NHS AYRSHIRE & ARRAN PATIENT EXPERIENCE ANNUAL REPORT 2018 - 2019 Contents
1. Encouraging & Handling Feedback ...... 3 1.1 How NHS Ayrshire and Arran Encourages Feedback ...... 3 1.2 Person Centred Care ...... 5 1.3 NHS Ayrshire and Arran Local Feedback ...... 11 1.4 National Feedback ...... 17 1.5 Customer Care Measures ...... 19 1.6 How Feedback is obtained by Equality Groups...... 21 1.7 Summary ...... 23 2. Encouraging & Handling Complaints ...... 23 2.1 Complaint Numbers, Stages and Response Times...... 23 2.2 Complaint Handling & Outcomes ...... 29 2.3 SPSO Activity ...... 33 2.4 Complaint Themes ...... 34 2.5 Complaint Experience ...... 35 2.6 Summary ...... 36 3.Learning & Improvement ...... 36 3.1 Learning from Complaints (KPI 1) ...... 36 3.2 Learning & Improvement ...... 37 3.3 Staff Training & Development ...... 39 3.4 Summary ...... 40 4. Governance Arrangements ...... 41 4.1 Reporting Structures ...... 41 4.2 Assurance ...... 42 4.3 Conclusion ...... 42
2 | P a g e 1. Encouraging & Handling Feedback
This section will outline the methods that NHS Ayrshire and Arran use to encourage and gather feedback from patients, carers, families and the public. The feedback sought may be targeting specific events and/or services, or it can be from individuals that have used our services. It will provide detail on the methods for feedback of both positive and negative experiences of care received or witnessed in NHS Ayrshire and Arran. This section will also detail how we have engaged with patients and carers who may have difficulty in offering feedback, and the support available to encourage their contribution.
Why Feedback is so important
There are various reasons why feedback from patients may be considered useful. These include:
• collaboration with the public to deliver and develop services • understanding current problems in care delivery • informing continuous improvement and redesign of services • helping professionals reflect on their own and their team’s practice • monitoring the impact of any changes • informing referring clinicians about the quality of services • informing patients about the quality of services and involving them to address issues or improvements • developing care pathways with patients, carers and the public
1.1 How NHS Ayrshire and Arran Encourages Feedback
NHS Ayrshire and Arran reviewed mechanisms to handle feedback and introduced a new process in June 2017, with supportive resources and promotion. This process runs in tandem with the feedback received via the independent feedback platform Care Opinion. These resources provide the information and methods people can use to give feedback to either NHS Ayrshire and Arran or Care Opinion.
3 | P a g e Other ways feedback is received by the patient feedback manager include; email, phone calls, passed from the Complaints Team or other staff in the organisation. Ten telephone calls were made to Care Opinion by members of the public in the last year, using the free phone telephone points (InfoPoints).
1.1.1 Sharing feedback
In addition to this, Facebook and Twitter are now regular ways that NHS Ayrshire and Arran share both good and not-so-good experiences and outcomes. In fact NHS Ayrshire and Arran were one of the first health boards in Scotland to share stories of a less positive nature on Social Media. We also have monthly featured feedback stories that are shared on the NHS Ayrshire and Arran’s public website. These are soon to be included on Athena, NHS Ayrshire and Arran’s intranet site.
1.1.2 Care Opinion
Care Opinion reports are shared monthly, quarterly and annually. Individual feedback is also supplied to service and staff, and also to the public if requested. Whilst Care Opinion posts can remain anonymous, approximately 36% of posters are happy to make contact with the Patient Feedback Manager or the staff involved to discuss their post or any changes that may result.
An important focus this year has been the continued spread of local responders to our care opinion posts. A range of staff now respond directly to Care Opinion posts and this has been positively received by posters and readers. Another positive outcome of this approach has been an increase in positive posts to areas where the clinical lead responds directly.
Within our Hyper Acute Stroke Unit in University Hospital, Crosshouse, the Senior Charge Nurse has embraced the role of responder to all posts relating to her area, and she is happy to promote Care Opinion amongst her patients as an easy way to provide valuable feedback. She has seen an increase in positive posts relating to her area as a result.
Over the next year, we are rolling out our responder training and aim to recruit a further 50 responders across the organisation.
4 | P a g e 1.2 Person Centred Care
NHS Ayrshire and Arran is committed to creating effective partnerships between patients, their families and carers, the wider community and staff. Their involvement is viewed as an integral and essential part of improving the quality of our services.
Our aim is for individuals, groups and communities to be engaged and involved in developing how we deliver our services. In the coming years we aim to strengthen partnership working and explore further ways to work more closely with people to share their care experiences. In taking forward the Person Centred Care (PCC) agenda in 2018/19 a number of engagement and feedback opportunities have been arranged and are outlined below.
A key aim this year has been to promote positive patient experience by keeping patients at the centre of what we do, in particular in relation to what matters to the patient, and who matters to them.
1.2.1 Ward Experience Programme
The PCC team work closely with others and use Care Opinion and Complaints as well as collaborating with staff to develop a more collaborative approach to collecting and analysing feedback. This combined programme introduces on-site coaching and support for ward staff based on organisational values, creating an enriched ward environment for all with the ultimate aim of developing a shared vision to improve patients, families and staff experiences.
The Person Centred Care (PCC) team collect experience data from patients, relatives, visitors and staff, which is then analysed to determine the level of PCC/Quality Improvement (QI) support required. This ensures that all person centred improvements are based on real experience whilst supporting staff to create an improved relationship centred culture. From April 2018 to March 2019 we completed Ward Experience in:
• 6 wards in University Hospital Crosshouse • 5 wards in University Hospital Ayr
A total of 11 wards were visited across NHS Ayrshire & Arran and, in total, we interviewed:
• 351 members of staff • 348 patients • 229 relatives/visitors
The main themes emerging from The Ward Experience programme are largely unchanged in the last two years:
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Patients and relatives/carers:
Positively:
• Praise the quality of care • Are treated with dignity and respect • Feel welcomed into the ward area
Improvements have been identified around:
• The need to involve patients and their families in all decisions about their care • Keeping patients and their families more informed about their care • Better access for carers and family members to assist with care of loved one
Staff:
Positively:
• Made visitors feel welcomed into their clinical areas • Saw the importance of involving both the patient and their families/carers in their care • Had enough access to their Senior Charge Nurse • Took time to get to know their patients as individuals • Feel more empowered to challenge bad behaviour
Improvements have been identified around:
• Giving staff praise, thanks or other recognition, especially after difficult or traumatic incidents • Improving team communication methods so all staff feel involved
1.2.2 Quality Indicators
The Person Centred Care (PCC) and Quality Improvement (QI) teams have collaborated over the last two years to bring together a series of tailored support and improvement packages to clinical areas when the Ward Experience and QI programmes have identified areas for improvement.
NHS Ayrshire & Arran are committed to creating effective partnerships with patients, their families and staff. This is an integral and essential part of improving the quality of our services. There are many precipitating factors which may impact patient, relative, visitor and staff experiences and the quality of care delivered within a clinical
6 | P a g e setting. Human factors, team relationships and improvement knowledge and skills can all impact on the experience of our patients and our staff and this programme addresses all these areas in collaboration with the ward team.
Details of some of the improvements evidenced to date include:
• Follow up ward experience after 2 years showed a large improvement in staff experience citing leadership as the main factor for this change. • New “What matters to me boards” are being tested and, providing a valued space for patients and family to record any preferences and document what is important to them during their stay in the ward. • Promoting and engaging staff in conversations with patients about who matters to them. As we move to a more person centred model of visiting this will encourage those people most important to the patient and their carers to remain with the patient as required and not restricted by visiting arrangements
These improvements are a strong indicator of the value of the Quality of Care Indicators improvement work. Staff feedback has been extremely positive and the team are enthused about undertaking further work to improve staff, patient and relative experience.
As we move towards the introduction of Excellence in Care, we are confident the Quality Indicators Programme has helped prepare staff by taking a collaborative approach to assuring high standards of care are consistently delivered in a way that promotes positive patient, family and staff experience.
1.2.3 The Caring Connections Programme
The key deliverables for the programme are highlighted below:
• Relationship Centred Care – presenting the ward experience model and attributes for successful change despite competing demands. • The impact of culture on building a strong team approach and how this impacts on patient experience • Team building • Resilience • Communication • Human Factors • Quality Improvement Session – basic instruction in the Model for Improvement, using both theoretical and practical learning, including exercises to promote a team approach to improvement, whilst building QI capacity
Full day sessions have been developed to address the identified issues and these were delivered to all members of the nursing team. The Caring Connections
7 | P a g e resource can be used as a stand-alone session in conjunction with the improvement team to deliver the necessary training and development. Six wards have had full or half day sessions from PCC facilitators with a total of 151 staff attending the workshops from April – March 2019.
Feedback from staff around the benefits of the sessions was very positive. Staff felt valued, they had a voice and enjoyed having the space to reflect and have discussion with their fellow team members. It allowed them the time to consider the impact of careless communication on patients and their families and to revisit their motivation and compassion as nursing professionals.
1.2.4 What Matters to You Day 2018
On 6 June 2018 the PCC team worked collaboratively on a number of activities to promote and inform staff, patients and their families on our person centred approach to patient and family experience. We worked collaboratively with our Alzheimer Scotland Nurse Consultant and Delirium Nurse to jointly promote Delirium Week and What Matters to You Day. These included;
• Hosting a Dementia Dog Walk around the grounds of University Hospital, Crosshouse with patients, staff, families and the local Dementia Dog training school • Hosting a Tea Party for patients with dementia and their families • Hosting information stalls on both acute sites and in our community hospital sites providing information on dementia, delirium and What Matters to You • Thomas Whitelaw (Alliance, Scotland) visited a number of clinical areas in University Hospital Crosshouse, chatting with staff about his experience as the main carer for his late mum, Joan. In the Intensive Care Unit, Thomas heard of one families excellent feedback on how included they felt whilst their brother was critically ill • Promoting the good practice demonstrated in a few key clinical areas where What Matters to You Boards are prominently displayed and regularly updated. Within both Ward 5D, and Ward 3E, staff, patients and families spoke about how useful this information was and how it improved engagement
Looking to the Future
In 2019, What Matters to You Day will become a Week in NHS Ayrshire & Arran! In addition to promoting What Matters, we will also be using this time to let staff know how much they matter and members of the Executive Team will be hosting drop in cafes to meet with staff and show their appreciation.
8 | P a g e 1.2.5 Patient Stories
NHS Ayrshire and Arran continues to use the experience of our patients and staff – both positive and negative, to support learning and improvement.
Stories are used in a variety of ways to educate, inspire, support improvement and share the experiences of our patients and our staff.
In 2018-2019, a total of 6 stories were heard at NHS Ayrshire and Arran’s Board Meetings and across the organisation at team and management meetings, public forums and to support improvement amongst teams. A further 6 were recorded for a variety of uses across the organisation and kept in a central store for future use where required.
Over the next year, work will be undertaken to ensure that all stories recorded across the organisation are registered and stored centrally where they can be accessed as required and used to their full potential.
Improvement from Patient Stories
A gentleman leaving the hospital after an outpatient appointment collapsed on the zebra crossing and emergency life support was carried
out by a nurse from the clinic who witnessed his collapse.
The story from the perspective of the patient and the nurse was used to promote the importance of all staff attending ELS training, no matter what area they work in.
1.2.6 Volunteers
NHS Ayrshire and Arran have a longstanding commitment to volunteering and recognise the benefits derived from volunteers being in place to support the service. The role of a volunteer is clearly defined as a role which predominantly is there to improve the experience of people using NHS Ayrshire and Arran services.
Over the last 12 months, Volunteering in NHS Ayrshire and Arran has undergone some significant changes to ensure that volunteers continue to contribute positively across all services provided for our patients and the local community.
The following national outcomes informed our plan over the last 12 months;
• Ensuring volunteering enhance the quality of the patient’s experience, and
9 | P a g e provides opportunities to improve the health and wellbeing of volunteers themselves • Actively supporting the development of new volunteer roles, especially for service users. Over the 12 months and beyond, a number of areas are being progressed. This includes; volunteer chaplains, dietetic volunteers to support healthy living work, physiotherapy volunteers, therapet, paediatric teaching support and wider development of the ward volunteer role • The infrastructure that supports volunteering is developed, sustainable and inclusive • Ensuring all volunteers attend mandatory training where relevant and all are aware of child and adult protection responsibilities. • New staff and volunteer handbooks are available and training DVDs are all updated to meet with GDPR and PVG requirements • We have “super users” volunteers support data input of the Volunteers Information System (VIS) ensuring all enquiries etc. are recorded and volunteer records are updated accordingly following placement or training • Volunteering, and the positive contribution it makes, is widely recognised with a culture which demonstrates its value across the partners involved. • Our public website is being updated to reflect our current processes and volunteering role opportunities • We are continuing to produce a bi-annual newsletter “Spotlight” which highlights current volunteering best practice and roles
Ward Volunteers
Over the last 12months, we have introduced the role of ward volunteers. Based on a specific ward, the volunteers work with the ward team to assist with basic tasks such as helping patients with their meals and drinks, keeping patients company and in some cases, providing useful information on certain conditions as peer supporters.
This role has been well received, with volunteers becoming valued members of the ward team; providing support to both patients and staff. Prior to entering wards, the volunteers attend relevant training, such as mealtimes training, wheelchair user training and any other days relevant to the volunteer or the ward allocated.
In addition, we now have a number of ward volunteers trained to carry out patient and relative interviews as part of our Ward Experience Programme. We find that patients and their loved ones respond well to volunteers and are more likely to speak openly to them about their experience than they are to staff when they carry out the interviews.
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Looking to the Future
Over the next 12 months, we aim to spread the Ward Volunteer programme to all acute inpatient areas before spreading to our community hospitals
We are aiming to work with No-one Dies Alone Ayrshire to
grow and develop this person centred approach.
1.2.7 The Public Involvement Network
The Public Involvement Network continues to grow. With the addition of our Public Involvement Network Group we are now visiting a variety of community venues and hospital settings to promote the network and to engage with members of our community. Our main aim is to hear what our communities think about the services we deliver and most importantly to find where members of our communities feel improvement is required. We gather the information offered to us and take this back to the relevant service leads to ensure that the public voice is heard and considered when planning, designing and delivering services. The Public Involvement Network with the assistance of our Public Involvement Network Group offers their full support to the “Caring for Ayrshire” programme.
At the start of this year we completed a cleansing of our database to ensure that the member details we hold are up to date, accurate and that we are in full compliance with the new General Data Protection Regulation (GDPR). Currently there are approximately 625 individual members and 192 groups/organisations registered with the Public Involvement Network.
We regularly share information with our public network members to hear their views and feedback and to ensure that the voice of the patient and their families are heard and used to promote positive patient and family experience.
1.3 NHS Ayrshire and Arran Local Feedback
Since its launch in 2017, we have seen a yearly increase in feedback received from the various platforms promoted using our owl feedback forms; there were 307 via the NHS Ayrshire and Arran ‘Owl’ feedback process, 22 via smart phone, 55 via the web address/computer and 307 in paper format (for scanning), totalling 394 as shown in Figure 1 below. This represents an increase of almost 85% from last year’s total of 260.
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Figure 1 – Breakdown of the method of feedback to NHS Ayrshire and Arran Number 450 394 400
350 307 300 250 200 150
100 55 50 32 0 Smart phone Owl' Website Paper/scanned Total
As demonstrated above, the majority of local feedback was received using our paper forms. This allows people using our services to use tick boxes to highlight their experience, and also provides an opportunity to provide comment further.
Analysing the feedback further, Figure 2 below demonstrates the majority of feedback reflected the Acute Services – both outpatient and inpatient, and Mental Health Services.
Figure 2 – Feedback per Service Area
300
250
200
150
100
50
0 Acute MHS Primary Care Other
In the paper feedback forms, patients were asked to rate their experience. Of the 307 forms received, over 200 chose “at ease” the most positive rating available. All other ratings can be seen in Figure 3 below;
12 | P a g e Figure 3 – Feedback Rating
Figure 4 below demonstrates how users rated their experience across a number of areas, from cleanliness and communication, to treatment and staff attitude.
13 | P a g e Figure 4
As demonstrated above, feedback was consistently positive and in all cases 95% of the feedback rating as good or very good.
14 | P a g e Below are some of the comments received via our local feedback platforms;
What a slick operation! In and out in under an hour, all ready for Feedback from a gentleman attending surgery. Thanks one Pre-op Assessment, UHA and all
Very welcoming and efficient A happy service user who attended service. Clean environment, very her local community hospital for an appointment positive experience.
Well done to all!
All the staff were helpful and
very friendly as they could see I was embarrassed.... I would like to express my gratitude and thanks to all the staff, surgeons etc. for their hard work. My operation was a great success and I am no longer in pain or discomfort. Thanks Feedback from patient in Day Surgery at again UHC
Looking To the Future
To increase feedback from our Health & Social Care Partnerships, the focus in 2019-2020 will be to engage with teams and ensure all feedback resources are available across a variety of services
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1.3.1 Improvement from Feedback
Below are some examples of how feedback can be used to make positive changes and improvements – and how small actions can have a big impact.
One small action can have a big impact!
Just before Christmas a bus driver was off sick for a long time and was now extremely distressed about money to keep his family (wife and two young children). Despite the neurologist telling the man he was fit to return to work, the man’s GP refused to sign him back to work as he had not received communication direct from the neurologist.
Contact with the appropriate secretary (on a Friday) enabled the letter to
be prioritised, typed and a communication sent to the GP on the same day. The man was back at work, earning money by the Monday.
Within 2 hours of receiving the feedback, the patient was delighted to be cleared to return to work
Feedback Received
I had a wonderful stay in the ward. The place was spotless, shower was great! The staff couldn’t do enough for me and the food was lovely.
Only one complaint – no shaving mirrors.
Action
A soon as the Senior Charge Nurse received the feedback; mirrors were purchased and available in every bathroom in the ward.
Evidencing improvement from both positive and negative experiences is an important characteristic of every learning organisation and more information on how NHS Ayrshire and Arran ensures improvements are made consistently is presented throughout this year’s Patient Experience Report.
16 | P a g e 1.4 National Feedback
1.4.1 Care Opinion
NHS Ayrshire and Arran was one of the early adopters of Care Opinion and Figure 5 below demonstrates that the number of posts have increased from almost 300 in 2015, to just under 500 this year.
Figure 5 – Number of posts per year 600
500
400
300
200
100
0 2015-2016 2016-2017 2017-2018 2018-2019
Figure 6 – Posts per month 2018-2019
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Whilst the number of posts has remained in keeping with the previous year, the criticality of posts continues to improve. Figure 7 below illustrates that over 70% of posts are rated positive. If mildly critical posted are included, this figure rises to almost 92%
.
The emerging themes from 2018-2019 are captured in the tag bubbles below;
18 | P a g e Positive themes are represented in green, with more critical themes in red. Most positive posts pertained to staff and the standards of care, whilst communication and waiting times represented the majority of negative posts.
More information on what could be improved is illustrated below.
There have been 2,000 Care Opinion posts to date, with a viewing figure of over 1 million.
The most read story of 2018-2019, with almost 300 views, is shown below. It demonstrates perfectly that everyone working in any healthcare organisation can positively impact the patient experience.
She lifted me up when I needed it most
As a first time mum I was totally overwhelmed after having my baby boy.
Adding to this both me and my baby had to stay in hospital for 10 days after he was born, with my baby having a stay in special care.
I was feeling particularly down one day and one of the domestic assistants came in to clean my room. She spoke so kindly to me and told me I was doing a good job. Her kind words and bright and friendly nature really lifted my mood. It's amazing how the small act of kindness of someone who wasn't actually in a patient care role really made me feel better. I think it's really important that people are recognised for doing a good job and are told when they make a difference. I'm sure the ladies name was Kate. Thank you Kate for lifting me up when I needed it the most.
1.5 Customerhttps://www.careopinion.org.uk/opinions/556315 Care Measures
19 | P a g e A Customer Care Audit is carried out by a wide range of staff over a period of one calendar month and it is repeated at 6 month intervals. The audit can be done at any time and some staff routinely carry this out on a monthly basis. The audit is self- reported at ward and departmental level and data inputted into our Quality Improvement Portal.
The audit measures performance against our Customer Care Commitments and are in addition to our Customer Care Learnpro module which is a mandatory requirement for all staff in NHS Ayrshire and Arran and, to date, has been completed by over 12,000 staff.
The results of this year’s audit are shown in the three charts below and demonstrate over 90% compliance for each measure.
Figure 9 – Communication Measures
Figure 10 – Environmental and Equality & Diversity Measures
20 | P a g e Figure 11 – Telephone Communication Measure
Looking to the Future This coming year, we will be reviewing our Customer Care Commitments and inviting members of the public to help us develop new commitments that best serve our patients and their families and ensure each patient contact is safe, respectful and person centred
1.6 How Feedback is obtained by Equality Groups
This section outlines a variety of ways in which we engage with specific groups as well as the wider population. NHS Ayrshire and Arran are sensitive to ensuring our approach to engagement is not tokenistic. As a public body delivering services we need to ensure any impacts faced by our service users are considered and where appropriate taken on board or at the least consider what we can do to minimise the impact. We do this through a variety of mediums including face to face engagement, public reference group, and online engagement such as patient opinion or a survey.
The Participation Network (PN) membership contains many of the equality protected characteristics. NHS Ayrshire and Arran has patient representatives in many groups. Patient and public representatives sit on health specific groups where service users become group members involved in decision making processes.
21 | P a g e Ayrshire Lesbian, Gay, Bisexual and Transgender (LGBT+) Development Group is a multi-agency partnership aiming to improve the lives of LGBT+ people. The group has representatives from the local authorities, police, health, education and third sector organisations as well as LGBT+ specific organisations such as the Terrence Higgins Trust. The group continues to provide opportunities for professionals and local people to develop their knowledge and skills, and to encourage greater interaction among communities. An annual event was held in February 2019 and this allowed greater opportunities to find out what the local LGBT+ community felt could support them better when accessing public services.
British Sign Language (BSL) engagement A BSL Action Plan Working Group was established in September 2017 to take forward a partnership approach to developing an Ayrshire Shared BSL Action Plan. This group has representation from the three Councils, three HSCPs, NHS Ayrshire & Arran, Ayrshire College and representation from the Deaf community. The working group were keen that BSL representation was involved at every stage of the development and will continue to be involved as we move forward to delivery. As well as the working group many events, meetings and engagement opportunities took place with the deaf community across the whole age spectrum to ensure their feedback was taken on board.
Helen Morgans-Wenhold from the British Deaf Association welcomed the move as a positive step, “The Ayrshire Shared BSL Plan places the region in a great position for promoting accessand inclusion for Deaf BSL users. We congratulate Ayrshire for involving BSL users in all levelsfrom the start to the end. We wish you great success for the next six years.”
BME Communities Engaging with black and minority ethnic (BME) communities has been more challenging as the Ayrshire Minority Ethnic Communities Association (AMECA) disbanded. That said, NHS Ayrshire & Arran along with our community planning partners have embarked on other ways in which to engage and seek feedback from BME communities. With the recent resettlement programmes such as the Syrian Refugee resettlement work, health have been heavily involved in supporting people to access health services as well as find out what other needs they have.
One particular piece of work which was taken forward was in partnership with CEMVO Scotland. CEMVO Scotland were commissioned to develop a Pan Ayrshire approach for engagement with ethnic minority communities across Ayrshire. As well as identifying specific issues and nuances that affect the likelihood of engagement, the objective was also to identify if there was an appetite to create a similar collective body to the previous AMECA. The rationale behind this body was to help gather,
22 | P a g e collate and share pan Ayrshire intelligence to ensure policy development was inclusive of ethnic minority communities and allow a clearer picture of the barriers and issues faced by these communities when accessing local services.
The ethnic profile of those who engaged were Gypsy Traveller, Afghan, Pakistani, Muslim, Nepalese, Sikh, and Syrian. Some of the respondents were seen as leaders or were considered representatives of their communities. The information collated through this work showed many were aware of service provision and how to access these, although we are aware there are still gaps in knowledge. We built upon this and developed a questionnaire to use at local events such as the opening of the new Mosque, to ascertain further needs of local BME groups and to gauge appetite for the development of a voluntary organisation in Ayrshire similar to AMECA. To date the feedback from those communities with whom we have engaged does not suggest the need to establish a voluntary organisation.
NHS Ayrshire & Arran provide access to interpretation support both face-to-face and telephone based and we are continually striving to improve this with digital technology.
1.7 Summary
We have seen significant increases in feedback received this year as our Owl branded feedback tools have been embedded. Care Opinion use has also increased, particularly in areas where staff have embraced the role of responders. This provides us with more opportunities to affect positive change, from small improvements, to large scale change projects.
2. Encouraging & Handling Complaints
Responding to complaints in a timeous, respectful and person centred manner is a clear ambition of NHS Ayrshire and Arran. In order to achieve this in a reliable manner, we are continually looking at ways to support service leads and clinical staff in their complaint handling processes and this year has been a busy one. This section of the report provides data and information on how we are performing in our complaint handling processes and what steps we are taking to ensure we are able to make improvements where necessary in this aspect of complaint management.
2.1 Complaint Numbers, Stages and Response Times
This year, the Customer Care Team has continued to promote early resolution and have taken a more proactive role to achieve this. The Team now makes contact with all complainants on receipt of their complaint and explains the process to them. This
23 | P a g e change was the result of SPSO feedback and user satisfaction surveys which are carried out on a monthly basis.
In addition, Section 4 sets out the rigorous reporting schedule we support to ensure all managers are sighted on their complaint priorities. This year’s report presents the data in accordance with the Key Performance Indicators (KPI)
Figure 12 – Total number of complaints received (KPI 4)
1600 1400 1200 1000 800 600 400 200 0 14/15 15/16 16/17 17/18 18/19
In 2017-18 we witnessed a rise in complaint activity which was attributed to the changes in classification from the new Complaint Handling Process. For 2018-19 the number of complaints received has risen from 1222 to 1421 - a rise of around 200. That equates to approximately 15 more per month.
Figure 13 shows total complaints received across the NHS Board in 2018-19
Figure 13 – Total Complaints received by Board (KPI 4)
1000 900 800 700 600 500 400 300 200 100 0 Acute Hospital Prisons per averge GPs Mental Health Services population
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In keeping with previous years the majority of complaints are received in relation to Acute Services (n= 900). This accounts for less than 1% complaint rate per episode of inpatient care, and less than 0.1%rate per outpatient contact.
Complaints from prisoners have increased significantly this year to 462, up from 290 last year. This year our prison population increased by 20% from 500 to 596 inmates and the number of complaints received represents 0.7% per prison population. This can also be attributed to an increase in complaints being escalated from concerns to Stage 1 & Stage 2 complaints.
Most complaints received from our prisoner population are in relation to medication, with this accounting for 82% of all complaints. The remainder relate to appointments and access to medical staff.
A further breakdown of prisoner complaints demonstrates a high number of Stage 1 escalations to Stage 2 as a result of failure to resolve at the early resolution stage.
These figures are shown in Figure 14 below
Figure 14 – Stages of Prisoner Complaints
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50
0 Stage 1 Stage 2 Stage 2 escalated
GP complaints have increased slightly from 100 to 134; whilst Mental Health complaints have seen an increase from 101 to 128. GP and Mental Health complaints account for less than 15% of all complaint activity.
Figure 15 below demonstrates complaints received for NHS Contractors. (Please note, not all contractor complaints are received via the complaint office. The figures below demonstrate those that have been recorded centrally and don’t include those that are resolved at the point of service).
As you can see, as expected, the largest proportion of complaints relate to GP services. This is in keeping with national data.
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Figure 15 – Total number of Complaints received by NHS Contractors
90
80
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50
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0 General Dental Practice General Practitioners Pharmacy (Community)
Improvement from Feedback
Prison staff asked for feedback from prisoners on how their
complaints were handled and as a result of prisoner feedback,
the Complaints Team worked with the Prison Staff to ensure
prisoners were offered meetings and provided with written
feedback following the outcome of their complaints.
The total number of complaints closed per stage in 2018-19 is detailed below. Figure 16a demonstrates the number of Stage 1 complaints made, and the percentage closed. As you can see, the percentage closed is stable across the year at around 95% closed. Those not closed at Stage 1 can be escalated to Stage 2.
Figure 16a – Total number of Complaints Closed per Board – Stage 1 (KPI 5)
26 | P a g e 100 80 60 40 20 0
Stage 1 Received % closed
Improvement from Stage 1 Complaint
• Colour coding of outpatient appointments to correspond to coloured area of hospital where clinic is held • Waiting List Coordinators responding to waiting time complaints has reduced time to response
Figure 16b below demonstrates there is much more variability in the number of Stage 2 complaints closed as a percentage of total complaints closed for 2018-19.
As Figure 16a demonstrated, a higher percentage of Stage 1 complaints are closed as a percentage of the total activity at around 95%, whilst that drops to 40-60% for Stage 2 as these tend to be more complex and often include more than one service.
In order to improve our complaint handling performance, particularly in relation to Stage 2 complaints, the Customer Care Team has been providing on site assistance to Investigation Leads, including maintaining regular contact with complainants to keep them informed of progress and to reduce any unnecessary waits
Figure 16b – Total number of Complaints Closed per Board – Stage 2 (KPI 5)
27 | P a g e 70
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10
0
Stage 2 Received % closed
Figure 16c – Total number of Complaints Closed per Board – Stage 2 Escalated (KPI 5)
110
90
70
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30
10 6 7 6 5 5 1 3 1 4 3 4 4 -10
Stage 2 Escalated Received number closed
Figure 16c above relates to small numbers of complaints that have been escalated to Stage 2. We believe our process for managing Stage 1 complaints is very successful at supporting early resolution and as a result, we rarely have to escalate. As witnessed with other Stage 2 complaints, there is variability on closure rates due to the often complex issues under investigation.
Improvement from Stage 2 Complaints
How we feedback complaints and their outcomes to the staff involved and the wider organisation has been reviewed this year and we are testing a 28 | Pnumber a g e of ways to ensure staff hear about and reflect on complaints across all directorates.
2.2 Complaint Handling & Outcomes
We have continued this year to promote early contact and 70% of complainants received a telephone call to establish how they wished their complaint to be handled. This is down from 88% last year due to the increase in the volume of complaints received. This area of performance will be reviewed in the coming year to determine how best we can ensure early contact in a more reliable way.
Figure 17a – Percentage Outcomes for Stage 1 Complaints (KPI 6) 90 80 70 60 50 40 30 20 10 0
Stage 1 Upheld Stage 1 Not Upheld Stage 1 Partially Upheld
Figure 17a shows the percentage of Stage 1 complaints not upheld has remained around 60-70 % over the year, in keeping with last year, despite the increase in complaints. Partially upheld complaints account for a relatively small percentage at around 5-10%, with a small spike evident in January to 25%. This is most likely in relation to waiting times being impacted by increased winter activity. Fully upheld Stage 1 complaints have remained under 25%.
Figure 17b – Percentage Outcomes of Stage 2 Complaints (KPI 6)
29 | P a g e 80 70 60 50 40 30 20 10 0
Stage 2 Upheld Stage 2 Not Upheld Stage 2 Partially Upheld
A little more variability is evident in Stage2 outcomes. A lower number are not upheld compared to Stage 1 and that is as a result of the complexity of Stage 2 complaints. Not upheld are around 34-50% with a spike of 70% evident in February. Partially upheld Stage 2 complaints account for approximately 20 to 30% of complaints closed at Stage 2. Fully upheld Stage 2 shows some variability from 48% to 12 %.
Figure 17c – Percentage Outcomes for Stage 2 Escalated Complaints (KPI 6)
110
90
70
50
30
10
-10
Stage 2 Escalated Upheld Stage 2 Escalated Not Upheld Stage 2 Escalated Partially Upheld
Figure 17c above shows those outcomes for Stage 2 escalated complaints are much more variable due to the small number that are escalated.
Figure 18 below shows the average working days taken to close complaints per stage. For stage 1 complaint, this figure is 4 working days and approximately 95% of Stage 1’s are closed in 5 or less working days (see Figure 16a).
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Stage 2 complaints, on average, take 30 working days to close, 10 days more than the target of 20 days. It is in this aspect of our performance that we are providing additional support to investigators to improve performance. Whilst Stage 2 escalated performance is better at 23 days on average.
Figure 18 - The Average Time in Working Days to Close Complaints per Stage – (KPI 7) 35
30
25
20
15
10
5
0 Stage 1 Stage 2 Stage 2 Escalated
Improvements to Stage 2 complaint handling
• Complaint Officer now provides onsite support • Time taken to arrange meetings has reduced from 38 days to 28 days • Development of new process to line with Adverse Event Management to reduce delay in commissioning reviews where indicated
Figure 19 below demonstrates the number of complaints closed within the targets set per stage, as a percentage of all closed per stage.
Whilst performance for Stage 1 complaints is good, Stage 2 and Stage 2 escalated complaints are only being closed within the target in approximately 50% of cases.
As indicated previously, additional support from the Complaint Team is being offered to address this and assist the Lead Investigators to improve the time taken to respond to Stage 2 complaints.
Figure 19 – Complaints Closed in Full within Timescales as Percentage of All Closed per Stage – (KPI 8)
31 | P a g e 120%
100%
80%
60%
40%
20%
0% Stage 1 Stage 2 Stage 2 Escalated
Figure 20 presents this data in numbers
Figure 20 – Number of complaints closed within target per stage (KPI 8)
Total Number Closed in Total Number Target Received Stage 1 Complaints 552 575 Stage 2 Complaints 265 530 Stage 2 Escalated Complaints 24 46
When a complaint is received and there is a known reason why it will not be possible to close it within the target working days, it is good practice to discuss this with the complainant and with their agreement, set an extension to the target. This can be due to a variety of reasons such as; clinician involved on extended leave, patient receiving care in another area of the Board limiting access to medical records etc.
From 2018/2019 we have begun recording when an extension is granted but as this is a relatively new practice for us, there is definite room for improvement in both setting and recording extensions, especially in relation to more complex Stage 2 complaints
Figure 21 – Number of Cases where an Extension was granted (KPI 9)
Number Percentage of total closed No. of complaints closed at Stage 1with
32 | P a g e authorised extension 189 29%
No. of complaints closed at Stage 2 with authorised extension 56 10%
Looking To the Future
Complaint Officers will work with Managers to identify criteria for granting extensions to working day targets and this information will be added to the updated Complaint Toolkit being prepared this year.
2.3 SPSO Activity
NHS Ayrshire and Arran Customer Care Team have always regarded our SPSO activity as a true indicator of our complainants’ satisfaction with our handling of their complaints. Whilst we do also routinely gather complainant feedback, we look at our SPSP activity as well to determine what aspects of our process require more attention. This year, an increase in complaint activity has also seen an increase in SPSO activity.
Figure 22 below highlights the number of SPSO referrals in the last 2 years on a quarterly basis. This demonstrates a slight increase in referrals this year from 10 to 12 in Q4 of both years
Figure 22 – SPSO referrals 2017-2018 & 2018-2019
14 12 10 8 2017-18 6 2018-19 4 2 0 Q1 Q2 Q3 Q4 Figure 23 below highlights those referrals that have proceeded to investigation in the same periods as used above.
Figure 23 – Number of referrals investigated
33 | P a g e 9
8
7
6
5 2017-18 4 2018-19 3
2
1
0 Q1 Q2 Q3 Q4
Despite some variation per year and quarter, the referral to investigation percentage remains around 30 – 40 % on the whole, with a slight peak to almost 50% in Q4 of the last year.
Those that have progressed to SPSO investigation and had the handling of their complaint investigated identify a lack of communication about delays in complaint handling as a factor. As highlighted earlier, improving contact with our complainants has been a key objective this year
Of all SPSO investigations approximately 30% were fully upheld, whilst around 50% were partially upheld, with approximately 20% not upheld. This is a rise from none fully upheld in 2017-2018. A number of decisions relating to the last Quarter are outstanding at the time of reporting
Improvement from SPSO Feedback
Comments on our complaint handling made in SPSO findings have helped progress improvement in relation to;
• How and When we communicate with complainants • What information we share in written form • Improved guidance in Complaints Toolkit for Investigators
2.4 Complaint Themes
The top themes from feedback and complaints have largely remained unchanged in the last three years. We are continuing to work in upgrading our systems to allow more detailed theming of complaints.
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Details of improvement resulting from feedback and complaints are discussed in Section 3.
As demonstrated in Figure 24 below, clinical treatment and attitudes and behaviour account for the largest number of complaints, followed by appointments and communication.
Figure 24 – Top Complaint Themes
Clinical Attitude and Date for Communication Communication treatment behaviour appointment (oral) (written)
Looking to the Future
Updating our Datix system in the year ahead will allow more accurate theming giving more details about our complaints.
As a result, we can ensure improvement activity addresses the identified need
2.5 Complaint Experience
As indicated by KPI 2, the experience of people using our complaint process is important to us and in the last 12 months, we have tested a variety of options to receive the most reliable feedback.
The two main methods used have been telephone experience interviews, and questionnaires sent out to a random sample of complainants every month via email.
We are now able to contact 10 complainants per month, via email and telephone to receive their feedback, which is presented below in Figure 25
35 | P a g e Figure 25 – Complaint Experience Feedback (KPI 2)
Questions Yes No Were you happy with the response to your complaint 88 12 Did you find it easy to complain 75 25 Did the staff member show empathy 78 22 Did the staff member offer an apology 80 20 Were you happy with the response time 65 35 Were you kept up to date about the progress of your complaint 69 31 Did you feel listened too 79 21 Did you feel the outcome of your complaint was fair 83 17
Feedback from Complainants
“Felt listened to by complaints team which was a relief” “All I wanted was someone to say sorry “ “The manager called me and immediately put me at ease. For the first time I felt someone was listening and it has restored my faith in the National Health Service” 2.6 Summary
Whilst our process remains person centred, we definitely have room for improvement, particularly around the time taken to reach resolution for our more complex complaints.
Plans currently being progressed, including holding a “Complaints Summit” with service leads and members of the public will help us to ensure we are dealing with all our complaints in a timely, effective and person centred manner moving forward.
3.Learning & Improvement
3.1 Learning from Complaints (KPI 1)
Significant progress has been made this year in ensuring learning and improvement is reliably achieved as a result of feedback and complaints.
However, further work is required to ensure sustainable improvement results reliably from complaints and this will be the key focus in 2019-2020.
Figure 26 – Quality Improvement Plans Completed
36 | P a g e 80%
70%
60%
50%
40% 2017-2018 2018-19 30%
20%
10%
0% Q1 Q2 Q3 Q4
As demonstrated above, completion of actions in response to complaints has dropped slightly in 2018-2019 with an average completion rate of approximately 68%. The drop in Q4 may be partially attributed to incomplete data.
We believe improving the quality of the improvements identified and the subsequent completion of actions will increase if we work with colleagues to theme improvements across a number of areas and this will be a key focus in 2019-2020.
This work has already begun with the Complaint Lead linking with colleagues in Risk Management to develop key processes to assure improvement opportunities are identified and linked to other work being progressed as a result of adverse events.
3.2 Learning & Improvement
3.2.1 Adult Support and Protection
A number of issues have been raised in relation to Power of Attorney for patients with cognitive impairment and reduced capacity. The issues raised identified practice across a number of specialties was varied and in a number of instances, POA was not appropriately consulted or communicated with around key clinical decisions and treatment plans
In response to this, the Adult Support & Protection Officer for Acute Services has developed a new information pack that gives staff full instructions on a number of aspects relating to assessing capacity and also how to report or act on safeguarding concerns. In addition, she has adapted our Adults with Incapacity paperwork including a prompt to identify Power of Attorney where relevant
Another action taken from feedback was to liaise with the Mental Welfare
37 | P a g e Commission and ensure their information leaflets about Capacity were readily available across clinical services and were shared with patients and families as required.
3.2.2 Treatment Escalation Plans (TEPS) & DNACPR Decisions
A number of complaints raised communication difficulties around clinical decision making in relation to resuscitation status and the level of ongoing treatment for patients with acute illness.
TEPs have been successfully implemented in High Care Areas for a number of years now and feedback suggests that the use of these plans would be welcomed in a number of areas.
In the last 12 months, TEPs have been implemented in both a community hospital setting, rehabilitation wards and across a number of acute inpatient areas.
DNACPR conversations and decisions are being discussed at medical staff induction and training sessions and the paperwork is being regularly monitored for best practice In addition to this, we are supporting clinicians to improve communication skills through Effective Communication for Healthcare (EC4H), a logic model which will increase confidence and competence and is key to transforming the conversations around anticipatory care planning, DNACPR best practice and realistic medicine.
3.2.3 Support at Discharge
Recognising the role of informal or family carers is an important part of discharge planning and one that when overlooked, contributed significantly to delayed discharges.
The role of Carers Support Worker is now being tested on both our acute sites Monday to Friday. In addition to supporting the patient and their carer, the support worker can help with discharge planning and their involvement can improve patient outcomes and reduce readmission rates for frail patients
3.2.4 Access for Carers and Family
NHS Ayrshire and Arran introduced more Flexible Visiting in 2017 and recent feedback has indicated that many carers and family members wish to play a more active role in the care of their loved one or wishing to have less restricted access to their family member while in hospital.
As a result, we are launching a focussed “Who Matters to You” exercise to identify 2- 3 key people that patients wish to have unrestricted access to them whilst in hospital.
38 | P a g e This new person centred approach to visiting in currently in the early stages of implementation, will plans for full implementation across all inpatient areas by August 2019.
3.2.5 Improved Triage for Patients presenting in the Emergency Department with dementia
A service user shared feedback on Care Opinion about feeling dismissed when their loved one was sent to the Emergency Department from a local Nursing Home with a care assistant. In addition to feeling her rights as POA were overlooked, she raised how distressing it was for dementia patients having to wait for prolonged periods in the waiting area, and how frightening and confusing it was for these vulnerable patients
As a result of her feedback, Emergency Department staff worked closely with the Dementia Nurse Consultant to ensure that patients with dementia and their carers and family are appropriately triaged to reduce their length of waiting time in the department. In addition, dementia patients and their carers and family will be provided with alternative facilities suitable to their needs during any waiting time, and staff will ensure that they are kept in contact at all times with their carer and/or spouse.
At the time of reporting, a dementia friendly room has been identified at University Hospital, Crosshouse and it is currently being refurbished for use.
3.2.6 Shared Learning & Reflection
In order to ensure consistent learning, complaints are reported at all levels of the organisation and are often presented as a shared learning opportunity in a variety of methods:
• Senior Charge Nurse Meetings – 1 or 2 complex complaints are presented and learning is shared and spread • Clinical Directorate Meetings – Patient stories and complaints are standing agenda items • Mortality & Morbidity Meetings – complaints are discussed and learning shared.
In addition, we are now testing the use of Learning Summaries for local learning and reflection following a complaint
3.3 Staff Training & Development
This year, in addition to our normal calendar of training, we held a number of
39 | P a g e workshops with an outside consultancy to provide some training around a number of aspects of effective complaint handling.
The topics covered in the workshops included; • The Power of Apology • Duty of Candour • Person centred Resolution
In total, eight workshops were held across a number of sites in NHS Ayrshire and Arran and a total 109 staff, from all services, managers and clinicians attended.
The workshops evaluated well and a notable improvement in written responses was seen amongst staff that had attended a workshop
Other training carried out this year is detailed below;
Training Delivered Workshops Number Held Attended Complaint Handling for Lead Investigators 4 34 Difficult Conversations 3 30 Learning from Complaints 2 18 Complaint Resolution for Clinical Staff 4 24 The Power of Apology 2 18 Implementing SPSO recommendations 1 8
In addition to our yearly training calendar, we will be updating our Feedback and Complaint Toolkit in 2019 which will be accessible for all staff involved in any aspect of complaint handling.
3.4 Summary
Whilst we have made some progress this year in evidencing learning and improvement from complaints, plans in place for the coming year will transform how we identify and action improvement by ensuring we are linking across a number of indicators and ensuring a risk based approach to improvement. As part of this process, key managers will receive regular information linking themes and detailing action being progressed.
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4. Governance Arrangements
NHS Ayrshire and Arran values the opportunity to learn from the patient and carer experience and this learning is shared widely at all appropriate governance and Board meetings. Feedback and complaints is reported through the Person Centred Care: Patient Experience framework
4.1 Reporting Structures
Board Level - NHS Ayrshire and Arran Board
At each Board meeting a specific issue related to feedback and complaints is submitted to provide assurance of improvements being made. A quarterly data report is also provided and a patient story is heard at each meeting which highlights service users’ positive and negative experiences and helps to inform improvement and learning.
Improvement resulting from complaints is also reported in detail in a separate paper.
Healthcare Governance Committee
Chaired by a Non-Executive Director, with membership consisting of Non-
41 | P a g e Executive Board members this Committee provides an assurance/scrutiny role for the Board. A quarterly report of feedback and complaints data and improvements is provided to this Committee, as is an SPSO update.
Management Level - Corporate Management Team
This is the strategic Executive Director team and a quarterly report on feedback and complaints is submitted to this group.
Directorate Level – Partnerships/Directorates
A monthly feedback and complaint report is prepared for service leads that details current activity and actions required. The Improvement Lead or Feedback and Complaints Team Leader meet with the identified leads to offer support and assistance with process.
A themed report that links feedback and complaint information and data with adverse events in acute services is now provided to the governance steering group and the clinical governance site teams. The aim of this reporting structure is to ensure early identification of learning and improvement needs.
Operational Level – Department/Ward Level
To ensure that all learning and improvement that occurs in relation to feedback and complaints, all wards and departments have to provide assurance that all learning has been shared with the relevant teams.
4.2 Assurance
SPSO recommendations are coordinated by the governance and assurance team and reported via the Healthcare Governance Committee on completion
We are presently looking at improving our assurance structures for improvement and learning plans that arise from complaints. The Improvement Lead for Customer Care will play an integral role in this new assurance structure to coordinate the improvement actions whilst ownership remains with service.
4.3 Conclusion NHS Ayrshire and Arran is committed to learning and improving from feedback and complaints. A great deal of work has recently been carried out to improve our processes and to develop a more person centred and effective approach to how feedback and complaints are dealt with, and our commitment to becoming a
42 | P a g e learning organisation that confidently embraces every opportunity to improve patient experience continues.
In the coming year we will be pursuing Excellence in Ayrshire. Learning and improving from our patient’s experiences are central to that aim.
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