Good practice in complaints investigation

“Patients and their families need to be empowered, encouraged and enabled to have their say. When they speak up, they need to be listened to and what they say should be acted on.”       
                                                           Ann Abraham to the Mid Staffordshire Public Inquiry

Dealing with complaints effectively throughout the NHS is fundamental to maintaining the confidence of patients in relation to its performance, efficiency, quality and safety of care.

Despite numerous independent inquiries and changes to the NHS complaints system, the Parliamentary Health Service Ombudsman has described the progress in improving complaints processes as “patchy and slow.”

In December 2011 the Mid Staffordshire Inquiry finished hearing the evidence into poor standards of care at Stafford Hospital between 2005 and 2009, and the Inquiry will provide its recommendations to the Health Minister in October 2012.

This article by Claire Bentley and Nadia Persaud provides a checklist to consider when managing complaints.

Recommendations to the Inquiry

The Counsel to the Inquiry has proposed a series of recommendations regarding effective complaint handling, which are as follows:

• Complaints must be embraced by trusts (and supervisory bodies) as a particularly valuable source of feedback
• Complaints must be investigated quickly, efficiently and objectively – if necessary with the use of independent expert or investigative input
• Clinicians must commit to using complaints to learn
• Complaints processes must be based on principles of candour, full disclosure of information about treatment provided and an acceptance of the value of complaints
• Dealing with complaints must be viewed as (a) a fundamental part of the hospital’s function in caring for patients and respect for their loved-ones, and (b) an opportunity to improve performance and prevent future harm
• National guidance and standards on complaints handling should be drawn up as a priority (probably by the CQC). The complaints system needs to be clearer, transparent and homogenous through the service
• Management and Boards must receive information on the detail of complaints to enable them to know realistically the experience of patients in their organisations
• The availability of independent impartial advice is crucial to assist patients who are unable to find satisfaction in the internal hospital complaints process, and should be widely publicised
• It is critical that the regulator has access to sufficient information about complaints to allow them to be able to identify trends, which may indicate poor standards of care
• CQC should have as open access to core complaints material as is feasible
• More information should be made publicly available (and available to those overseeing quality within the NHS) in relation to complaints
• Consideration should be given to whether the statutory role of the PHSO should be widened or better resourced to enable formal investigation into a greater proportion of complaints
• Patients and the public must be informed of how to raise concerns outside their hospital’s own structures. Ideally, there should be a single point of contact, such as the CQC or Healthwatch

Checklist for Complaints Departments

The Inquiry’s actual recommendations in relation to the handling of complaints will not be known until the Inquiry reports in the autumn.  We will have to wait and see whether the Inquiry recommends significant structural changes to existing complaints handling processes. 

However, in the meantime, all NHS organisations should revisit the effectiveness of their complaints processes in the light of one fundamental question - Are complaints being investigated because they have to be, or because of a passion and desire to improve the organisation and the patient experience?

A consideration of the themes emerging in the evidence to the Inquiry highlights a number of practical points for complaints departments to consider:

Are complaints given a sufficiently high priority?

• Do those staff responsible for the management of complaints have sufficient status and authority to get responses from clinical staff?

Is your complaints management process fit for purpose?

• Is your PALs service properly resourced and does it have sufficient training and skills to be able to function properly?
• How do you prioritise which complaints are dealt with first?
• Do you identify and document a complainant’s expectations at an early stage?
• Do you have a system for checking that reports are complete and all relevant documentation is attached?
• Are your clinicians allocated sufficient time to respond to complaints?
• Do you challenge where clinicians are not providing quality and timely responses to complaints?

How do you ensure that the voice of the patient is embedded in the system?

• Do you have a range of approaches to obtain feedback from complainants?
• Are complainants always offered a face to face meeting?

Is impartial advice readily available to your patients? 

• Have you identified a straightforward way of explaining to patients how to make a complaint and how it will be progressed and handled?
• How do you make patients aware of the role of PALs, ICAS and the Ombudsman?
• How do you support frail, vulnerable and disabled people in the complaints handling process?

How do you promote public confidence in the merit of complaining?

• Do you make comprehensive, relevant and meaningful information about complaints publicly available?
• What steps do you take to reassure complainants that a complaint will not adversely affect the care that they or a relative receives?
• Do you publicise the changes made as a result of complaints?

Does the culture of your organisation positively embrace complaints?

• How do you ensure that your clinicians take the time to assist in the preparation of investigative reports into complaints?
• Do your senior executives lead the way in valuing and learning from complaints?
• Do your staff acknowledge mistakes and apologise in a personal and compassionate way?

Do your staff understand the importance of an effective complaints process?

• Do your clinicians take ownership of complaints?
• How do you support staff who are the subject of a complaint?
• What active steps are you taking to establish an open, positive, sensitive and constructive complaints handling culture?
• Do you welcome any issues staff may raise as causes for concern as demonstrating a desire for improvement?

Are your staff well trained?

• What training do you provide to complaints managers and front line staff to improve their skills and attitudes to complaints?
• Do staff have sufficient guidance to enable them to follow NHSLA guidance when responding to complaints?
• Do staff understand the role of PALs, ICAS and AvMA?
• Are staff aware that advocacy services are available for people making complaints?
• Do staff have sufficient knowledge of other services to assist patients, such as signers, interpreters, access to Language Line, and medicolegal advice to explain terms or concepts?

How well do you monitor the resolution of complaints?

• Have you established a tracking system setting out time scales, costs incurred, any action taken and if appropriate, any changes to services as a result of complaints?

How accountable is your complaints process?

• Do you make sure that you identify the author of investigation reports on the report?
• How do you hold staff to account for the quality of their reports and responses?

How well do you learn from your complaints?

• Do you have central co-ordination of all complaints to facilitate learning and themes?
• Does every investigative report explain what steps have been taken to ensure that mistakes are not repeated?
• Is the implementation of action plans following complaints monitored?
• Do complaints files remain open until the action plan has been implemented, and is failure to implement escalated?
• How do you evaluate risks to quality and safety? Do you analyse patterns of complaints alongside information from incidents?
• How do you ensure that identified learning points are actioned throughout your organisation?
• How regularly do management and the Board receive reports on complaints?
• Do the reports contain a summary of trends in complaints, breakdowns by division, number and theme and details of particular complaints to illustrate problems?
  

How can we help?

We understand that the management of complaints can be very sensitive and time consuming. It is important, however, for organisations to handle complaints efficiently in order to maximise the opportunities complaints provide for learning and improvement of the quality of care.  Our experienced team of specialists at Bevan Brittan can help with training your staff to address complaints effectively and can provide assistance with complex cases.