AKI) and was investigated for likely malignancy, until her death on 11th April 2014 Despite an ultrasound carried out on the day of admission showing hepatic metastases, a cancer diagnosis was not shared with the family until the day before her death, and, despite worsening renal function, staff did not recognise that her IV fluid therapy was not being administered as prescribed, resulting in dehydration Also, poor cognitive function was not recognised as acute delirium and instead was attributed to anxiety WHAT WENT WELL? Assessment in the Emergency Department was carried out to a high standard by the multidisciplinary team that included a cognitive function assessment by the elderly mental health nurse and a care of the elderly consultant as part of the Frail Elderly ED Pilot WHAT CAN WE IMPROVE? The review group were of the opinion that many aspects of this patient’s care fell below the expected standard, and that care could have been better managed from both the patient and family perspective if a number of opportunities had been taken to; • Despite failure to recognise acute delirium during the ward assessment, nursing staff recognised the increased risk of falls and monitored the patient accordingly, preventing any further harm from a fall • Recognise the deterioration in the patient using the organisational processes in place, and communicate this more openly to family Follow the organisational processes in place to ensure optimal management of Acute 67 | P a g e The family found some members of nursing and medical staff to be supportive, compassionate and caring • • • Kidney Injury Recognise and treat acute delirium Listen to the concerns voiced by family members and ensure they had access to senior staff responsible for their relative’s care Employed better communication around the end of life phase of illness, including meaningful discussions about resuscitation decision WHAT HAVE WE LEARNED? A lack of a clear organisational policy around IV fluid administration and fluid balance monitoring contributed to the failure to recognise this patient’s deterioration – this is currently being progressed by a short life working group Their recommendations include ; adopting an acute services fluid balance chart and a hydration policy Time bundle for patients with cognitive dysfunction needs to be spread across the organisation following successful testing in acute elderly – this will be progressed with the support of the quality improvement team Communication with patients and their families during acute illness is very important – hearing families concerns can assist in diagnosis and management and should always be considered All staff in acute services are reminded to ensure accurate documentation, particularly around communication with patients and their families There was a delay in recognising the deterioration in this patient – the deteriorating patient improvement programme is now being spread and will assist staff to improve their recognition and management of acutely deteriorating patients ADDITIONAL INFORMATION This learning summary will be used to develop a patient story to promote learning and reflection 68 | P a g e Glossary Quality Improvement Plan QIP Scottish Public Services Ombudsman SPSO Information Statistical Data ISD Significant Event Analysis SEA Significant Adverse Event Review SAER Patient Opinion PO Patient Feedback Manager PFM 69 | P a g e References & Useful Resources Patients Rights (Scotland) Act (2011) Scottish Health Council 2009 Scottish Public Services Ombudsman (2006) Apologies (Scotland) Bill http://www.gov.scot/Resource/0040/00407731.pdf - Your Health Your Rights http://athena/patcommrels/complaints/Documents/canIhelpyou.pdf - Can I help you http://athena/patcommrels/complaints/Documents/Complaints-leaflet-AA-2012.pdf complaints leaflet http://www.spso.org.uk/sites/spso/files/communications_material/leaflets_buj/2011_March_SPSO%20Guid ance%20on%20Apology.pdf Guidance on apology http://www.patientadvicescotland.org.uk/ PASS 70 | P a g e