Slide 1

Report
Complaint Themes
Providing more detail
Sally Smith
Deputy Chief Nurse and Deputy Director
of Quality
Liz Coleman
Head of Patient Experience Team
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
Formal
complaints
110
139
17
44
5
1
316
Concerns
10
25
4
7
1
0
47
Total
120
164
21
51
6
1
363
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
KCH
QEQM
WHH
Doctor communication
issues
13
24
34
Misleading or
contradictory information
16
14
21
Nurse communication
issues
6
9
14
Lack of information on
how procedure went
6
3
10
TOTAL
41
52
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
= 26,923
= 33
= 1:815
Episodes of care
Number of complaints
Ratio
Expressed as a ratio to
the number of staff
= 25,936
= 50
= 1.518
= 1:24
= 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
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

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