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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Background
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
TOTAL
KCH 13 16 6 6
41
QEQM 24 14 9 3
52
WHH 34 21 14 10
79
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.
Outcome:
Complaint upheld – telephone numbers on appointment letters were incorrect.
Actions:
• 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.