Complaints: Senior Charge Nurse Acute Division Development Event

1
Complaints Senior Charge Nurse (Acute Division)
Development Event
Appendix 3

• One Way to Improve Practice?

2
Housekeeping
3
(No Transcript)
4
Joan James Divisional Nurse Director (Acute)
Appendix 4
5
Complaints
Who Do They Affect?

• Senior nurses/service managers
• GMs/ADNs/AMD
• Ombudsman
• Procurator Fiscal
• In Time

• Patients
• Relatives
• Carers
• Nursing/Medical Team
• Complaints Manager

6
Context/Professional View

• Customer Care.
• Patient Centred/Patient Focussed.

7

• Customer-
• Buyer, Purchaser, Client.
• Patient-
• A person receiving medical treatment.
• A sick person.

8
Observations of a Visitor/Carer

• Information-
• How?
• Who?

9
Visiting Times

• Outside the Ward.
• Entering the Ward.
• The Patient
• Anxieties
• Information
• The Visitor/Carer
• Anxieties
• Information

10

• HANDOVERS / REPORTS!

11

• Tae See Ourselves As Others See Us.
• (To a Louse 1786 Robert Burns)

12
Complaints
Appendix 5

• One Way to Improve Practice?

13
Complaints Today

• What do they tell us?
• How do we manage them?
• The importance of closing loops
• What support is there?

14
What do complaints tell us?

• Formal (written)
• Hairmyres 162
• Monklands 163
• Wishaw 149
• 1 for every 1416 patient episodes!

• Informal (verbal)
• Hairmyres 90
• Monklands 207
• Wishaw 68

15
Issues raised in complaints

• Formal (474)
• Clinical treatment (197)
• Oral communication (92)
• Attitude/behaviour (80)

• Informal (365)
• Oral communication (100)
• Clinical treatment (66)
• Attitude/behaviour (50)

16
What do these issues mean in practice?

• Clinical treatment
• Not ensuring patient receives correct diet no
  assistance with feeding
• Not giving medication within a reasonable time
  e.g. Parkinsons, diabetes
• Urine samples left for long periods

17
What do these issues mean in practice?

• Communication
• How we address patients honey
• Poor documentation e.g. spelling of forename /
  surname incorrect
• Lack of visibility at visiting times avoiding
  relatives

18
What do these issues mean in practice?

• Attitude/behaviour
• Throw away comments Id complain about that
  You should write to the complaints manager
• Not attending to basic details nurse call system
  / bed table left out of reach
• Inappropriate conversations in front of
  patients/relatives

19
What do these issues mean in practice?

• One poorly judged comment can escalate
  exponentially!

20
How do we manage complaints?

• An overview of the NHS Complaints Procedure
• The role of the Scottish Public Services
  Ombudsman
• A short case study

21
What is a complaint?

• An expression of dissatisfaction requiring a
  response
• May be
• Informal i.e. verbal
• Formal i.e. made or put in writing

22
Informal (verbal) concerns

• Resolve a concern before it becomes a complaint!
• Best dealt with as they occur .
• By staff as close as possible to the issue
  (usually the nurse in charge of the ward)
• If not resolved can be escalated to Senior Nurse

23
Formal complaints

• National procedure
• Must be referred to complaints manager
  immediately and without acknowledgement
• Consent issues resolved
• Acknowledged within 3 working days
• Advice on
• Independent Advice and Support Service
• Ombudsman

24
Formal complaints

• Comments sought from staff concerned, usually via
  the Senior Charge Nurse
• Remember the complainant can ask to see these
• Requests mostly scanned and emailed comments
  actively pursued
• Opportunity given to review draft response
• Response time target 20 working days if
  delayed gt 40 days can go to Ombudsman

25
Formal complaints

• Offer of further investigation or of meeting if
  unhappy with response
• Senior staff participate in follow up meetings
• Complainant not obliged to give us a second
  chance can go to the Ombudsman

26
Scottish Public Services Ombudsman

• One-stop shop
• Only Court of Appeal for a complaint
• Can investigate clinical treatment, including
  mental health
• Wide discretionary powers
• Can obtain evidence from anyone SPSO thinks is
  qualified to give it
• Same powers as the Courts to take evidence

27
Common complaints to SPSO

• Attitude of staff
• Clinical care and treatment
• Delays
• Record-keeping
• Drug administration
• Poor communication

28
Ombudsman

• Reports issued at end of investigation
• Laid before Parliament
• Absolutely privileged
• Special reports
• www.spso.org.uk

29
A Short Case Study

• 76-year old woman sickness, diarrhoea, rapid
  weight loss
• 1st GP home visit
• Sent to AE for inpatient assessment

30
A Short Case Study

• 1st SHO refuses to admit symptoms due to
  depression due to recent death of dog
• Seen by 2nd GP next day
• Sent to AE with further letter needs admitted
  for further investigation
• Seen by JHO who feels she should be admitted but
  needed to check with 1st SHO

31
A Short Case Study

• 1st SHO I told you to take (her) home, there is
  nothing wrong with her, this is a social issue
  and I will be phoning your mothers GP
• 2nd SHO then sees patient If I admit her she
  will not be getting any preferential treatment,
  she will have to wait her turn

32
A Short Case Study

• Complaint received 7 weeks later about admission
  and the attitude of the two SHOs
• MSP writes too
• Response sent
• Patient died in hospital 3 days later lung
  cancer

33
A Short Case Study

• Family asks for meeting and arrive with list of
• 27 questions
• Fluid and nutrition
• Failure to supervise medication
• Discharge arrangements
• Overall nursing care
• Delay in fitting syringe driver
• Relatives not informed patient was dying
• Clinical records inadequate
• Two hour meeting 11 pages of notes
• Follow up letter with answers to outstanding
  questions

34
A Short Case Study

• Family asks for a second meeting
• Meeting lasts 1 hour 5 pages of notes follow up
  letter
• Family takes matter out of complaints process
• Further contact from MSP
• Contact from Health Department
• Family re-enters complaints process

35
A Short Case Study

• Family is advised that there is nothing we can
  add
• Family contacts Ombudsman who decides to
  investigate
• Staff interviewed by Ombudsmans office
• Ombudsman report made public in July 2008
• National Press coverage

36
What do these issues mean in practice?

• One poorly judged comment can escalate
  exponentially!

37
The Importance of Closing the Loop

• Using complaints as a positive driver for change
  and improvement
• Take a step back
• Evidence change
• De-brief meetings

38
The Importance of Closing the Loop

• Take a step back
• Patient / relative perspective may well be very
  different to our own
• See ourselves as others see us
• Different values and expectations
• May feel vulnerable / disenfranchised

39
The Importance of Closing the Loop

• Ive discussed the issue with staff
• Are you able to evidence this?
• Ensure that you record and retain that evidence
• Provide a copy to the complaints manager
• We may have to produce it
• For the complainant
• For the Ombudsman

40
The Importance of Closing the Loop

• De-briefs started at Monklands
• Recently positively evaluated
• Being rolled out to other sites

41
What Support is there?

• From Senior Nurses
• In handling informal concerns
• Reviewing comments on formal complaints
• Chairing de-briefs

42
What Support is there?

• From Complaints Managers
• Assisting with
• informal concerns
• compiling comments
• assisting at de-briefs
• Following up on actions
• NB not a clinical perspective

43
What Support is there?

• Intranet resource
• National and local procedures
• Guide for staff
• Guidance on Statement Writing and Responding to
  Formal Complaints
• due to be updated comments welcome
• Being Open

44
What Other Support is Needed?

• Response template?
• Electronic letter template
• Framework for response
• What else?