Implementing the NHS Complaints Reform A pilot programme for PCTs Dr John Hasler & Dr Jenny King

Implementing the NHS Complaints Reform Implementing the NHS Complaints Reform

A pilot programme for PCTsA pilot programme for PCTs

Dr John Hasler & Dr Jenny King

Aims of the ProgrammeAims of the Programme

To update delegates on the current complaints process

To enable delegates to understand future reforms

To enable delegates to develop effective complaints processes

To be aware of resources available To generate ideas for rolling out further

workshops

Problematical ComplaintsProblematical Complaints

“Majority” “30%” Especially those going to 2nd stage Vexatious complaints Non responding or unco-operative

practitioners Patient expectations Timescales

Main ChallengesMain Challenges

Convincing complainants local resolution is appropriate Lack of guidance/conflicting advice Monitoring areas of concern Poor communications Organising RP panels Persistent complaints Ensuring complaints lead to improvements Tight timescales: achieving performance targets Workload Developing a recording system

Issues for the CourseIssues for the Course

Proposals for reforms Handling local concerns and performance

issues Training staff Attitudes to complaints Using complaints to secure improvements Getting FHS contractors to report

complaints CH(A)I’s relationship to PCT

Handling complaintsHandling complaints

Are we singing off the same hymn sheet?

If not – then why not? And what are the implications?

Personal experiencesPersonal experiences

Think of two instances where you made a complaint

(not necessarily in the NHS)

One where the outcome was positive and why

One where the outcome was negative and why

Discuss briefly with your neighbour

What do patients want?What do patients want?

Resolution? Retribution? Revolution?

Compensation? Explanation?

What patients want…What patients want…

Acknowledgement of the incident Explanation in clear lay language An apology Reassurance that recurrence will be

prevented

NB The majority do NOT seek financial compensation!

Sometimes things just don’t work out…Sometimes things just don’t work out…

Causes of complaintsCauses of complaints

When complaints occur they are almost all to do

with :Attitudes and behaviourAdministrationAccessibility Interpersonal skillsTime managementTeam working

Jack Sanger 2000

What the research tells usWhat the research tells us

Clinical complaints are seldom about clinical incidents

alone

Most included a clinical component and

dissatisfaction with personal treatment of the patient

or care

Complainants’ primary motive was to prevent

recurrence of a similar incident

Lack of detailed information and staff attitude were

identified as important criticisms

The Bristol Enquiry ReportThe Bristol Enquiry Report

Patients, for the most part do not want to

complain. Often they feel forced to because their

concern has been ignored or not properly

addressed.

The message is clear: improve communication

generally, be more open with patients

The system in place must be open, minimally

bureaucratic, receptive, and appropriately

independent.

Leadership dimensionsLeadership dimensions

There are 2 sorts of leadership (Hershey & Blanchard)

Leadership of tasks (requiring concentration, firmness, clarity)

Leadership of people (requiring involvement, enthusiasm, warmth)

The four key lessons of leadershipThe four key lessons of leadership

Create a compelling vision of the future Purpose and Inspiration Mission and Values Strategy and Plans

Create a committed workforce Proud to belong Thriving in the culture and climate

Create and maintain trust Competent, caring, consistent and courageous

Relentlessly pursue learning and improvement Learns rather than blames

(Bennis and Nanus)

Leading NHS teamsLeading NHS teams

“Clear leadership involves creating alignment around shared objectives and strategies to attain them; increasing enthusiasm and excitement about work, maintaining a sense of optimism and confidence, helping them to confront and resolve differences constructively.”

Michael West and colleagues

(Borrill, West et al 2001)

A model for leadershipA model for leadership

InspireVision is having the image of the Cathedral as we carve the granite

FocusFocus transforms enthusiasm into productive action

EnableEnabled people have the skills, resources and mandate to act

RewardReward reinforces behaviour and convinces people we mean what we say

LearnLearning turns failure into success and competence into excellence

Setting a new directionSetting a new direction

1 2 3 4 5

PLAN(5)

Helps (3)

Hinders (4)

In the future (1)

12345

Five achievements

Right now (2)

……Some people find visioning difficult…Some people find visioning difficult…

“The greatest danger for most of us is not that our aim is too high and we miss it but that our aim is too low and we hit it.”

Michelangelo

A positive approach..A positive approach..

“A customer is the most important visitor on our premises. He is not dependent on us – we are dependent on him. He is not an interruption of our work – he is the purpose of it. He is not an outsider on our business – he is part of it. We are not doing him a favour by serving him – he is doing us a favour by giving us the opportunity to do so.”

Mahatma Gandhi

The benefit of complaintsThe benefit of complaints

Information about complaints is free feedback about your service. This is the best form of market research you can get.

“How to Deal with Complaints” Cabinet Office

The culture in today’s NHS?The culture in today’s NHS?

CHI GMC NCAA NPSA

Audit

Lawyer

Whistle blower

Complaint

IRP

College

Appraisal

DoctorPatient

The impact of complaintsThe impact of complaints

Initial impactBeing out of control, shock, panic, indignation, fear and hurt,

vulnerability

ConflictEmotional e.g professional ID/doubts re: clinical competence;

with family & colleagues; from management of the complaint;

concern about reputation; resentment towards the complainant or Trust

Resolution Practising defensively; planning to leave;

becoming immune; seeing it as a learning experience

A culture of blame?A culture of blame?

“…physicians …..often respond to their own mistakes with anger and projection of blame, and may act defensively or callously and blame or scold the patient or other members of the healthcare team.”

Albert W WuBMJ 2000; 320: 726-727.

ExerciseExercise

What behaviours would you see in an organisation that had a positive culture?

When was the last time your morale was really high at work - what was the single most important factor that made you feel like this?

CultureCulture

Manifests what is important by how we behave, what we value, what we accept in an organisation

It is not easily changed Is set by the Chief Executive and

senior management How they view and treat complaints

will permeate the whole organisation

The climate that boosts performanceThe climate that boosts performance

ClimateJob

Involvement Effort Performance

Supportivemanagement

Clarity

Recognition

Challenge

Time commitment

Workintensity

Increasedsales

BetterAdministration

ImprovedKnowledge

Contribution

Self expression

(Study by Brown and Leigh, of medical equipment sales teams. J. Appl. Psych. 1996)

The effect we are trying to create:The effect we are trying to create:

Increased Motivation

& Commitment

More sharing of information

Less blame

Openness to learning

Culture (the way we

do things)

Climate(the way it

feels at work)

More satisfied patients and staff

Leadership

Features of a successful changeFeatures of a successful change

Offers advantages over status quo

Compatible with existing needs and values

Not too complex

Little risk

Can be tried out

Effects observable

Proposer credible

(Rodgers. E. 1983)

Introducing change – target groupsIntroducing change – target groups

Initiators (2.5%) - love change! Easily bored with established procedures, regarded as a little “flaky” or impractical.

Early adopters (13.5%) - often seen as group leaders; they realise the possible impact of change and are willing to promote it.

Early majority (34%) - need to have the change demonstrated; slower to adopt the change, but create the point at which critical mass is established.

Late majority (34%) - less enthusiastic about any change - but make the change when the benefits to them can be clearly proved. They need PROOF the change works and is for them.

Laggards (16%) - more traditional members of the organisation and only change when they see making the change as linked with their survival.

(Rodgers., E. 1983)