Nick Nurden Business Partner – The Ridge Medical Practice

Don’t get bogged down – lets make a difference! We have already looked at what the HSE says in its policies and processes We are Going to look at: The role of the ombudsman Various medico legal matters How to deal with unreasonable complaints Gain some new skills to help us manage complaints It is easy to get bogged down in process and policy, My aim is to strip all that back and share some ideas that might help make a difference.

Introduction We will consider: What causes complaints and how we can avoid them Resolving issues promptly and informally Adopting a "customer service" mentality Managing complaints at a local level Learning from complaints Data Protection issues

Root Causes of Complaints Administrative mistakes Poor "customer service" Poor Communication between Doctor & Patient lack of connection with patient Misdiagnosis or Wrong treatment Failure to have hindsight

Spotting a Complaint It is often obvious when a situation may develop into a complaint, especially administrative ones. When this happens we should move to defuse rather allow it to inflame. Deal with it promptly Deal with it at the right level Don’t be frightened to say sorry! If you are at fault work as a team to offer resolution

Defusing Complaints Intervene early, before it escalates Remain calm – always be polite Create the right work environment Call patients back promptly – or speak to them before they leave Involve the "main man" – make people feel that they matter (which they do!) Don't be afraid to apologise ("I'm sorry you feel that way")

Informal Complaint Management Formal complaints are very time consuming Involve the complaints team and front-line clinicians Often are too formal and don't really appease the complainant Can be slow to respond, and (by necessity) often seem to be about covering liability Better to respond quickly and informally Important still to maintain records but these can be less onerous

Having the Right Conversation What is going through the clinicians mind? His/her late running clinic His/her volume of work Lookout for Red Flags Making sure he does miss something serious

Having the Right Conversation What is the patient thinking? Wants to chat about how hard its been to get an appointment Has a list of things that they want to discuss now they have finally got in Feels a bit over-awed by the Doctor Expects the Dr to know what is best Is frightened to ask the Doctor to explain

The appointment Guide an appointment guide which helps patients understand the unspoken 'etiquette' of the consultation. It encourages patients to play an active role and to tell the doctor or nurse what they want from their appointment. Encourage Patients to think what they want to get from the appointment Encourage them to share this with the Doctor Encourages the Doctor to have the "right conversation"

The importance of Organisational Culture The integrity of the complaints process is important and staff must be accountable for their actions achieved either by: A blame culture that seeks to find scapegoats and excuses or sees complaints as a chore A learning culture that seeks to support staff in helping the organisation to learn and improve

Developing an Open Culture Avoid a blame culture People need to be accountable but no one set out to come to work today and make a mistake need to understand the underlying causes for behaviour that leads to complaints This forms part of the accepted behaviours in your organisation

Encouraging Feedback Make complaints an integral part of the feedback mechanism Work hard to encourage positive feedback regularly Make sure that success is regularly celebrated in your organisation Make sure that this comes from “the top” Set this off against the complaints – it is far less negative

Reflecting & Learning Key aspect of complaints management Look for common themes in the complaints Facilitate the right forums for this to occur Encourage learning and sharing Need time to reflect and learn Have structure and support in place Make sure any learning is implemented

Local Complaints Processes How and where are complaints managed in your organisation? From “on high” Locally within departments Encourage local ownership Local departments investigate and respond to the complaint With help and support from the complaints “department” Have efficient systems in place

Accountability & Ownership Individual departments should own their own complaints Support with the process and the learning facilitated by the specialists This will help increase learning from the process and help to change behaviour This makes it clear that accountability for behaviour lies with everyone

Creating Frontline Resolutions Better for the operational team to deal with and respond More likely to satisfy the complainant if the response comes from them Design your processes to support this with appropriate safeguards in place Encourage direct contact between the frontline team and the complainant

Involving Frontline Clinicians If they have to deal with the fallout they may be more cautious in future Will help learning and reflection Has better impact on the patient Make sure this is done in the right spirit (and is not seen as an attempt to fob someone off)

Support Mechanism for Staff Suggesting a new role for the complaints department Complaints are stressful for staff They worry about the implications of their actions They worry about the security if their jobs Make sure the process doesn't make this worse Have in place a system that supports staff When required this needs to be robust – including counselling support where applicable

Data Protection - Confidentiality Complaints must be strictly confidential They do not form part of the medical record Any patient identifiable data must be handled in the same way as the medical record Only managers and staff actually involved in the complaint/investigation should be aware

Data Protection - Consent Ensure that you have patient consent for the use and sharing of information – this should not be implied Information should not be disclosed to a third party without consent Complaint must be made by the patient Except For Child (typically up to 16) A deceased patient – must be the personal representative Patient with incapacity Has been given explicit consent Has delegated authority to do so

Data Protection – Record Keeping Keep clear and accurate records Ensure information is stored in line with data protection rules Records should be retained for a period of 10 years Ensure any reports made are anonymised

Managing Complaints - Summary Have the right culture throughout the organisation Work harder to defuse and avoid complaint situations arising Try to make clinical consultations more effective Adopt a “customer service” mentality Facilitate local complaint resolution processes Make sure that sufficient time is spent reflecting and learning