1. Investigating Complaints Training Session
PALS & Complaints Team
Sara Chaudhry & Nadine Lipscombe PALS & Complaints Manager

2. Your
objectives

3. “an expression of dissatisfaction”
What is a complaint?
“an expression of dissatisfaction”

4. PALS Concern or Complaint?
On the spot or quick resolution
Generally less serious concerns
- Requires little investigation
Often a verbal response (but can also be a written response)
Generally responded to by the department/ward/consultant directly

5. Complaint Requires investigation Generally more serious concerns
Must be handled in line with the NHS Regulations
Requires a written response from the CEO

6. NHS Complaints Regulations
The aim of the NHS Complaints Regulations is to resolve issues at a local level, known as ‘Local Resolution’
To listen to, investigate and respond to complaints in full and use the findings to influence service improvement
If, at the end of local resolution, the complainant remains dissatisfied they have the right to take their complaint to the Parliamentary & Health Service Ombudsman
Note: As a general rule the Ombudsman will only accept a case after local resolution has been exhausted.

7. What do complainants want?
Resolution?
Retribution?
Revolution?
Compensation?

8. Why do people complain? They are angry / frightened / worried
They want someone to blame….
They require an explanation – honest
They want an apology
They want to prevent someone else having the same experience – the Trust to learn lessons
Financial gain
NB The majority do NOT seek financial compensation

9. Francis Report (Mid Staffordshire NHS Foundation Trust)
Why bother….?
Recent National reports:
Francis Report (Mid Staffordshire NHS Foundation Trust)
Serious failings at the Trust, suffering of patients, failed to listen to complaints and concerns, failed to act on poor standards, poor leadership, unacceptable standards of care
Keogh Report
High levels of patient mortality identified at various hospitals, highlighted issues around Liverpool Care Pathway, concerns regarding quality of care & treatment provided – patient experience and safety . Lack of engagement with patients and staff. Imbalance around accountability & blame rather than support and improvement

10. Think of two instances where you
Personal experiences
Think of two instances where you
have made a complaint
One where the outcome was positive and why
One where the outcome was negative and why

11. NHS Complaints Regulations Who may complain?
Any patient, current or former, using the Trust’s services
Any relative can act on behalf of existing or former patient, as long as they have the patient’s explicit consent
If the patient is deceased or unable to act for themselves, in most cases consent is required from the registered next-of-kin

12. Dealing with complaints as a member of staff – How do complaints affect you?
Can be stressful
Can be emotionally draining
Can be very time consuming
Routine work does not get done
Pressure increases
Can be rewarding

13. The Complaints Process: Local Resolution
Acknowledge within 3 working days (in line with national regulations)
Action investigation within 24 hours (from PALS & Complaints to Division)
Investigating Officer appointed (by Division) to investigate and complete investigation (approx 12 days)
Approval of Investigation Report required with ‘sign off’ for recommendations
Response sent from CEO (normally between working days. Timeframe agreed by PALS & Complaints Staff at start of investigation)

14. Investigating Officer
Sent allocation (appointed by Division – normally ACN/CD)
Sent copy of complaint, blank investigation report (IR), any other information
Medical records need to be ordered (liaise within Division to identify who is arranging this)
Carry out investigation – if investigation covers more than one Division, liaise with other IO’s
Complete IR, identify learning/recommendations and obtain approval for these
Send IR back to Division Lead for approval
Approved IR sent back to PALS & Complaints
CEO letter and report checked & sent

15. The report/response to complaint
a summary of the complaint
result of investigation (including explanations of what went wrong / what is the normal process etc)
an apology (if relevant)
what actions will be taken, by when
who is responsible for making this happen
what steps have been taken to prevent the same thing happening to other people
the report/response should be balanced, factual and impartial, as well as clear and easy to understand (do not become defensive)
response also needs to include advice on what the complainant should do if they remain unhappy

16. Managing your time Ensure medical records are requested
Begin to do the background work immediately on receipt of the complaint
Don’t avoid it…it won’t go away…….
Set up meetings with all key personnel
Gather information, including statements, relevant policies, supporting documents etc
Complete Investigation Report – be factual, use Layman’s terms (reflect language in complaints letter)
Ensure learning/recommendations identified are discussed with and agreed with all relevant senior staff/managers

17. Feedback – result of a good investigation & response

18. What happens if the investigation and response is not adequate?
Re-opened Complaints
Audit carried out reviewing complaints re-opened between 01/01/12 to 31/12/12.
Our Trust received 444 complaints, of which 119 (27%) were re-opened

19. Re-Opened Complaints

20. Main findings of the Audit

21. Examples of complainants’ issues
No sincere apology
No sense that the complaint had been taken seriously
No process of informing the complainant that the changes had been initiated
Superficial or inadequate recommendations (e.g. nurse will be spoken to, memo will be sent out to inform staff members)
Lack of assurance that anything had changed or processes will be improved in future.
The response did not address the concerns at all

22. Examples of complainants’ issues continued…
The responses were standard and not personal
Response answered some concerns but also contained inaccurate information. (often basic information re: name, initial diagnosis or incorrect dates)
First response raised new information leading to further concerns which resulted in a second complaint.
Hospitals versions of events were incorrect
Basic information was incorrect
Inadequate remedies being offered

23. Parliamentary & Health Service Ombudsman (PHSO)
In there were 16,337 complaints received by the PHSO about NHS
7,403 of these were regarding NHS Hospitals, Specialist & Teaching Trusts
In the PHSO received 82 contacts regarding Mid Essex Hospital Services NHS Trust (we sent 23 files to PHSO)
Of these, 4 complaints accepted for investigation

24. Identifying recommendations/learning
Root Cause Analysis (RCA)
What was the root cause? (there may be more than one issue and more than one root cause)
Could this have been prevented? If so, how? (i.e. new policy / review of process / staff training)
Is this wider than this Department / Ward? (does this learning need to be shared Directorate wide / Trust wide?)
Is there a cost implication?
All recommendations must be ‘SMART’
(Specific ; Measurable ; Achievable ; Realistic ; Timely)
All recommendations must be agreed and “signed off” by relevant senior staff (i.e. Lead Nurse / Head of Nursing / Clinical Director / Department Manager)

25. Recommendations cont…
- Some recommendations may be specific to an individual complaint
- Some may be due to a number of complaints about the same or similar incidents (obvious trend)

26. System for logging and monitoring Recommendations
Approved/agreed by key senior staff
Logged by Complaints & PALS Team onto Datix Database as a new “action”
Lead person receives from Datix alerting them to the new action assigned to them
Lead person to update Datix on progress of recommendation
Lead person to close action on Datix by deadline (6 weeks)

27. Practical Exercise Investigating a complaint….
Review complaint example
What are the main issues and who do you need to speak to during the investigation?
What information do you need to enable you to complete the investigation report?

28. Review of objectives
Have we been able to cover all objectives during the session?
Are there any outstanding questions / issues?

29. Sara Chaudhry & Nadine Lipscombe PALS & Complaints Managers
Thank you
Sara Chaudhry & Nadine Lipscombe
PALS & Complaints Managers