Not Them Again - Dealing with Complaints Flashcards
what is a complaint?
The NHS states that a complaint is an expression of dissatisfaction
But we need to add: That requires a response
“a statement that something is wrong or not satisfactory”
NHS Scotland - The NHS regards a complaint as “any expression of dissatisfaction about our action or lack of action, or about the standard of service provided by us or on our behalf”
Who complains?
Patients
Colleagues
Employers
Health Boards / Heath Trusts
The GMC
The Police
The Courts
What do People Complain About?
Everything that you can think of
Alleged poor treatment
Alleged poor performance
Rudeness
Not listening
Failure to comply with job plans
Health Problems
Fraud
Criminal Offences
what are the majority of complaints about?
Communication issues
what sort of things can a patient complain about?
The things you can complain about using NHS procedure include:
Care or treatment you have had or having from the NHS
Anything to do with the place you are seen, e.g. GP practice, hospital, dental practice, optician, pharmacy, prison health centre or an ambulance
Any NHS staff member involved in your care
How NHS services are organised in your local area if this has affected your care or treatment
when should a complaint be made in relation to the incident?
Should be within 6 months of the incident or within 6 months of becoming aware assuming that it is not 12 months from the incident
What if your are the person complained about? What do you do?
Take these issues seriously
Apologise where it is necessary
Explain to the patient what has happened and why
If you are going to try and sort something out tell the patient what you are doing, when it will be done, and when it is done
Keep a record of this
Direct to the complaints procedure
Inform seniors
Inform university
Good opportunity for reflection
How do you protect yourself when dealing with complaints?
Join a Defence Organisation
Be aware of and follow the GMC’s Advice, “Good Medical Practice”
Be aware of the local complaints procedure / deal with complaints expeditiously
Put patients first and always try to act in their best interests
Do not be judgmental
Do not be afraid to refer or get a second opinion
Clinical Audit
Peer Review
Act responsibly
Do not break the law
Remember that complaints about you as a student, your behaviour / perceptions etc. could lead to a student _______ to practise hearing
fitness
deadling with complaints can be significantly ________
stressful
who may you seek help form when dealing with complaints?
Seek support of supervisors and colleagues
Should be disclosed to supervisors anyway
GP
BMA Counselling service
Student support etc
The main complaints in the NHS will be patients or colleagues complaining about a doctor, their behaviour or their treatment
hwo do NHS boards/trusts deal with complaints?
All NHS Boards, Trust etc. follow a universal complaints procedure that is very similar wherever you are working
If a complaint involves you a complaints officer will deal with it and you may well be interviewed to provide your response to the complaint.
If your employer thinks the disciplinary procedure needs to be followed, the procedure now is the same for all staff; doctors and dentists are no longer treated differently.
which proffesion tends to get the most ocmplaints?
GPs
What is the New Scottish Complaints Procedure?
- Must have a written compliant complaints procedure with clear notice of the complaints officer and the procedure. Must be available for patients – they should not need to ask for it if they make a complaint
- The main April 1st change in Scotland is that there is now a period of 5 days when the complaints officer can decide whether the complaint can be dealt with informally and during that period deals with it successfully as far as the complainer is concerned – need to tell the complainer immediately that you wish to deal with the complaint informally and gain the complainer’s agreement – DOCUMENTATION IS VERY IMPORTANT
- If following a formal procedure MUST acknowledge within 3 working days. (Prudent to do this even if using the Informal Procedure)
- Decide whether it requires written or verbal response, or a meeting, gather full information
- Give a full response within 20 days unless impossible in which case must let the patient know when they will get a response and why the delay – respond as quickly as possible is always best. Note in the response that if they are dissatisfied they can contact the complaints officer again or go to the Public Services Ombudsman; (giving full contact details of the PSO)
- Ask the patient to respond if dissatisfied but try to have responded to every point they make
- If the patient remains dissatisfied might wish to consider mediation
- Respond again and if an NHS patient advise that they can contact the NHS Ombudsman within 28 days if still dissatisfied
- The Health Board will require details of complaints quarterly
- Must comply with the Patient Rights Act
Patients have the right to have:
Any complaint made about NHS services _____ with ________ and to have it properly investigated
dealt
efficiently
Patients have the right:
To know the ________ of any investigation into their complaint
outcome
Patients also have the right:
To take their complaint to the independent Health Service ________ if they are not satisfied with the way their complaint has been dealt with by the ___
Ombudsman
NHS
Patients have the right:
To make a claim for ______ review if they think they have been directly affected by an unlawful ___ or _______ of an NHS body or individual
judicial
act
decision
Patients have the right to __________ where they have been harmed by negligent treatment
compensation
The NHS commits when mistakes happen, they do what?
to acknowledge them, apologise, explain what went wrong and put things right quickly and effectively; and to ensure that the organisation / practitioner learns lessons from complaints and claims and uses these to improve NHS services
Public Service Ombudsman
Lets Examine a Case More Closely:
Ms C complained on behalf of her son (Mr A) about the care and treatment he received following a road traffic accident. Ms C said Mr A had suffered a serious injury to his arm in the accident, which had required two operations. Following surgery, Mr A was transferred for a third operation to another NHS board
Ms C said she was told following the third operation that Mr A’s original surgery had not been properly performed and had had to be revised. She was told that the original surgery had damaged a nerve in Mr A’s arm and that he had developed a life-threatening infection
Following her complaint to the board, Ms C and her son met the board. Ms C said the board would not explain why Mr A’s first operation had been incorrectly carried out. Ms C also believed that her son’s infection had been caused by a failure to clean his wounds correctly and that the board should have identified this sooner
The PSO took independent medical advice from a consultant orthopaedic surgeon on the standard of care provided to Mr A. The adviser said that the board’s position that Mr A’s operations had been properly performed and his nerve left in the correct position was not logical. Mr A had as a consequence suffered further damage to his nerve. The adviser noted that Mr A’s wounds were heavily contaminated and at high risk of infection. However, the cleaning of his wounds and provision of antibiotics to prevent infection were carried out to a reasonable standard. Overall, the PSO found the board had failed to provide Mr A with a reasonable standard of care and treatment. The PSO were highly critical of board’s failure to acknowledge that Mr A’s surgery had not been carried out correctly, resulting in damage to the nerve in his arm
The PSO also found that the board’s handling of Ms C’s complaint was inadequate as it did not properly acknowledge the failures in care, despite the board being aware of these at the time. The PSO found that the board had failed to handle Ms C’s complaint in an open and transparent manner and failed to address the concerns of the family properly
Carry out a significant event analysis ensuring that Surgeon 1 reviews the findings of Operation 3; and
provides evidence that Surgeon 1 has reflected on the failings identified in this report as part of its appraisal process;
review its complaints investigation in light of the comments from the Adviser and provide Ms. C with a full explanation for the findings of Operation 3; and
review its handling of Ms. C’s complaint in order to identify areas for improvement and ensure compliance with the ‘Can I help you’ guidance.
Apologise unreservedly in writing to Ms. C and Mr. A for the failings identified in this report.
What is the guidance that appleis to doctors?
The General Medical Council
Good Medical Practice
Professional Behaviour and Fitness to Practise:
in relation to a doctors fitness to practice the GMC states what?
what needs to be thought about when deciding whether to refer students to fitness to practice?
What needs to be thought about in regards to is it an isolated incident or part of a pattern?
if a medical school has tried to support a student and it hasnt worked then what should be done?
has a student abused a patients trust or violated a patients autonomy or other fundemental rights? if so what should be done?
is a students health or disability compromising patient saftey?
You must take part in systems of quality assurance and quality improvement to promote patient safety. This includes:
Taking part in regular reviews and audits of your own work and that of your team, responding constructively to the outcomes, taking steps to address any problems and carrying out further training where necessary
Regularly reflecting on your standards of practice and the care you provide. Reviewing patient feedback where it is available
To help keep patients safe you must:
Contribute to confidential inquiries
Contribute to adverse event recognition
Report adverse incidents involving medical devices that put or have the potential to put the safety of a patient, or another person, at risk
Report suspected adverse drug reactions
Respond to requests from organisations monitoring public health. When providing information for these purposes you should still respect patients’ confidentiality
What Does Good Medical Practice State?
Contribute to and comply with systems to protect patients
Respond to risks to safety
Risks posed by your health
Establish and maintain partnerships with patients
Treat patients and colleagues fairly and without discrimination
Openness and legal or disciplinary proceedings
Honesty in financial dealings
What are the Steps to raise a concern?
You must follow the procedure where you work for reporting near misses and incidents. This is because routinely identifying incidents or near misses at an early stage, can allow issues to be tackled, problems to be put right and lessons to be learnt
If you have reason to believe that patients are, or may be, at risk of death or serious harm for any reason, you should report your concern to the appropriate person or organisation immediately. Do not delay doing so because you yourself are not in a position to put the matter right
Wherever possible, you should first raise your concern with your manager or an appropriate officer of the organisation you have a contract with or which employs you – such as the consultant in charge of the team, the clinical or medical director or a practice partner. If your concern is about a partner, it may be appropriate to raise it outside the practice – for example, with the medical director or clinical governance lead responsible for your organisation. If you are a doctor in training, it may be appropriate to raise your concerns with a named person in the deanery – for example, the postgraduate dean or director of postgraduate general practice education
You must be clear, honest and objective about the reason for your concern. You should acknowledge any personal grievance that may arise from the situation, but focus on the issue of patient safety
You should also keep a record of your concern and any steps that you have taken to deal with it
“I understand and will uphold that all those caring for and treating patients are bound by a Duty of Candour
What is the duty of candour?
This means that you must be open and honest with patients when something goes wrong with a patient’s treatment or care which causes, or has the potential to cause, harm or distress
If you are unsure of the consequences immediately seek the advice of an appropriate senior colleague to peer review your view and subsequently tell the patient (or the patient’s advocate, carer or family) when something has gone wrong even if the patient is not aware or has not complained
What Might the Outcome of a Complaint Be?
Sleepless nights
Anxiety
Dissatisfied patients
Litigation
Loss of reputation
Discipline
Loss of job
Fitness to practise at the GMC
Restrictions on licence
Erasure (the removal of all traces of something)
Conclusion:
Complaints are jewels to be treasured!!!!!!
Complaints can be beneficial
Complaints can be destroying
Have a written complaints procedure and train all staff how to administer it and to follow it
Have preventive mechanisms in place
Guidelines
Protocols
Read and follow the GMC’s ‘Good Medical Practice’
Remember your duty if patients are at risk
Remember your duty if your behaviour might put patients at risk
