Not Them Again - Dealing with Complaints

Question 1

what is a complaint?

Answer 1

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”

Question 2

Who complains?

Answer 2

Patients

Colleagues

Employers

Health Boards / Heath Trusts

The GMC

The Police

The Courts

Question 3

What do People Complain About?

Answer 3

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

Question 4

what are the majority of complaints about?

Answer 4

Communication issues

Question 5

what sort of things can a patient complain about?

Answer 5

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

Question 6

when should a complaint be made in relation to the incident?

Answer 6

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

Question 7

What if your are the person complained about? What do you do?

Answer 7

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

Question 8

How do you protect yourself when dealing with complaints?

Answer 8

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

Question 9

Remember that complaints about you as a student, your behaviour / perceptions etc. could lead to a student _______ to practise hearing

Answer 9

fitness

Question 10

deadling with complaints can be significantly ________

Answer 10

stressful

Question 11

who may you seek help form when dealing with complaints?

Answer 11

Seek support of supervisors and colleagues

Should be disclosed to supervisors anyway

GP

BMA Counselling service

Student support etc

Question 12

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?

Answer 12

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.

Question 13

which proffesion tends to get the most ocmplaints?

Answer 13

GPs

Question 14

What is the New Scottish Complaints Procedure?

Answer 14

• 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

Question 15

Patients have the right to have:

Any complaint made about NHS services _____ with ________ and to have it properly investigated

Answer 15

dealt

efficiently

Question 16

Patients have the right:

To know the ________ of any investigation into their complaint

Answer 16

outcome

Question 17

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 ___

Answer 17

Ombudsman

NHS

Question 18

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

Answer 18

judicial

act

decision

Question 19

Patients have the right to __________ where they have been harmed by negligent treatment

Answer 19

compensation

Question 20

The NHS commits when mistakes happen, they do what?

Answer 20

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

Question 21

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

Answer 21

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.

Question 22

What is the guidance that appleis to doctors?

Answer 22

The General Medical Council

Good Medical Practice

Question 23

Professional Behaviour and Fitness to Practise:

in relation to a doctors fitness to practice the GMC states what?

Answer 23

Question 24

what needs to be thought about when deciding whether to refer students to fitness to practice?

Answer 24

Question 25

What needs to be thought about in regards to is it an isolated incident or part of a pattern?

Answer 25

Question 26

if a medical school has tried to support a student and it hasnt worked then what should be done?

Answer 26

Question 27

has a student abused a patients trust or violated a patients autonomy or other fundemental rights? if so what should be done?

Answer 27

Question 28

is a students health or disability compromising patient saftey?

Answer 28

Question 29

You must take part in systems of quality assurance and quality improvement to promote patient safety. This includes:

Answer 29

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

Question 30

To help keep patients safe you must:

Answer 30

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

Question 31

What Does Good Medical Practice State?

Answer 31

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

Question 32

What are the Steps to raise a concern?

Answer 32

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

Question 33

“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?

Answer 33

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

Question 34

What Might the Outcome of a Complaint Be?

Answer 34

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)

Question 35

Conclusion:

Answer 35

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