implementing the nhs complaints reform a pilot programme for pcts dr john hasler & dr jenny king
TRANSCRIPT
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)