47
Clinical Clinical Governance Governance VTS 24.11.10 VTS 24.11.10
Clinical GovernanceClinical Governance
VTS 24.11.10VTS 24.11.10
Clinical GovernanceClinical Governance
““a system through which NHS organisations are a system through which NHS organisations are accountable for continuously improving the accountable for continuously improving the quality of their services and safeguarding high quality of their services and safeguarding high standards of care by creating an environment standards of care by creating an environment in which excellence in clinical care will in which excellence in clinical care will flourish”. flourish”.
Liam DonaldsonLiam Donaldson
Plan for the afternoonPlan for the afternoon
14.15 - Dealing with patient complaints14.15 - Dealing with patient complaints 15.15 – Tea!15.15 – Tea! 15.30 – Local clinical governance 15.30 – Local clinical governance
structuresstructures 15.45 – Patient access to records15.45 – Patient access to records 16.00 – Appraisal and Revalidation16.00 – Appraisal and Revalidation
Patient ComplaintsPatient Complaints
VTS Teaching 24.11.10VTS Teaching 24.11.10
Tom LawesTom Lawes
Aims and objectivesAims and objectives
• Review our existing knowledge of Review our existing knowledge of handling complaintshandling complaints
• Scenarios on handling complaints:Scenarios on handling complaints:– Face-to-face, andFace-to-face, and– WrittenWritten
• Personal case discussions if timePersonal case discussions if time
Complaints proceduresComplaints procedures
• Both a legal and contractual Both a legal and contractual obligation for NHS organisations (and obligation for NHS organisations (and their contractors) to have systems in their contractors) to have systems in place.place.
• New Regulations 2009New Regulations 2009
• Care Quality CommissionCare Quality Commission
NHS ConstitutionNHS Constitution
• Patients have the right:Patients have the right:– To have complaints dealt with efficiently To have complaints dealt with efficiently
and have them properly investigatedand have them properly investigated– To know the outcome of any To know the outcome of any
investigationinvestigation– To take complaints to the Ombudsman if To take complaints to the Ombudsman if
not satisfied with how complaints are not satisfied with how complaints are dealt with by the NHSdealt with by the NHS
‘‘Spotlight on complaints’Spotlight on complaints’Healthcare Commission Healthcare Commission 20082008
• GPs most common subject of complaintGPs most common subject of complaint
• 45% of complaints were upheld by HC45% of complaints were upheld by HC
• Many complaints could be reconciled Many complaints could be reconciled before needing secondary level before needing secondary level investigation if dealt with appropriately.investigation if dealt with appropriately.
Complaints QuizComplaints Quiz
You receive a complaint that involves your You receive a complaint that involves your practice and a local nursing home. After practice and a local nursing home. After investigating the complaint, how should you investigating the complaint, how should you write your response to the complainant?write your response to the complainant?
a)a) Each organisation should write a separate Each organisation should write a separate response response
b)b) Each individual involved should write a response Each individual involved should write a response
c)c) The organisations involved should write a single The organisations involved should write a single responseresponse
You receive a written complaint from a You receive a written complaint from a 20 year old patient. Within what 20 year old patient. Within what time period should you acknowledge time period should you acknowledge receipt of the complaint?receipt of the complaint?
a)a) Within three working daysWithin three working days
b)b) Within five working daysWithin five working days
c)c) Within seven working daysWithin seven working days
You receive a phone call from a patient You receive a phone call from a patient who is unhappy about the care she who is unhappy about the care she received from another doctor at the received from another doctor at the practice. What should you do?practice. What should you do?
a)a) Listen to the patient and record the details Listen to the patient and record the details of the complaint of the complaint
b)b) Ask her to speak to the doctor she wants Ask her to speak to the doctor she wants to make a complaint aboutto make a complaint about
c)c) Ask her to speak to the practice managerAsk her to speak to the practice manager
You receive a written complaint from a 55 year You receive a written complaint from a 55 year old man who is a patient at your practice. old man who is a patient at your practice. After reading the complaint you find that it After reading the complaint you find that it is about social services and not the practice. is about social services and not the practice. What should you do first?What should you do first?a)a) Forward the complaint to the correct Forward the complaint to the correct
organisationorganisationb)b) Contact the patient to explain that the complaint Contact the patient to explain that the complaint
has been made to the wrong organisationhas been made to the wrong organisationc)c) Return the written complaint to the patient and Return the written complaint to the patient and
ask them to contact social servicesask them to contact social services
Which one of the following statements Which one of the following statements about why patients make complaints is about why patients make complaints is correct?correct?
a)a) Patients usually want financial compensationPatients usually want financial compensation
b)b) Patients usually complain because of a Patients usually complain because of a perceived or actual failure to investigate or perceived or actual failure to investigate or treattreat
c)c) Patients often want to prevent other people Patients often want to prevent other people experiencing the same problemsexperiencing the same problems
A 40 year old woman makes a complaint A 40 year old woman makes a complaint and wants to see her records. When she and wants to see her records. When she has gone you realise there are many has gone you realise there are many letters from the hospital specialist in her letters from the hospital specialist in her records. You wonder whether you should records. You wonder whether you should ask this doctor for permission to copy his ask this doctor for permission to copy his letters. What is the best course of action?letters. What is the best course of action?a)a) You must get permission from the hospital You must get permission from the hospital
specialist before releasing copies of his lettersspecialist before releasing copies of his lettersb)b) You don't need the hospital specialist's You don't need the hospital specialist's
consent before releasing copies of his lettersconsent before releasing copies of his letters
Your practice recently wrote a response to a Your practice recently wrote a response to a patient who made a complaint about patient who made a complaint about waiting times for appointments at your waiting times for appointments at your practice. The patient does not feel the practice. The patient does not feel the response has dealt with her concerns. response has dealt with her concerns. What should you advise her to do?What should you advise her to do?
a)a) Contact the health service ombudsmanContact the health service ombudsman
b)b) Contact the primary care trustContact the primary care trust
c)c) Contact the Department of HealthContact the Department of Health
Which one of the following statements Which one of the following statements about the role of the health service about the role of the health service ombudsman is correct?ombudsman is correct?
a)a) Patients can direct their initial Patients can direct their initial complaint to the ombudsman complaint to the ombudsman
b)b) The ombudsman will assess whether The ombudsman will assess whether the patient has a valid case that needs the patient has a valid case that needs addressing addressing
A patient at your practice has made six A patient at your practice has made six complaints about access to the car park complaints about access to the car park at your practice. You have responded to at your practice. You have responded to the complaint and the patient’s case was the complaint and the patient’s case was not upheld by the health service not upheld by the health service ombudsman. You feel that the patient is ombudsman. You feel that the patient is an unreasonable complainant. How an unreasonable complainant. How should you manage the situation?should you manage the situation?a)a) Make sure one person from your practice Make sure one person from your practice
oversees the situationoversees the situationb)b) Remove the patient from the practice listRemove the patient from the practice listc)c) Contact the health service ombudsmanContact the health service ombudsman
A 55 year old man has had chronic bronchitis for many A 55 year old man has had chronic bronchitis for many years and was diagnosed with mesothelioma three years and was diagnosed with mesothelioma three months ago. He worked as an electrician for years and months ago. He worked as an electrician for years and has also worked as a docker. He is very unhappy with has also worked as a docker. He is very unhappy with the care he has received from you and from the local the care he has received from you and from the local hospital and wants to make a complaint. He also wants hospital and wants to make a complaint. He also wants to see his records. You say you will sort this out, but he to see his records. You say you will sort this out, but he wants to see the records immediately. How quickly wants to see the records immediately. How quickly must you comply with his request to see the records?must you comply with his request to see the records?
a)a) You must give him a copy of the records immediatelyYou must give him a copy of the records immediatelyb)b) You must give him a copy of the records within 20 daysYou must give him a copy of the records within 20 daysc)c) You must give him a copy of the records within 40 daysYou must give him a copy of the records within 40 days
Role-play ScenarioRole-play Scenario
Responding to written Responding to written complaintscomplaints
Initial response:Initial response:– Should be within 3 daysShould be within 3 days– Acknowledge patient’s complaintAcknowledge patient’s complaint– Should offer a discussion to agree on Should offer a discussion to agree on
how complaint will be handled and how complaint will be handled and reasonable timescalereasonable timescale
– Otherwise give timescale in initial letterOtherwise give timescale in initial letter
Responding to written Responding to written complaintscomplaintsFull response:Full response:
• Avoid being defensiveAvoid being defensive
• Address every issue raisedAddress every issue raised
• Fully explain all findings of an investigationFully explain all findings of an investigation
• Apologise where appropriateApologise where appropriate
• Detail any changes being made as a resultDetail any changes being made as a result
• Advise the patient of their right to complain Advise the patient of their right to complain to the Ombudsman if not satisfiedto the Ombudsman if not satisfied
Investigating complaintsInvestigating complaints
• Assess seriousness and likelihood of Assess seriousness and likelihood of recurrence (low-extreme)recurrence (low-extreme)
• Consider SEA or RCAConsider SEA or RCA
• Remember to seek consent if Remember to seek consent if forwarding information to other forwarding information to other bodies or discussing with patient’s bodies or discussing with patient’s relatives.relatives.
Practice arrangementsPractice arrangements
• Make complaints procedures freely Make complaints procedures freely available to patients (e.g. posters, available to patients (e.g. posters, leaflets)leaflets)
• Should have a ‘Responsible Person’ Should have a ‘Responsible Person’ (partner) and Complaints Manager (partner) and Complaints Manager (can be same person)(can be same person)
• Annual reports to PCTAnnual reports to PCT
Quiz AnswersQuiz Answers
You receive a complaint that involves your You receive a complaint that involves your practice and a local nursing home. After practice and a local nursing home. After investigating the complaint, how should you investigating the complaint, how should you write your response to the complainant?write your response to the complainant?
a)a) Each organisation should write a separate Each organisation should write a separate response response
b)b) Each individual involved should write a response Each individual involved should write a response
c)c) The organisations involved should write a single The organisations involved should write a single responseresponse
You receive a complaint that involves your You receive a complaint that involves your practice and a local nursing home. After practice and a local nursing home. After investigating the complaint, how should you investigating the complaint, how should you write your response to the complainant?write your response to the complainant?
a)a) Each organisation should write a separate Each organisation should write a separate response response
b)b) Each individual involved should write a response Each individual involved should write a response
c)c) The organisations involved should write a The organisations involved should write a single responsesingle response
• You receive a written complaint from You receive a written complaint from a 20 year old patient. Within what a 20 year old patient. Within what time period should you acknowledge time period should you acknowledge receipt of the complaint?receipt of the complaint?
a)a) Within three working daysWithin three working days
b)b) Within five working daysWithin five working days
c)c) Within seven working daysWithin seven working days
• You receive a written complaint from You receive a written complaint from a 20 year old patient. Within what a 20 year old patient. Within what time period should you acknowledge time period should you acknowledge receipt of the complaint?receipt of the complaint?
a)a) Within three working daysWithin three working days
b)b) Within five working daysWithin five working days
c)c) Within seven working daysWithin seven working days
• You receive a phone call from a patient You receive a phone call from a patient who is unhappy about the care she who is unhappy about the care she received from another doctor at the received from another doctor at the practice. What should you do?practice. What should you do?
a)a) Listen to the patient and record the details Listen to the patient and record the details of the complaint of the complaint
b)b) Ask her to speak to the doctor she wants Ask her to speak to the doctor she wants to make a complaint aboutto make a complaint about
c)c) Ask her to speak to the practice managerAsk her to speak to the practice manager
• You receive a phone call from a patient You receive a phone call from a patient who is unhappy about the care she who is unhappy about the care she received from another doctor at the received from another doctor at the practice. What should you do?practice. What should you do?
a)a) Listen to the patient and record the Listen to the patient and record the details of the complaint details of the complaint
b)b) Ask her to speak to the doctor she wants Ask her to speak to the doctor she wants to make a complaint aboutto make a complaint about
c)c) Ask her to speak to the practice managerAsk her to speak to the practice manager
• You receive a written complaint from a 55 You receive a written complaint from a 55 year old man who is a patient at your year old man who is a patient at your practice. After reading the complaint you practice. After reading the complaint you find that it is about social services and not find that it is about social services and not the practice. What should you do first?the practice. What should you do first?a)a) Forward the complaint to the correct Forward the complaint to the correct
organisationorganisationb)b) Contact the patient to explain that the complaint Contact the patient to explain that the complaint
has been made to the wrong organisationhas been made to the wrong organisationc)c) Return the written complaint to the patient and Return the written complaint to the patient and
ask them to contact social servicesask them to contact social services
• You receive a written complaint from a 55 You receive a written complaint from a 55 year old man who is a patient at your year old man who is a patient at your practice. After reading the complaint you practice. After reading the complaint you find that it is about social services and not find that it is about social services and not the practice. What should you do first?the practice. What should you do first?a)a) Forward the complaint to the correct Forward the complaint to the correct
organisationorganisationb)b) Contact the patient to explain that the Contact the patient to explain that the
complaint has been made to the wrong complaint has been made to the wrong organisationorganisation
c)c) Return the written complaint to the patient Return the written complaint to the patient and ask them to contact social servicesand ask them to contact social services
• Which one of the following statements Which one of the following statements about why patients make complaints about why patients make complaints is correct?is correct?
a)a) Patients usually want financial Patients usually want financial compensationcompensation
b)b) Patients usually complain because of a Patients usually complain because of a perceived or actual failure to investigate perceived or actual failure to investigate or treator treat
c)c) Patients often want to prevent other Patients often want to prevent other people experiencing the same problemspeople experiencing the same problems
• Which one of the following statements Which one of the following statements about why patients make complaints is about why patients make complaints is correct?correct?
a)a) Patients usually want financial Patients usually want financial compensationcompensation
b)b) Patients usually complain because of a Patients usually complain because of a perceived or actual failure to investigate or perceived or actual failure to investigate or treattreat
c)c) Patients often want to prevent other Patients often want to prevent other people experiencing the same people experiencing the same problemsproblems
• A 40 year old woman makes a complaint A 40 year old woman makes a complaint and wants to see her records. When she and wants to see her records. When she has gone you realise there are many has gone you realise there are many letters from the hospital specialist in her letters from the hospital specialist in her records. You wonder whether you should records. You wonder whether you should ask this doctor for permission to copy his ask this doctor for permission to copy his letters. What is the best course of action?letters. What is the best course of action?a)a) You must get permission from the hospital You must get permission from the hospital
specialist before releasing copies of his lettersspecialist before releasing copies of his lettersb)b) You don't need the hospital specialist's You don't need the hospital specialist's
consent before releasing copies of his lettersconsent before releasing copies of his letters
• A 40 year old woman makes a complaint A 40 year old woman makes a complaint and wants to see her records. When she and wants to see her records. When she has gone you realise there are many has gone you realise there are many letters from the hospital specialist in her letters from the hospital specialist in her records. You wonder whether you should records. You wonder whether you should ask this doctor for permission to copy his ask this doctor for permission to copy his letters. What is the best course of action?letters. What is the best course of action?a)a) You must get permission from the hospital You must get permission from the hospital
specialist before releasing copies of his lettersspecialist before releasing copies of his lettersb)b) You don't need the hospital specialist's You don't need the hospital specialist's
consent before releasing copies of his consent before releasing copies of his lettersletters
• Your practice recently wrote a response Your practice recently wrote a response to a patient who made a complaint about to a patient who made a complaint about waiting times for appointments at your waiting times for appointments at your practice. The patient does not feel the practice. The patient does not feel the response has dealt with her concerns. response has dealt with her concerns. What should you advise her to do?What should you advise her to do?
a)a) Contact the health service ombudsmanContact the health service ombudsman
b)b) Contact the primary care trustContact the primary care trust
c)c) Contact the Department of HealthContact the Department of Health
• Your practice recently wrote a response Your practice recently wrote a response to a patient who made a complaint about to a patient who made a complaint about waiting times for appointments at your waiting times for appointments at your practice. The patient does not feel the practice. The patient does not feel the response has dealt with her concerns. response has dealt with her concerns. What should you advise her to do?What should you advise her to do?
a)a) Contact the health service ombudsmanContact the health service ombudsman
b)b) Contact the primary care trustContact the primary care trust
c)c) Contact the Department of HealthContact the Department of Health
• Which one of the following Which one of the following statements about the role of the statements about the role of the health service ombudsman is health service ombudsman is correct?correct?
a)a) Patients can direct their initial complaint Patients can direct their initial complaint to the ombudsman to the ombudsman
b)b) The ombudsman will assess whether the The ombudsman will assess whether the patient has a valid case that needs patient has a valid case that needs addressing addressing
• Which one of the following Which one of the following statements about the role of the statements about the role of the health service ombudsman is health service ombudsman is correct?correct?
a)a) Patients can direct their initial complaint Patients can direct their initial complaint to the ombudsman to the ombudsman
b)b) The ombudsman will assess The ombudsman will assess whether the patient has a valid whether the patient has a valid case that needs addressingcase that needs addressing
• A patient at your practice has made six A patient at your practice has made six complaints about access to the car park complaints about access to the car park at your practice. You have responded to at your practice. You have responded to the complaint and the patient’s case was the complaint and the patient’s case was not upheld by the health service not upheld by the health service ombudsman. You feel that the patient is ombudsman. You feel that the patient is an unreasonable complainant. How an unreasonable complainant. How should you manage the situation?should you manage the situation?a)a) Make sure one person from your practice Make sure one person from your practice
oversees the situationoversees the situationb)b) Remove the patient from the practice listRemove the patient from the practice listc)c) Contact the health service ombudsmanContact the health service ombudsman
• A patient at your practice has made six A patient at your practice has made six complaints about access to the car park complaints about access to the car park at your practice. You have responded to at your practice. You have responded to the complaint and the patient’s case was the complaint and the patient’s case was not upheld by the health service not upheld by the health service ombudsman. You feel that the patient is ombudsman. You feel that the patient is an unreasonable complainant. How an unreasonable complainant. How should you manage the situation?should you manage the situation?a)a) Make sure one person from your practice Make sure one person from your practice
oversees the situationoversees the situationb)b) Remove the patient from the practice listRemove the patient from the practice listc)c) Contact the health service ombudsmanContact the health service ombudsman
• A 55 year old man has had chronic bronchitis for many A 55 year old man has had chronic bronchitis for many years and was diagnosed with mesothelioma three years and was diagnosed with mesothelioma three months ago. He worked as an electrician for years and months ago. He worked as an electrician for years and has also worked as a docker. He is very unhappy with has also worked as a docker. He is very unhappy with the care he has received from you and from the local the care he has received from you and from the local hospital and wants to make a complaint. He also wants hospital and wants to make a complaint. He also wants to see his records. You say you will sort this out, but he to see his records. You say you will sort this out, but he wants to see the records immediately. How quickly wants to see the records immediately. How quickly must you comply with his request to see the records?must you comply with his request to see the records?
a)a) You must give him a copy of the records immediatelyYou must give him a copy of the records immediatelyb)b) You must give him a copy of the records within 20 daysYou must give him a copy of the records within 20 daysc)c) You must give him a copy of the records within 40 daysYou must give him a copy of the records within 40 days
• A 55 year old man has had chronic bronchitis for many A 55 year old man has had chronic bronchitis for many years and was diagnosed with mesothelioma three years and was diagnosed with mesothelioma three months ago. He worked as an electrician for years and months ago. He worked as an electrician for years and has also worked as a docker. He is very unhappy with has also worked as a docker. He is very unhappy with the care he has received from you and from the local the care he has received from you and from the local hospital and wants to make a complaint. He also wants hospital and wants to make a complaint. He also wants to see his records. You say you will sort this out, but he to see his records. You say you will sort this out, but he wants to see the records immediately. How quickly wants to see the records immediately. How quickly must you comply with his request to see the records?must you comply with his request to see the records?
a)a) You must give him a copy of the records immediatelyYou must give him a copy of the records immediatelyb)b) You must give him a copy of the records within 20 daysYou must give him a copy of the records within 20 daysc)c) You must give him a copy of the records within 40 daysYou must give him a copy of the records within 40 days
