Implementing the NHS Complaints Reform A pilot programme for PCTs

Dr John Hasler & Dr Jenny King

Aims of the Programme

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To update delegates on the current complaints process

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To enable delegates to understand future reforms

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To enable delegates to develop effective complaints processes To be aware of resources available To generate ideas for rolling out further workshops

Problematical Complaints

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“Majority” “30%” Especially those going to 2 nd Vexatious complaints stage Non responding or unco-operative practitioners Patient expectations Timescales

Main Challenges

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Convincing complainants local resolution is appropriate Lack of guidance/conflicting advice Monitoring areas of concern Poor communications Organising RP panels Persistent complaints Ensuring complaints lead to improvements Tight timescales: achieving performance targets Workload Developing a recording system

Issues for the Course

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Proposals for reforms Handling local concerns and performance issues

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Training staff Attitudes to complaints Using complaints to secure improvements Getting FHS contractors to report complaints CH(A)I’s relationship to PCT

Handling complaints

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Are we singing off the same hymn sheet?

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If not – then why not? And what are the implications?

Personal experiences Think of two instances where you made a complaint (not necessarily in the NHS)

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One where the outcome was positive and why

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One where the outcome was negative and why

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Discuss briefly with your neighbour

What do patients want?

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Resolution?

Retribution?

Revolution?

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Compensation?

Explanation?

What patients want…

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Acknowledgement of the incident Explanation in clear lay language An apology Reassurance that recurrence will be prevented

NB The majority do NOT seek financial compensation!

Sometimes things just don’t work out…

Causes of complaints When complaints occur they are almost all to do with :

 Attitudes and behaviour  Administration  Accessibility  Interpersonal skills  Time management  Team working

Jack Sanger 2000

What the research tells us

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Clinical complaints are seldom about clinical incidents alone

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Most included a clinical component and dissatisfaction with personal treatment of the patient or care

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Complainants’ primary motive was to prevent recurrence of a similar incident

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Lack of detailed information and staff attitude were identified as important criticisms

The Bristol Enquiry Report

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Patients, for the most part do not want to complain. Often they feel forced to because their concern has been ignored or not properly addressed.

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The message is clear: improve communication generally, be more open with patients

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The system in place must be open, minimally bureaucratic, receptive, and appropriately independent.

Leadership dimensions

There are 2 sorts of leadership (Hershey & Blanchard)  Leadership of tasks (requiring concentration, firmness, clarity)  Leadership of people (requiring involvement, enthusiasm, warmth)

The four key lessons of leadership Create a compelling vision of the future

   Purpose and Inspiration Mission and Values Strategy and Plans

Create a committed workforce

  Proud to belong Thriving in the culture and climate

Create and maintain trust

 Competent, caring, consistent and courageous

Relentlessly pursue learning and improvement

 Learns rather than blames

(Bennis and Nanus)

Leading NHS teams

“Clear leadership involves creating alignment around shared objectives and strategies to attain them; increasing enthusiasm and excitement about work, maintaining a sense of optimism and confidence, helping them to confront and resolve differences constructively.” Michael West and colleagues (Borrill, West et al 2001)

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A model for leadership Inspire Vision is having the image of the Cathedral as we carve the granite Focus Focus transforms enthusiasm into productive action Enable Enabled people have the skills, resources and mandate to act Reward Reward reinforces behaviour and convinces people we mean what we say Learn Learning turns failure into success and competence into excellence

Setting a new direction

Right now (2)

1 2 3 4 5

Helps (3) Hinders (4) PLAN (5) In the future (1)

Five achievements

1 2 3 4 5

…Some people find visioning difficult…

“The greatest danger for most of us is not that our aim is too high and we miss it but that our aim is too low and we hit it.” Michelangelo

A positive approach..

“A customer is the most important visitor on our premises. He is not dependent on us – we are dependent on him. He is not an interruption of our work – he is the purpose of it. He is not an outsider on our business – he is part of it. We are not doing him a favour by serving him – he is doing us a favour by giving us the opportunity to do so.” Mahatma Gandhi

The benefit of complaints

Information about complaints is free feedback about your service. This is the best form of market research you can get.

“How to Deal with Complaints” Cabinet Office

The culture in today’s NHS?

IRP CHI Doctor GMC Appraisal NCAA NPSA Lawyer Audit College Complaint Whistle blower Patient

The impact of complaints Initial impact

Being out of control, shock, panic, indignation, fear and hurt, vulnerability

Conflict

Emotional e.g professional ID/doubts re: clinical competence; with family & colleagues; from management of the complaint; concern about reputation; resentment towards the complainant or Trust

Resolution

Practising defensively; planning to leave; becoming immune; seeing it as a learning experience

A culture of blame?

“…physicians …..often respond to their own mistakes with anger and projection of blame, and may act defensively or callously and blame or scold the patient or other members of the healthcare team.

” Albert W Wu BMJ 2000; 320: 726-727

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Exercise

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What behaviours would you see in an organisation that had a positive culture?

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When was the last time your morale was really high at work - what was the single most important factor that made you feel like this?

Culture

   Manifests what is important by how we behave, what we value, what we accept in an organisation It is not easily changed Is set by the Chief Executive and senior management  How they view and treat complaints will permeate the whole organisation

The climate that boosts performance Supportive management Clarity Contribution

Climate

Recognition Self expression Challenge

Job Involvement

Time commitment

Effort

Work intensity Increased sales Improved Knowledge

Performance

Better Administration

(Study by Brown and Leigh, of medical equipment sales teams. J. Appl. Psych. 1996)

The effect we are trying to create: Leadership Culture

(the way we do things)

Climate

(the way it feels at work)

Increased Motivation & Commitment More sharing of information Less blame Openness to learning More satisfied patients and staff

Features of a successful change

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Offers advantages over status quo Compatible with existing needs and values Not too complex Little risk Can be tried out Effects observable Proposer credible

(Rodgers. E. 1983)

Introducing change – target groups

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Initiators (2.5%)

- love change! Easily bored with established procedures, regarded as a little “ flaky ” or impractical.

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Early adopters

(13.5%) - often seen as group leaders; they realise the possible impact of change and are willing to promote it.

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Early majority

(34%) - need to have the change demonstrated; slower to adopt the change, but create the point at which critical mass is established.

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Late majority

(34%) - less enthusiastic about any change but make the change when the benefits to them can be clearly proved. They need PROOF the change works and is for them.

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Laggards

(16%) - more traditional members of the organisation and only change when they see making the change as linked with their survival.

(Rodgers., E. 1983)