1. Complaint Themes Providing more detail Sally Smith Deputy Chief Nurse and Deputy Director of Quality Liz Coleman Head of Patient Experience Team

2. 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;

3. Complaints Open

4. Main Themes Problems with Communication; Problems with Clinical Management; Problems with Delays.

5. 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).

6. Hot Spots - Problems with Clinical Management A&E; HCOOP; T&O; Obstetrics; Evenly spread across sites.

7. Hot Spots - Problems with Delays A&E; General Surgery; T&O; Fewer at Kent & Canterbury Hospital.

8. 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.

9. 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.

10. 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.

11. 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.

12. Problems with Communication by Site ( April – Oct 2014) Note: All three sites have the same top four communication issues: Communication breakdown KCHQEQMWHH Doctor communication issues 132434 Misleading or contradictory information 161421 Nurse communication issues 6914 Lack of information on how procedure went 6310 TOTAL415279

13. 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.

14. Top Three Themes Finally, expressing as ratios (Oct 14): K&C:Episodes of care = 26,923 Number of complaints = 33 Ratio= 1:815 Expressed as a ratio to the number of staff= 1:24 WHHEpisodes of care= 25,936 Number of complaints= 50 Ratio= 1.518 Expressed as a ratio to the number of staff = 1:24

15. QEQMEpisodes of care = 22,929 Number of complaints = 37 Ratio= 1:619 Expressed as a ratio to the number of staff= 1:25

16. 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;

17. 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.

18. Thank you – Any Questions