Northern Devon Healthcare NHS Trust
Benefits of Early Resolution in the Complaints Process
Northern Devon Healthcare NHS Trust operates across 1,300 square miles in the county of Devon, providing both acute services, centred on North Devon District Hospital (NDDH), and community services, which span a network of 17 community hospitals and nine clusters, across Torridge, North Devon, East Devon, Exeter, Mid Devon, Teignbridge and West Devon.
The Trust was one of the first in England to integrate acute and community healthcare services, in 2006, adding adult community health and social care services in 2008. At any one time, the Trust supports 6,000 patients in their own homes and 600 people in hospital beds. It employs more than 4,300 staff and serves a population of around 484,000, with a budget of £209 million.
The Trust has systematically changed the way it manages complaints by introducing both verbal acknowledgement and discussion of issues raised at the outset of a complaint, alongside routinely offering a meeting with relevant staff.
This initiative provides a more responsive and supportive service to complainants and has improved the number of complaints which are resolved first time. It has also improved staff engagement with the complaints process.
The new process has systematically changed the way we manage complaints and has increased satisfaction amongst complainants and staff.
Identifying the issues by talking to the person and not just interpreting a letter enables:
- De-escalation of issues with more being dealt with on the spot as concerns are referred to appropriate managers for action, particularly when it relates to on-going care
- Quicker information being gathered from medical/nursing staff
- Issues for resolution to be signed up to by the individual
- Collaborative working between the complainant, customer relations team, service managers and clinical teams
- Clear responses can be provided, focussing on previously agreed issues, learning and associated remedial actions using a story telling approach
- An effective quality checking process by the Executive team and Chief Executive to ensure all issues have been adequately addressed
Ensuring the right people attend a meeting enables:
- Dedicated time for an open discussion to take place
- Promotes participation and involvement creating a level playing field
- Facilitates the management of anxiety creating a balance of ego states
- An opportunity to address behaviour and barriers to communication
- Positive renewal through showing compassion and the desire to learn from experiences
Addresses narrative wreckage (where we may be hung up on issues) through the ability to recount an unpleasant or traumatic experience, and by doing so and feeling truly listened to. Individuals are able to overcome issues related to the experience
This project is:
- Innovative – it is applied to all complaints and was something the trust did not undertake previously
- Leadership – it has been fully embraced and implemented by the complaints team, service managers, clinical staff and Trust board
- Outcomes – our reputation for resolving complaints first time round and cases referred to the Ombudsman is good with NO upheld or partially upheld complaints for 2012/13 or 2013/14
- Sustainability – the project has made a significant difference in relation to way the organisation manages and resolves complaints and has fully involved healthcare teams in this process to make it sustainable
- Transferability and dissemination – staff have ‘bought into’ the process and apply the principles for issues raised locally or informally. This philosophy could also be replicated in other organisations
Rationale & Context
The management of complaints within our organisation falls within the remit of the Customer Relations department who are responsible for liaising with and co-ordinating investigations undertaken by the various divisions and service areas. The team and Trust Board wanted to improve the patient experience by changing the way we manage formal complaints to ensure we resolve as many complaints as possible, first time round.
It was recognised this was not always possible through the medium of a written response and there were occasions when several complaint responses would be issued to try and resolve dissatisfaction. This was not considered good customer service and where resolution meetings were held for re-opened complaints, these helped resolve stagnated issues through the opportunity to discuss matters face to face with the relevant clinical and non-clinical staff.
The initiative described for this award was implemented to provide a more responsive and supportive service to complainants, during a time which could be very stressful, whilst maximising our ability to resolve issues in a timely way by preventing re-opened complaints and stagnated issues. Verbal acknowledgement was introduced which has allowed issues to be discussed openly and an agreement to be gained with the complainant and the customer relations team on the matters to be investigated. Where a written response is requested the summarised issues would be individually addressed within the response letter and where a meeting was agreed and held, these would inform the meeting agenda.
The verbal acknowledgment process has provided the opportunity for our complaints process to be more personalised and allow issues to be investigated and responded to in a way that is proportionate to the issues raised and in line with the complainant’s wishes. Resolution meetings facilitate an open dialogue between the patient and clinician/practitioner, and have enabled broken down relationships to be resolved.
These changes have improved the patient experience through better satisfaction with our complaints process, low numbers of complaints being referred to the Ombudsman for review and good outcomes for those complaints which have been subject to a review. This process also fulfils the requirements of the statutory complaints regulations, the Parliamentary and Health Service Ombudsman Principles for Good Complaint Handling and Remedy, alongside meetings some of the recommendations from the recent Francis, Keogh and Clywd reports.
Planning & Delivery
The changed was identified by the Customer Relations team and recommended to the Trust through existing committee structures and the senior management team. It was implemented collaboratively with service leads and clinical staff to achieve effective engagement of staff likely to be required to attend and to also ensure sustainability of the process change to support the increased number of meetings held. A meeting with divisional managers and service leads responsible for the investigation of complaints was held by our Director of Nursing to discuss the proposed changes and any considerations the divisions/service areas may have in relation to capacity to release medical and nursing staff to attend meetings and administrative staff to note the meeting.
Once agreed the following process was put in place:
Where contact details were known and could be located, all complainants would receive a telephone call from the Customer Relations Manager within three working days once the complaint had been received and a discussion would be had on the issues requiring investigation and resolution. A meeting would be offered and for those who declined or a meeting was not appropriate (e.g. a third party solicitor or MP letter), a response via a letter would be agreed. Where a meeting was accepted the Customer Relations Manager would advise the complainant the issues identified will form the basis of an agenda for the meeting and the team would then send the relevant divisional or service area complaint lead details of the complaint, asking them to identify the most appropriate staff to attend the meeting. Possible dates and venues for a meeting would be gathered and sent to the customer relations team, who would in turn contact the complainant and offer the proposed dates.
Once a date is agreed an agenda is sent to the complainant and the complaints lead, and where necessary a pre-meet with the medical and nursing staff would be held before the meeting to ensure all of the issues raised had been reviewed and investigated prior to the meeting. Where necessary, a room would also be offered to the complainant to meet with relatives, advocates or the customer relations team beforehand, and all meetings are facilitated by the Customer Relations Manager to ensure the issues are appropriately addressed and the complainant/patient is supported through the process. The meeting would be noted and the complainant is provided with a copy of summary notes and any remedial actions identified from our Chief Executive as an alternative to a written response letter.
The impact from this project has been two fold. It has demonstrated improved patient experience through patients and their families deciding at an early stage how they wish for their complaint to be managed via a choice of options in how we respond and therefore being satisfied with the outcome, alongside improved staff experience and engagement of the complaints process and resolution of issues. The latter has required a change in practice to how our clinical staff used to respond to complaints.
The outcome of the change has been measured through satisfaction from both complainants and staff, and on a statistical level, as identified below.
No complaints were upheld in this period by the Ombudsman. Testimonials from staff attending these meetings show they have found them beneficial and we have seen changes in practices and interpersonal skills from staff as a result of attending meetings and gaining feedback directly from patients or complainants.