Managing Complaints
Jon Wigmore Head of Complaints Resolution & Litigation Guy’s and St Thomas’ NHS Foundation Trust
- Foundation Trust since 2004
- 900 year history
- Three hospitals on two separate sites
- 750,000 patient contacts per year
- Annual Budget approx. £700m
- 9,000 staff
Complaints hurt
“It's my belief we developed language because of our deep inner need to complain”. Lily Tomlin
“He who avoids complaint invites happiness”. Abu Bakr
“The usual fortune of complaint is to excite contempt more than pity”. Samuel Johnson
Improving services
Are we doing what we say we are doing?
Improve individual practice, systems, services, environment - Most complainants say they want this
Key area for inspection & audit
External Monitoring
- Standards for Better Health
- NHS Litigation Authority
- Healthcare Commission, Ombudsman
- Impact on GMC, NMC and legal processes
- Department of Health
- Monitor
Why complain?
- To understand what happened
- Accountability
- To help others
- For us to fix things
- Control vs powerlessness
- ‘Resolution’
Complaint triggers
- Attitude
- Communication
- Worried about vulnerable person (carers)
- Lack of ‘join’
- Media reportage
What you get from complaining
- Written explanation
- Fixes
- Undertakings
- Action plans
- Meetings
- ‘Resolution’
Reasons for dissatisfaction
- NHS account does not resemble experience
- Questions not answered
- Complaint handling has amplified anger
- Defensive attitudes
- No sense that anything has changed
Context
17,000 NHS staff lost Sept 2005-6 (ICHSC)
34,250 junior doctors are chasing 18,500 UK posts
59,000 physical assaults on NHS staff in 2005-06 (UNISON)
8,500 public sector targets since 1998
Turnover
How learning is lost
- The complaint (not the service failure) becomes the issue
- Service-led thinking
- Protective approach to staff
- ‘Ownership’
- Turnover
How learning occurs
- Experience
- Reflection
- Investigation, audit
- Teamwork
- Training & education
- Leadership
Clinical Governance
A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.’
Successful approaches
- Be open, early on
- Give weight to the complainant’s evidence
- Take on board patient’s total experience
- Involve the complainant in implementation
Complaints handling
Knowing the name of the person dealing with the complaint
Active contact & engagement
Checking understanding of issues / desired outcomes
Trying again
Horses for courses:
- Fixes
- Information, understanding
- Face to face and/or written answers
- Vindication, retraction, apologies
- Commemoration
- Collaboration
Case study:
Complaint
Ward environment in children’s hospital, age mix and bed management inappropriate. Limited parents’ facilities – kitchen, toilets, bathroom. Children screaming – no rest for parents or children. East Grinstead Hospital invites parents in pre-admission
Response
Busy 42 bed medical / surgical ward, Maximising bed usage means patients and carers can be inconvenienced, ‘We are sorry if you found the facilities unsatisfactory’, ‘We hope you will raise issues at the time next time’
Resolution
Notification of HCC review. In the meantime, the Children’s Hospital improved parents’ facilities & information and put into practice the visiting suggestion. The complainant was invited back to see the improvements and to see how her aim of improving the service had been realised. She then asked HCC to close the case
A duty to collaborate
- Give weight to the complainant’s evidence
- Try and understand what people want
- Keep people informed
- Involve people in implementation
Jon Wigmore 020 7188 1419 jonathan.wigmore@gstt.nhs.uk