The aim of the project was to see every complaint as a learning opportunity to support healthcare staff to improve patient experience. By applying CG138 NICE patient experience in adult NHS services and QS15 NICE quality standard for patient experience in adult NHS services, we categorised and themed our complaints, then supported healthcare staff to focus on improving the quality of care where themes emerge and practice is identified as poor through this process. We then focused on improving the patient experience of the complaints process to prevent added distress to the complainant/patient/carer, rebounds to the Trust and escalation to the Parliamentary and Health Service Ombudsman.
Aims and objectives
Objective 1 - Categorise complaints by NICE patient experience guidance. Identify themes and areas of poor practice.
Objective 2 - Focus on complaints rather than surveys. Discover and address areas where we are failing rather than seeking re-assurance through surveys.
Objective 3 - Focus efforts to improve patient experience where practice is weaker and share good practice.
Objective 4 - Focus on improving the patient experience of the complaints process to prevent added distress to the patient/carer, rebounds to the Trust and escalation to the Parliamentary and Health Service Ombudsman
Reasons for implementing your project
In February 2012, NICE published guidance for patient experience in adult NHS services, however our understanding of the patient experience and how this can be improved is still developing (NICE, 2012). About 50% of NHS complaints relate to patient interactions with healthcare staff, and therefore improving patient experience requires a culture shift (NICE, 2012). Our annual complaints report established that as an organisation, we did not appear to be truly learning from complaints as the same themes emerged year on year. The culture shift required in our Trust therefore was to see every complaint as a learning opportunity. Most complaint letters contain an emotional journey with positive and negative experiences; therefore complaints provide us with an opportunity to both recognise good practice and improve services. However, most complaint letters also bring about emotional responses in staff, which can lead to defensive attitudes. Using the NICE guidance lessened emotional, defensive responses and enabled staff to be more analytical of complaints in order to learn from them.
How did you implement the project
- Coded all complaints to QS15 quality standards of the NICE patient experience of adult NHS services guidelines (CG138) using our complaints recording system Datix.
- Trained PALS team to code the complaints using key words used in the complaint.
- Coded to more than one standard.
Objectives 2 & 3 - Focus on complaints rather than surveys. Focus efforts to improve patient experience where practice is weaker and share good practice, rather than seeking re-assurance through surveys.
- Quarter 1 - identified 5 standards which had the most complaints associated with them.
- Focused on Standard 1 - patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honest as this will positively impact on the other standards and corresponds to the 6 Cs of nursing.
- Quarter 2 - increase in complaints in each standard, could be attributed to the PALS team familiarizing themselves with the new coding.
- Trust executive agreed to make ward sisters/charge nurse supervisory, enabling them to be clinically based, visible and accessible to the team, patients and visitors and promote Standard 1.
- Main medical ward piloted a system of intentional rounding.
- Sisters and matrons actively met with complainants to discuss their concerns and learning was shared with ward staff.
- Quarter 3 saw a sharp decrease in complaints associated with Standard 1 and this was sustained in quarter 4.
Objective 4 - Focus on Standard 1 during the complaints process to improve the patient experience and respond more compassionately, preventing added distress to the patient/carer, complaint rebounds to the Trust and escalation to the Parliamentary and Health Service Ombudsman,
- Trained our clinical leaders in Being Open and from the National Patient Safety Agency to ensure that our staff feel confident and competent to have open and honest conversations in challenging circumstances.
- Mapped complaints using the experience based design approach (NHS Institute for Innovation and Improvement) and clinical human factors, used this emotional mapping to write a compassionate response and ensure that lessons are learnt and shared. This exercise is regularly carried out in sisters/matrons meetings, grand rounds, team meetings, junior doctors training, using 'live' anonymised complaints.
- We saw a 61% decrease in complaints coded to standard 1 in quarter 3 and this was sustained in quarter 4.
- The total number of complaints escalated to the Parliamentary and Health Service Ombudsman in 2013/14 was 1, this was an 87.5% (n=8) decrease on the previous year.
- All patient feedback is coded to QS15 NICE Quality standard for patient experience in adult NHS services. This includes Real time kiosks, PALS, Compliments, Friends & Family Test comments, National NHS Survey Programme comments, WOW! Awards (our customer service award scheme)
- WOW! Awards is an international customer service recognition scheme, they have added the QS15 standards to their administration page, which means that the other NHS organisations using the WOW! Awards can also code their nominations this includes:
- Ashford & St Peter's Hospitals NHS Foundation Trust
- Medway NHS Foundation Trust
- South Devon Healthcare Foundation Trust
- Plymouth Hospitals NHS Trust
- Solent NHS Trust
Real time patient feedback:
We shared our QS15 coding methods with St George's NHS Trust in order to put this on the real time patient feedback system (RaTE © 2013 St George's Healthcare NHS Trust). This has been added to their system for the benefit of all the NHS organisations using it:
- Croydon Health Services NHS Trust
- Kingston Hospital NHS Foundation Trust
- St George's Hospital NHS Trust
Friends & Family Test:
- We shared our QS15 coding methods with About Time Group (our text/telephone suppliers of the friends & family test), to share with the other NHS Trusts they service which includes:
- Heart of England NHS Foundation Trust
- George Eliot Hospital NHS Trust
- University Hospital Southampton NHS Foundation Trust
- Poole Hospital NHS Foundation Trust
Key learning points
- Staff can appear resistant to complaints mapping feeling that they already know how to do it. Although they may be familiar with process mapping, they had not mapped to emotions and clinical human factors before. The support of senior staff in these meetings was important to persist and overcome this resistance. Now the sessions are well received.
- Mapping emotional journeys opens up emotions in staff. Make staff aware of how they may feel during the process and ensure staff are supported during and after.
- Live complaints are used in the process mapping and although the complainant and individuals are anonymised, the clinical area is not. Therefore staff need to be open and honest and prepared to explore their poorer practice with clinical staff from other areas, in order that learning can be shared.
- We needed administration support to get the NICE quality standard put onto our Datix system (used for cataloguing complaints).
- Following a complaint mapping session, the foundation year 1 doctors gave negative feedback, which showed they had little understanding its purpose. The education lead agreed that their feedback was an emotional defensive response to the complaint rather than the session. We therefore changed the session to deliver to the foundation year 2 doctors instead, as by the second year we expect them to be more emotionally mature to benefit from it.