HEALTHCARE COMPLAINTS

MANAGEMENT CONFERENCE 2015

Dealing with Unreasonable Complainants

Dr JP Nagle,

CEO, APC

About Us

• Alpha is a company dedicated to providing support to practice managers, GPs and

healthcare professionals.

• Founded in 2003, the company are expert in practice change management, practice

facilitation and practice benchmarking.

• The company has worked in practices across Ireland and across England -in

Manchester, Newcastle and London.

• In Ireland AHC has completed practice benchmarking and change management

programs; has worked on practice partnerships; promoted the roll of a TQM within

healthcare & developed primary care centres (www.alphaprimarycare.com)

• In England examples of APC’s services include pre-inspections and ongoing

compliance support for CQC, implementation of a “Demand Management Access

model” to simply patient access at practices and facilitating practices working at scale

(see www.alphaprimarycare.co.uk) .

• Alpha formed a strategic partnership with the NHS Alliance in 2010 focused on

practice standards and key performance indicators for general practice who jointly

launched a primary care virtual support website Health Management Plus (see

www.healthmanagementplus.co.uk ).

Learning Aims

• Complaints process –

complainant v complainee

• Perspective of complainee –

understanding how to deal

with anger, verbal abuse,

bullying & intimidation

• Assessing risk to staff & taking

appropriate risk mitigation

actions

• Sharing & learning from test

cases

Complaints Process

• Healthcompliants.ie provides information on how to make a complaint or

give feedback about health & social care services in Ireland,

• Website developed by a steering group of those organisations involved in

the delivery, regulation or overseeing of health & social care – and was an

initiative spearheaded by the Ombudsman,

• Key Areas:

– Public & private Hospitals,

– General Practice,

– Nursing Homes,

– HSE Organisation ( providing Health & Social Care),

– HIQA – monitoring standards,

– The Ombudsman,

– The Medical Council,

Complaint Pathway

Refer: healthcomplaints.ie

Complaint Figures

IRISH HEALTHCARE SYSTEM:

• Irish population of 4.59 million ( 2013 )

• HSE employs 100,000 + people,

• 5.7 million doctor-patient interactions in 34 hospitals ( between 2000-2005),

• Complaints about doctors represented less than 0.03% of these interactions or 1,642 in all,

• Plus -approx 350 complaints to MEDICAL COUNCIL each year/ approx 10,000 doctors

• GP Consultations per year – approx 20 million/year

• Public attitudes survey ( 2011) – ~ 90% satisfaction rating with doctors

Complaint Figures

ENGLAND – NHS

• Employs 1.7m people,

• 120,000 hospital doctors,

40,000 GPs, 400,000 nurses

& 25,000 ambulance staff

• NHS UK – caters for 51m

population

• Deals with 1m patients very

36 hours or 463 patients a

second!

• 162,019 written complaints in

2012/13,

But…Verbal Abuse etc…

• Level of verbal abuse much higher than these figures suggest,

• On the increase…

• Patient demanding more..

• Higher risk to staff of abuse:

– Verbal

– Physical

– Emotive

Verbal Abuse etc…

Verbal Abuse

Intimidation

“Workplace Bullying is repeated inappropriate behaviour, direct or indirect, whether verbal, physical or otherwise, conducted by one or more persons against another or others, at the place of work and/or in the course of employment, which could reasonably be regarded as undermining the individual’s right to dignity at work. An isolated incident of the behaviour described in this definition may be an affront to dignity at work but, as a once off incident, is not considered to be bullying”

Employee Support

• Employment Equality Acts 1998 -2011 places an obligation on all employers to prevent harassment in the workplace.

• The Code of Practice on Sexual Harassment & Harassment at Work aims to give practical guidance to employers and employees on how to prevent harassment at work and putting procedures in place to deal with it.

• Bullying in the workplace can affect both the safety and the health of employees

• Employers have a duty under the Safety, Health & Welfare Act – “to prevent any improper conduct or behavior likely to put the safety, health and welfare of employees at risk”.

• The HSA works to ensure that workplace bullying is not tolerated and that employers have procedures for dealing with bullying at work.

Risks to Staff.

Threatening behaviour

Verbal or written threats

Harassment

Anxiet Physical assault

Verbal Abuse

Leading to Stress, Injury, Anger…

How & Why…

Start as a simple discussion..

Get a little heated

End in physical…

Response…

• Stay Calm..

• Try to diffuse situation..

• Staff trained in:– Sensing a problem

– Responding calmly ..

– Respond to diffuse the situation…not enflame it

– Responding in situations of danger..

• Workplace policies & training

Prevention & Support Techniques

• Quality – the delivery of effective, safe and quality healthcare is essential.

• TQM - a philosophy!

– Focus on the patient,

– Focus on preventing problems rather than having to fix them,

– Relentlessly eliminating waste and inefficiencies,

– Involving all staff,

– Benchmarking and sharing best practice,

– Monitoring and reviewing performance,

• Re Complaints

– Focus on prevention,

– Diffuse ….

– Use internal processes & staff feedback,

– Significant Event/Near miss – log and action,

– CAPA – Corrective Action – Preventive Action,

Prevention & Support Techniques

Prevention & Support Techniques

Complaints Process

Complaint Options for Public Patients:

• Option 1 - Complain locally– Service providers & organisations that provide health and social care – Health Centres, hospitals, GPs,

dentists, social workers, primary care healthcare professionals etc

– First place to complain is directly to service provider,

– HSE complaints procedure – “Your Service-Your Say” – expect update on complaint within 30 days,

• Option 2 - Request a Health Service Review– If unhappy with initial response your can ask for a review fro the HSE Director of Advocacy or complain

direct to the Ombudsman or Ombudsman for Children,

• Option 3 - Complain to the Ombudsman– Use only if public patient,

• Option 4 - Complain to the regulator– Regulators have responsibility for protecting the quality and safety of health and social care service.

– Professional regulators are - Medical Council, The Nursing & Midwifery Board of Irl, The Pharmaceutical

Society of Irl, The Opticians Board & CORU

– Service Quality – HIQA,

– Medicines & product – Irish Medicines Board & The Food Safety Authority of Irl.

• Option 5 – Get legal advise– For serious complaints one may seek legal advise.

Complaints Handling

• All Service Providers should have a written policy on complaint handling which is

freely available to all patients & clients.

• A good complaints process will include:– Clear instructions to staff on handling a complaint,

– Listening carefully to patient /client,

– Recording all facts /details of complaint,

– Attempt to resolve the complaint immediately if

possible & this in many instances can address issue

- Very often a complaint /feedback , if immediately

addressed, can be resolved without matter actually

becoming a formal written complaint,

- Written complaints – acknowledge within 3 working days (recommended)

- Manager /clinician will instigate an internal review of complaint and speak with all personnel involved,

- The matter should then be reviewed and a formal response prepared and issued to the complainant outlining

how it was investigated; the conclusions and recommended actions that practice is taking.

- The manager /provider should ensure that a log is kept of all complaints and that appropriate records of

each individual complaint is kept

CSF’s

• Provider –clear policy available for clients/patients & staff familiar with details

• Be pro-active – engage with patient /client,

• Listen to concerns /feedback,

• Be responsive,

• Written complaint – acknowledge promptly,

• Investigate / action / respond,

• Keep records,

• Maintain log & review at provider meetings

Complaint Summary

CASE STUDIES

Degree – varies “minor” to “serious/litigation

Patient Complaints / “Significant Events”

• Staff rude to patients,

• Access /wait times,

• Referral letter /scripts not ready,

• Inappropriate Examinations,

• Report to MC re alcohol/drug abuse,

• Report to GMC/Fraud squad,

• Clinical care – reported negligence,

CASE STUDIES

1. Report to GMC/Fraud squad,

Summary: GP Partners reported colleague to the Local Primary Care

Trust alleging professional misconduct & forging of records.

Synopsis: Senior Partner investigated under two areas – professional

standards & Fraud. Legal process.

Outcome: All allegations dropped but only after a 2 year period

Impacts: Partnership breakup, reputation of senior doctor tarnished,

very stressful for everyone involved – time factor

CASE STUDIES

2. Physical Abuse – Patient threw physical items at receptionist

Summary: Lady carer for elderly father. Miscommunication re

appointment time at surgery. Carer got verbally aggressive and violent.

Synopsis: Carer arrived with her elderly father to surgery but there had

been a miscommunication on time. Required testing needed long

appointment time which was not available. Receptionist tried explaining

but carer got progressively more verbally abusive and ultimately threw

objects at the receptionist.

Outcome: GP partner came out and got situation under control. Post

incident held a significant event review. Warning to patient carer.

Impacts: Stressed receptionist, impacted all patients in waiting room

CASE STUDIES

2. Prevention …. of a potentially explosive situation..

CASE STUDIES

3. Staff Rude & Practice Regularly Cancels Appointments

Summary: Negative comments posted on NHS choices re practice; Complaints

to regulator – CQC.

Synopsis: Triggered a “responsive” CQC inspection of practice. Practice

response was not good; Major escalation of events when practice did not react

to inspection. CQC inspector initiated a “Code B” warning. Matters addressed &

practice inspection completed.

Outcome: CQC cited non compliance with 3 standards; requires matters to be

addressed and will be re-inspecting.

Impacts: Lack of awareness of practice of powers of CQC lead to a major

escalation and potentially serious situation. In ways. Re-enforced comments of

patients about practice. Practice must now address as priority.

RECAP

• Verbal abuse on the increase,

• Puts staff under pressure and causes anxiety

• Zero Tolerance policy & training of staff

• Employer – responsibility to risk assess and put in place risk

prevention measures,

• Complaints handling – learning process

• Remember:

“PREVENTION IS BETTER THAN CURE”

Q & A

Contact & References:

• jnagle@alphaprimarycare.com

• www.alphaprimarycare.com

• www.primarycare.ie

• www.alphaprimarycare.co.uk

• www.healthmanagementplus.co.uk

AHC at : www.alphahealthcare.com