Transcript Slide 1

Complaint Themes

Providing more detail Sally Smith

Deputy Chief Nurse and Deputy Director of Quality

Liz Coleman

Head of Patient Experience Team

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Increased number of formal complaints over the financial year; Decreased number of compliments since the publication of the CQC Report; Inconsistent achievement of the response time standard;

Complaints Open

Division Urgent Care and Long Term Conditions Surgical Services Specialist Services Clinical Support Corporate Other TOTAL

110 139 17 44 5 1

316 Formal complaints

10 25 4 7 1 0

47 Concerns

120 164 21 51 6 1

363 Total

Main Themes

• • • Problems with Communication; Problems with Clinical Management; Problems with Delays.

Hot Spots -

Problems with Communication

• • • • • • A&E; Health Care of the Older Person (HCOOP); General Surgery; Trauma & Othopaedics (T&O); Obstetrics; Evenly spread across sites (WHH has 50 more beds).

Hot Spots -

Problems with Clinical Management

• • • • • A&E; HCOOP; T&O; Obstetrics; Evenly spread across sites.

Hot Spots -

Problems with Delays

• • • • A&E; General Surgery; T&O; Fewer at Kent & Canterbury Hospital.

We Care

Example 1

Patient said:

• Medical staff were not listening to her about her pain levels; • Conflicting information re long term problem.

Complaint upheld, plus After Action Review:

• Nurses were not empathetic, didn’t listen to patient and person-centred approach not provided; • No pain assessment; • No physical assessment; • No agreed plan of action.

Actions :

– Developed team knowledge about Functional Presentation; – Effective workplace culture to be developed with this team: ground rules, team vision, role clarity, when to escalate; – Multidisciplinary Team Meetings to be more structured and ‘fresh eyes’ approach; – Time for reflection regarding this case.

We Care

Example 2:

Parents said:

• No communication with specialist at another hospital; despite there being instructions on the medical records; • Doctor did not fully consider the significance of diagnosed condition; • Doctor did not complete thorough examination; • Antibiotics not administered by appropriate route.

Complaint upheld:

• Staff unaware of Special Register function; • Information was not specific with instructions for liaison with medical team.

Actions :

– Memo to all Emergency Departments to highlight Special Register function; – Laminated cards placed on PC screens; – Special Register entry for patient amended and parents agreed wording; – Parents provided with a copy of the Special Register entry so they can bring it in if they need to attend in future.

Problems with Communication by Site (

April – Oct 2014) Note: All three sites have the same top four communication issues:

Communication breakdown

Doctor communication issues Misleading or contradictory information Nurse communication issues Lack of information on how procedure went


KCH 13 16 6 6


QEQM 24 14 9 3


WHH 34 21 14 10


Clinical Management

Client said:

Could not attend appointment. Tried in vain to contact Division, no answer phones, no-one on reception. Patient now down as DNA.


Complaint upheld – telephone numbers on appointment letters were incorrect.


• Staff to be reminded that telephones and reception desks are manned and that a notice is displayed if not possible; • Computer system upgrade to address some of the DNA problems and updates of patient letters.

Top Three Themes Finally, expressing as ratios (Oct 14):

K&C: WHH Episodes of care Number of complaints Ratio Expressed as a ratio to the number of staff Episodes of care Number of complaints Ratio Expressed as a ratio to the number of staff = 26,923 = 33 = 1:815 = 1:24 = 25,936 = 50 = 1.518

= 1:24

QEQM Episodes of care Number of complaints Ratio Expressed as a ratio to the number of staff = 22,929 = 37 = 1:619 = 1:25

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Recommendations Going Forward

A focussed piece of work on Patient Experience using triangulation of all data to reduce the number of formal complaints (commenced November); – Matron Walk-Arounds; – Emotional Touchpoints – Ward Peer Review – Better use of existing data – Heat Maps, Dashboard, FFT etc.

Triaging of all complaints (commenced November); Clients will be called on receipt of their letter to agree the complaint management and what is the most important aspect for them (clarity); Apology letters up front wherever possible; Single letter from the CEO (commenced); Greater emphasis on meeting with the client to resolve issues earlier; Returning clients to be offered a meeting; Improvements in the initial response letter is in place to reduce returning complaints;

Recommendations Going Forward

• • • • • • • • • • Complaints Workshop (held in November); Performance metrics (PET & Divisions); Review of the EPR metrics to reflect performance; Escalation process in place regarding timelines (commenced); Greater visibility of themes for Divisions and Hot Spots by monthly reports; Ensure the investigations identify the root cause (commence in December); Sharing of the learning Trust wide; Divisional accountability of recurring themes or people; Training; All expressed in the Trust wide Improvement Plan.

Thank you – Any Questions