This report presents the first year experience of NHS Boards of the new Complaints Handling Procedure (CHP) implemented in April 2017. The findings highlight the progress in complaints handling, the culture around complaints as well as the challenges and barriers faced by Boards. The report was informed by reviewing the 2017/18 feedback and complaints annual reports as well as discussions with key staff from several NHS complaints teams and with stakeholders from the Scottish Public Services Ombudsman's office, NHS Education for Scotland, the Patient Advice and Support Service and the Scottish Mediation Network.
The finding and suggestions detailed in the report focus on:
- How NHS Boards are encouraging and gathering feedback;
- How the CHP is working in the Boards and the differences it has made;
- How learning is captured and is used to drive improvements;
- The complaint process experience for complainants;
- Staff training and development and sharing between Boards;
- How the CHP is working for independent contractors and in prisons;
- Accountability and governance mechanisms;
- Reporting and benchmarking.
The findings show that the NHS Boards have made progress in various aspects of complaints handling. The key findings that emerged were:
- 1. Progress in culture: The CHP implementation has been positive for the Boards with progress in the culture around complaints, embracing learning and steadily moving away from the blame culture. Moreover, the feedback and complaints teams have been empowered by the CHP as it has enabled them to compel staff to follow their complaints process and it increased their visibility in the organisation. They are also more positively received by staff and complaints and learning are regarded more highly by senior management.
- 2. Early resolution is encouraged and getting better: The formalisation of stage one complaints and the focus on early resolution is viewed positively by the Boards. It is seen as opportunity for work done by frontline staff to be recognised and supported. Although challenges still exist, Boards are satisfied with their progress.
- 3. Increased involvement of complainants and their families in the process: Meetings with complainants and their families have increased. Boards see that the benefits of meetings outweigh the cost (timescale) as they often increase clarity of the complaint issues and expectations, lead to a quicker resolution and higher satisfaction for both patients and staff.
- 4. The complaint process experience measure is a challenge: Boards are dissatisfied with this KPI with challenges around collecting the data and analysing and using the data to inform improvement.
Encouraging and Gathering Feedback
1. Although understandably challenging for the larger Boards, Boards should consider restructuring to ensure a more integrated approach to feedback and complaints with an effort for a more systematic approach for learning and improvement.
2. Boards should consider reviewing whether they could increase the visibility of the feedback and complaints teams.
3. Healthcare Improvement Scotland and the four participating Boards could share their learning from the Healthcare improvement Scotland real-time and right-time care experience improvement models evaluation for other Boards to consider adopting these feedback models.
4. Boards should consider identifying a person in each service area as a Care Opinion responder. The central team could monitor initial responses to gain quality assurance but staff should be empowered to respond to feedback about their services.
5. Feedback and complaints webpages should aim to be simple to find and simple to understand. Ideally, there is one form or contact for both concerns and complaints and the team then applies the CHP definitions accordingly.
6. Boards need to upload their most recent annual report on their website.
Encouraging and Handling Complaints
1. Boards to consider some access to the complaints system for services for slicker communication between the central and local teams e.g. on pending actions or upcoming deadlines.
2. Continue to raise awareness among staff on CHP and empower them for early local resolution.
3. More effort for increasing contact with complainants at the beginning to clarify issues, manage expectations and explain the process.
4. Develop structured guidance for meetings.
5. Offer a debrief for staff and patients/family after a meeting for complex/sensitive cases.
6. Boards to consider reviewing whether the central complaints team have the capacity to send complaints out to relevant services soon after they are received, preferably the same day to allow enough time for care teams to investigate.
7. Boards to ensure sign off responsibilities are not delaying closure of complaints.
8. Continue to build the complaints teams and staff's confidence around closing complaints and directing to SPSO if a complainant is still unhappy once they have completed the investigation and issued their response.
9. Boards could highlight their consent issues through NCPAS whilst considering the general guidance provided in the CHP appendix 8.
10. Scottish Government to consider the impact of their requests on the NHS. They could ensure consent from the patient has been given and that the patient fully understands what information will be shared and with whom.
11. When dealing with joint complaints, Boards need to have clear communication and agreement between the organisations involved and refer to the CHP guidance.
12. It would be helpful if the NHS National Services Scotland assists with the provision of a common system and version for the territorial boards. This would ensure Datix is fit for purpose and that all Boards benefit from any changes and improvements to the system as well as ensure consistency in recording and reporting.
13. It could be useful for complaints team that have not yet done so to arrange a visit to SPSO to get a clearer understanding of their procedures.
14. SPSO could clarify their own timescales.
15. SPSO could ensure there is consistency between their investigation handlers
e.g. in what type of evidence is acceptable.
16. SPSO could offer more guidance on how frequently to keep complainant updated and how long is it acceptable to extend the timescale.
17. The mediation network could continue to clarify how mediation fits in the CHP. They could share this information along with testimonials from public services, particularly within health.
18. Boards should continue to increase the knowledge of staff in relation to the benefits of mediation and identification of where it may be appropriate within the complaints handling process. Taking up the Scottish Mediation offer of delivering workshops for staff may be beneficial in supporting this.
19. The demands on the PASS service should be monitored closely to ensure resources are sufficient to meet demands.
Key Performance Indicator One: Learning from Complaints
1. Consider including an actions tracker on Datix.
2. Service reviews could incorporate an analysis of feedback and complaints to ensure themes and matters that require more significant/wider service improvement and/or resource from the Boards are identified.
3. Boards could share resources they have for capturing learning such as reflective learning forms and response templates.
4. Continue to remind staff to include actions and learning in response letters.
5. Consider having a learning summary/form for stage two complaints including what went well and improvements identified. The management team need to commit to at least one improvement action.
6. Boards to encourage monitoring of actions/quality improvement plans.
7. Consider the healthcare analysis tool used by NHS Dumfries and Galloway to help analyse complaints and identify themes and trends.
8. Complaints teams could ask for evidence of actions to be provided immediately. This provides assurance to the Boards and they are prepared ahead for any cases that go to SPSO.
9. Complaints teams could seek opportunities for sharing learning and improvements carried out by services or the organisation via internal communications.
10. To encourage services to share learning summaries that might be beneficial for other services as well as patients.
11. Staff named in complaints could be kept informed of investigation and actions and receive a copy of the final response letter.
12. Arrangements could be put in place to support staff who are the subject of complaints.
Key Performance Indicator Two: Complaints Process Experience
1. A national approach could be developed with discussion in NCPAS to discuss Boards' concerns, challenges and ideas for solutions.
2. Consider involvement of the Scottish Health Council (SHC)to identify a national approach – e.g. NHS Forth Valley have been working with SHC on this KPI and have a revised survey form and are considering other feedback formats. It would be good if their experience were shared with other Boards. Also, it might provide better response if data is collected by an organisation independent of the Board to reduce bias and because people that were not satisfied might not see value of providing feedback.
3. SPSO could advise on the processes that are successful for this KPI in other public sectors to discuss if they could be adapted for the NHS.
4. NHS Boards to ask for guidance from the Information Commissioner about consent required for KPI 2 to ensure GDPR compliance.
5. Consider learning from the HIS real-time and right-time model, namely that qualitative feedback might be more valuable than survey data.
Key Performance Indicator Three: Staff Training and Development
1. Scottish Government could clarify the level of detail required in reporting this KPI.
2. Boards to consider whether some of the complaints related training could be made mandatory to certain staff groups or at least highly encouraged.
3. Complaints teams could seek opportunities to attend staff meetings/huddles to raise awareness of complaints issues, resources available and training.
4. Promote training and SPSO resources to contractors.
5. More training considered for frontline staff related to building confidence and managing difficult conversations.
6. Boards could review whether complaints and learning from complaints is included in senior managers' performance objectives and to consider adding these objectives if absent.
7. Frequent internal communication such as sharing Care Opinion stories, learning from complaints, patient experiences or promotion of training to maintain awareness of CHP among staff.
8. Could increase opportunities for face-to-face training for complaints teams and for contractors.
9. Could commission a training impact evaluation.
10. To discuss with NES the possibility of developing a learning network for complaints and adverse events teams.
11. To have discussions at NCPAS about the development and use of the complaints website within the knowledge network to coincide with NES' move to the new system. This could be used as a discussion forum and for sharing resources.
1. Discuss the conflicting feelings of collecting and reporting performance data for independent contractors with the Scottish Government.
2. Consider a national effort for engaging contractors including opening and promoting training to them.
3. Could review the possibility of providing access to systems (e.g. Datix) to contractors with shared experiences from Boards.
4. Could offer a point of contact in the complaints team who can offer advice and support to contractors.
5. Independent contractors could complete the CHP compliance self-assessment.
Accountability and Governance
1. Boards should consider completion of the Complaints Improvement Framework self-assessment for all areas/services, including contractors.
Reporting and Benchmarking
1. It would be helpful to have clear annual figures and percentages in the annual complaints and feedback reports. Although graphs by month are helpful to observe trends and patterns within the Board, the annual figures are important for benchmarking.
2. To discuss KPIs 1-3, especially the patient experience measure during the NCPAS meeting to clarify the requirements, discuss the challenges and to reach an agreement on what is and what is not feasible in terms of measuring, collecting and analysing this information and ultimately guidance on using this information.
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