Report to: Clinical Governance Committee Agenda item: CGC091812 Date of Meeting: 25 th September 2018 Report Title: Annual Customer Care Report 2017-18 Status: Information Discussion Assurance Approval X X Prepared by: Hazel Hardyman, Head of Customer Care Gill Sheppard, Clinical Governance Administrator Executive Sponsor (presenting): Lorna Wilkinson, Deputy Director of Nursing Appendices (list if applicable): N/A Recommendation: The Board is asked to note this report. It brings together the themes from all patient experience feedback, identifying where improvements can be made. Executive Summary: This report provides an overview of Customer Care activity in 2017-18. It brings together the themes from patient experience feedback e.g. comments, concerns, complaints, compliments, Friends and Family Test (FFT), real time feedback and NHS Choices. It also provides an overview of Patient and Public Involvement (PPI) activity and outcomes across the Trust to improve our services for patients. There were 262 complaints which is a decrease of 43 complaints on 2016-17. Directorate Management Team rotas are helping to manage concerns more proactively in real time. The main themes from complaints were clinical treatment, communication and staff attitude. There were four requests for independent review by the Parliamentary and Health Service Ombudsman, with 3 cases partly upheld and the Trust is awaiting an outcome on the final case. There were 397 concerns logged, 1501 comments and 37 general enquiries received, which is 166 more than 2016-17 in total. Comments saw the largest increase where people were requesting further information. 1404 compliments were also received. Patients were involved in 34 projects this year, using many different methods including patient stories, focus groups and questionnaires. There were 72 comments posted on the NHS Choices website (60 positive, 9 negative and 3 mixed). A total of 995 inpatients were surveyed for real time feedback over the year. From the quantitative data, consistently high results have been achieved for: cleanliness; and patients being treated with care and compassion. Less favourable results have been achieved for patients being disturbed at night by noise from other patients. The responses to the Friends and Family Test remain overwhelmingly positive and the numbers are too low to identify any main area of concern. This report provides assurance that the Trust is responding and acting appropriately to patient feedback.
Transcript
Report to: Clinical Governance Committee Agenda item:
CGC091812
Date of Meeting: 25th September 2018
Report Title: Annual Customer Care Report 2017-18
Status: Information Discussion Assurance Approval
X X
Prepared by: Hazel Hardyman, Head of Customer Care
Gill Sheppard, Clinical Governance Administrator
Executive Sponsor (presenting):
Lorna Wilkinson, Deputy Director of Nursing
Appendices (list if applicable):
N/A
Recommendation:
The Board is asked to note this report. It brings together the themes from all patient experience feedback, identifying where improvements can be made.
Executive Summary:
This report provides an overview of Customer Care activity in 2017-18. It brings together the themes from patient experience feedback e.g. comments, concerns, complaints, compliments, Friends and Family Test (FFT), real time feedback and NHS Choices. It also provides an overview of Patient and Public Involvement (PPI) activity and outcomes across the Trust to improve our services for patients.
There were 262 complaints which is a decrease of 43 complaints on 2016-17. Directorate Management Team rotas are helping to manage concerns more proactively in real time. The main themes from complaints were clinical treatment, communication and staff attitude.
There were four requests for independent review by the Parliamentary and Health Service Ombudsman, with 3 cases partly upheld and the Trust is awaiting an outcome on the final case.
There were 397 concerns logged, 1501 comments and 37 general enquiries received, which is 166 more than 2016-17 in total. Comments saw the largest increase where people were requesting further information. 1404 compliments were also received.
Patients were involved in 34 projects this year, using many different methods including patient stories, focus groups and questionnaires.
There were 72 comments posted on the NHS Choices website (60 positive, 9 negative and 3 mixed).
A total of 995 inpatients were surveyed for real time feedback over the year. From the quantitative data, consistently high results have been achieved for: cleanliness; and patients being treated with care and compassion. Less favourable results have been achieved for patients being disturbed at night by noise from other patients.
The responses to the Friends and Family Test remain overwhelmingly positive and the numbers are too low to identify any main area of concern.
This report provides assurance that the Trust is responding and acting appropriately to patient feedback.
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Board Assurance Framework – Strategic Priorities
Local Services - We will meet the needs of the local population by developing new ways of working which always put patients at the centre of all that we do
X
Innovation - We will promote new and better ways of working, always looking to achieve excellence and sustainability in how our services are delivered
X
Care - We will treat our patients, and their families, with care, kindness and compassion and keep them safe from avoidable harm
X
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Annual Customer Care Report 1st April 2017 to 31st March 2018
1.0 PURPOSE OF PAPER
1.1 The annual Customer Care report focuses on the lessons learnt and changing
practice as a result of comments, concerns, complaints, patient and public involvement (PPI), national patient surveys (NPS), real time feedback (RTF), the Friends and Family Test (FFT) and NHS Choices. The report also complies with The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, which requires each NHS Trust to produce regular reports about complaints received, including an annual report. It also fulfils the contractual requirement of our commissioners.
2.0 Number of Complaints Received 2.1 2.2
The total number of complaints received for this year was 262, a decrease of 43 complaints on 2016-17. There were 397 concerns, 1501 comments and 37 general enquiries received, which is 166 more than 2016-17 in total. Comments saw the largest increase where people were requesting further information. 1404 compliments were also received. In 2017-18, the Trust treated 67,707 people as inpatients, day cases and regular day attendees. Another 59,503 were seen in the Emergency Department and 129,650 as outpatients. This represents 0.1% of people treated made a formal complaint, which is the same percentage as last year. The following graph shows the trend in complaints received by quarter:
In the breakdown by quarter it can be seen that Q2 was significantly higher than the other three quarters in 2017-18. In Q2 clinical treatment and communication had the highest increases, followed by attitude of staff, appointments and hospital
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procedures. The spike represented increased volume of common reported issues such as unsatisfactory treatment, lack of communication, medical and nursing staff attitude and cancelled appointments. Over the year there was a significant decrease in complaints considering the pressures on services and the major incident in March 2018.
2.4 The following table shows a comparison of comments, concerns, general enquiries and compliments received over the last three years. All wards and departments are encouraged to send their compliments to Customer Care to be recorded.
Wiltshire Clinical Commissioning Group, and Governor’s meetings receive a quarterly report on the analysis of issues raised in complaints.
3.2 Comments, concerns and complaints are coded on Datix under subject codes
broken down further by sub-subjects. The three main themes across all these areas in 2017-18 were clinical treatment, appointments and communication.
3.3 Clinical treatment has a wide range of sub-themes and any complaint with an
aspect of clinical care has been recorded against this theme on Datix. At the beginning of Q4, the K041 codes were adopted for clinical treatment, therefore a
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complaint about clinical treatment will now be coded against the specialty as the sub-theme. The Head of Litigation is working with clinical teams to reduce claims.
3.4 The second highest theme is communication with the following sub themes: insensitive communication; lack of communication; wrong information; information not given; and delays in sending/receiving information. There was not a link to a particular area, however the Emergency Department are coding each diagnosis with a qualifier of suspected or confirmed diagnosis to improve clarity for the GP/patient and they are also redesigning and improving the quality of Emergency Department GP discharge letters and working to get all letters messaging electronically to GPs.
3.5 The third highest theme is attitude of staff and specific staff members who struggle with appropriate communication are offered support/training; regular 1:1s; and there is direct action for staff that had more than one complaint relating to attitude/communication which is to improve communication with patients about their diagnosis. If several complaints are received about the same person then the line manager will develop a plan with the individual through the appraisal process or possibly disciplinary or capability procedures. All doctors must discuss complaints in which they have been named at their annual appraisal.
3.6 The graph shows the complaints themes for 2017-18:
4.0 Complaints by Staff Group
4.1 Complaints are coded into Staff Group on Datix, which is a quarterly reporting
requirement to NHS Digital. Medical staff had the highest number of complaints and this group includes many grades of staff and the complaints cover a wide range of sub-themes such as care, treatment, communication, attitude etc.
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4.2 There were 76% of complaints linked to medical staff, which was 4% higher than
last year’s figure (72%). These were mainly linked to complaints about clinical treatment, staff attitude and communication. Nursing were linked to 16% of complaints which was 3% lower than last year (19%). These are all discussed with individuals as part of the investigation and the Director of Nursing and Medical Director receive all of these complaints and responses. Medical staff complaints are also fed back into the appraisal process. Many compliments are received about staff through letters, emails, NHS Choices, real time feedback, national patient surveys and the Friends and Family Test, all of which are shared with the relevant staff/teams.
5.0 Parliamentary and Health Service Ombudsman (PHSO)
5.1 In 2017-18, the PHSO requested to undertake four independent reviews of
complaints that the Trust had already investigated. To date three cases have been partly upheld and the Trust is awaiting an outcome on the final case. Action plans have been developed for the three partly upheld cases, to address the potential impact for other patients of the failings identified.
5.2 The PHSO publishes quarterly reports on complaints about acute Trusts available
at http://www.ombudsman.org.uk/reports-and-consultations/reports/health/quarterly-reports-on-complaints-about-acute-trusts
6.0 Examples of Quality Improvement from Complaints
6.1 Complaints are a key element to improving the patient’s overall experience of the
Trust’s services, ensuring that high quality care is provided at Salisbury District Hospital. To improve how complaints are handled, Customer Care contact the directorate management team on receipt of a complaint to see if it can be resolved more quickly; there have been good results to date. Face-to-face meetings are offered in many cases, this gives staff the opportunity to fully understand the concerns and the outcome that the complainant wants to achieve. Specific examples of improvements as a result of complaints themes are set out below.
6.3 Appointment cancellations - review of clinic cancellation process and management
6.4 Use of Electronic Referral System for appointment booking – processes reviewed whilst the system is bedding in and the referral management system was visited to help smooth processes.
6.5 Emergency Department discharge procedures - commenced using Electronic
Discharge Summary on Short Stay Emergency Unit. Working to get all discharge letters electronically messaged to GPs and to have them stored in E-case notes
6.6 Orthopaedics, Plastic Surgery and Oral Surgery appointment concerns – continuing
to review long waiters; increased capacity in specialities through additional sessions; Informatics to provide accurate waiting list information by specialty; and active waiting list validation by specialty to reduce waiting times.
6.7 Maternity - patient information leaflets about aftercare following an emergency
hysterectomy in the intrapartum or immediate postpartum period have been developed following a complaint about the lack of information given.
6.8 Central Booking – introduced additional complaint handling support due to the number of concerns about appointments, whilst outstanding issues with Lorenzo were being managed.
6.9 Bowel Screening – concerns regarding the sedation offered and the testing kits
have been fed back into the national programme and work is still ongoing. 6.10 Individual staff members who struggle with appropriate communication are offered
support/training. 7.0 NHS Written Complaints Data Collection (KO41A) 7.1 NHS Digital is responsible for the K041A quarterly complaints data collection. 7.2 At the beginning of Q4, the K041 codes were adopted for generating a report
directly from Datix Web; however there are still some issues to be resolved. 8.0 Survey of Complaints Management 8.1 A survey of complaints management is produced annually and enables us to
consider how well we deal with complaints from people who had first-hand experience of our complaints procedure and to identify if we need to make any changes to our service. The report is available at Appendix A.
9.0 NHS Choices 9.1 There were 72 comments posted on the NHS Choices website (60 positive, 9
negative and 3 mixed). Examples of comments are: Urology Department – “You are amazing and I will always be indebted to you. I would like to mention a few names but I know it's not allowed, but you know who you are and I will always see your faces whenever I think back to that time”.
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Tisbury Ward - “It was lovely to meet such a mix of nationalities, who were very competent and their English excellent. I hope the government realise how important it is that we need them and give them the same rights as us. CQC should give Salisbury an excellent rating”. Maternity - There was one mixed comment where the patient was expecting to see the consultant more as her pregnancy was high risk but the midwife had been very supportive. Day Surgery Unit - “At all times we were kept informed about what had happened and what was going to happen. The nursing staff were absolutely lovely and so caring and efficient given the workload they were expected to handle…every single patient was treated with great care, respect and efficiency. The Unit was spotlessly clean and tidy and the staff seemed to relate well with each other. I am extremely impressed”. Cardiology – There was one mixed comment stating that all the staff were good apart from one member of staff. General Surgery - “Two weeks ago I was admitted again with severe abdominal pain due to gall stones and cholecystitis; you operated the same day and saved me from pancreatitis and developing more serious liver complications than had already developed. That’s twice you have saved me now. How exactly do you go about thanking someone adequately for that? A few sentences on a website doesn't do it justice, I don’t have words for how incredible you all are. Greatest hospital in the world. I'm only here because of you”.
9.2 The Communications Team respond to all comments on NHS Choices and if there
is a negative comment, they invite the person who posted it to contact Customer Care so that their concerns can be investigated appropriately.
10.0 Translating and Interpreting 10.1 There were 136 face-to-face interpreting sessions booked, covering 28 different
departments. This was an increase of 91 sessions on 2016-17 (45). There were 41 sign language sessions booked, which is a decrease of 19 from 2016-17 (60). Further work needs to be done to promote telephone interpreting over the next year.
11.0 Patient and Public Involvement (PPI) 11.1 Patient and public involvement continues to play an important part in the
development of hospital services. Patients were involved in 34 projects this year (8 more than last year) using many different methods including patient stories, focus groups and questionnaires.
11.2 Examples of completed projects include:
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Orthopaedics
Ankle pathway questionnaire undertaken by the orthopaedic therapy team, to gain an understanding of patient satisfaction of their pre-operative management following an ankle fracture. The project was completed in Q1 and the department scored well with regards to the environment and all patients felt that they were listened to by the doctor and given opportunities to ask questions. One area for improvement was written information for patients. The main outcome from this project is the development of a virtual fracture triage clinic. Patient information is being written for a number of injuries, including information on self-management, exercises and a timeline of expected progression and return to function. Contact from the Orthopaedic Department with all patients prior to their appointment will result in an appointment being made at a more convenient time for them. Information will be sent out to the patient about this. This will facilitate patients into the right clinic at the right time, to reduce the number of internal referrals between consultants and patients having to return several times. Speech and Language Therapy Patients with Aphasia worked with the Speech and Language Therapy Team to develop a Communication Skills Training package and they deliver to staff. The decision to provide this type of training was taken as it was felt that the benefits of having a workforce of staff skilled in supporting patients with Aphasia on Farley Stroke Ward would outweigh the disadvantages of the unit staff not being trained. Some of these concerns were highlighted by staff during the training e.g. the safety implications of patients not understanding physiotherapy instructions, nurses being unable to complete a comprehensive assessment due to communication difficulties, and implications for consenting patients for procedures. Anticoagulant Service
A patient satisfaction survey identified the following areas for improvement: to reduce phlebotomy waiting times; greater use of CUC (finger prick) tests; greater explanation of diagnosis to patient (by all health care professionals); increase in GP phlebotomy appointments; GPs to have CUC provision; continuity of care and increased staffing levels. Older Persons Assessment and Liaison Service (OPAL) Customer feedback outcome:
Improved discharge communication including comprehensive geriatric assessment (CGA) and care plans through a collaborative team quality improvement (QI) process including patient involvement.
Produced a new Personalised Care Plan (PCP) that has been positively received and is now in use in the practice area.
Plan to roll-out the PCP to other areas of the hospital.
Therapy
The Early Supported Discharge for hip fractures – enhancing discharge planning by the therapists’ project was completed. Some patients agreed to be filmed whilst telling their story. In terms of patient opinion on what was important about their discharge, they rated the following as extremely important:
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having a telephone number to call for questions or problems;
having opportunities to ask questions about discharge plans; and
having worries or concerns about discharge listened to and understood.
Project outcomes are currently available on the Intranet at: http://intranet/website/staff/quality/customercare/patientandpublicinvolvement/ppiprojects/home.asp The PPI page is currently being updated to be more user-friendly.
12.0 Real Time Feedback
12.1 Real-time feedback (RTF) has been conducted in-house within Salisbury NHS
Foundation Trust since October 2009. It is undertaken by a team of volunteers covering adult inpatients (including spinal), maternity and paediatric patients. The volunteer reports back to the nurse-in-charge at the time RTF is completed so that any actions required can be undertaken as soon as possible. Both quantitative and qualitative data is captured. This is analysed monthly and reported widely across the Trust from Board level to the wards.
12.2
Adult Inpatients (excluding spinal)
A total of 995 inpatients were surveyed over the year. From the quantitative data, consistently high results have been achieved for:
cleanliness;
patients being treated with care and compassion. Less favourable results have been achieved for:
patients being disturbed at night by noise from other patients. In addition to responses to the set questions, patients made 714 positive and 522 negative comments. These have been categorised and the balance of positive to negative comments is shown in the graph below.
Action taken to address areas of concern Action is taken wherever possible to address patients’ concerns. Specific actions taken for the three areas with the highest number of negative comments are detailed below. Food and Nutrition on the Ward
Work continues in all areas to try to maintain the temperature of food before it reaches the patient.
Amesbury Suite has been working with voluntary services to increase support for drinks rounds in the morning and afternoon.
Durrington ward have re-launched protected mealtimes as a priority for all staff.
Patients on Plastics and Burns Unit had said that they did not always get the food they had ordered. As a result of efforts to ensure that menus are completed daily by the patient and/or relative, such comments are no longer received.
Environment The main issues relate to bathrooms, toilets and showers.
Britford Ward has submitted a capital bid for the renovation of all bathrooms on the ward. In the meantime, they are ensuring that these areas are monitored daily by Housekeeping and the nurse-in-charge.
Breamore (medical) Ward had also submitted a capital bid for improved bathrooms but this was superseded by their move to Whiteparish Ward which has improved facilities.
Repeated attempts to repair the shower on Breamore (surgical) Ward have proved unsuccessful. Attempts to obtain a replacement shower are now being made.
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Physiotherapy
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Respect and Dignity
Food & nutrition - Facilities
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Balance of Comments (Negative-Positive)
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Noise
Breamore (short-stay surgical) have asked Estates Technical Services (ETS) to check all doors and make improvements where possible. They are also purchasing silent closing bins.
Chilmark Suite is offering earplugs to patients during the evening drug round.
Downton Ward have undertaken a number of initiatives including offering ear plugs to patients, challenging visiting staff on the ward and managing patients’ expectations about the level of noise on a ward.
Durrington Ward is increasing staff education and managing patients’ expectations.
Plastics and Burns Unit have asked ETS to check all doors and are managing patient’s expectations.
Redlynch Ward is closing windows where possible to reduce early morning noise from outside vehicles.
Tisbury Ward is explaining to patients that cardiac monitors and call bells cannot be turned off at night.
12.3 Spinal Inpatients
A total of 95 inpatients were surveyed over the year.
From the quantitative data, consistently high results have been achieved for patients:
knowing which nurse is looking after them;
having confidence in the doctor looking after them;
receiving help with their meals;
being treated with care and compassion. Less favourable results have been achieved for response to call bells during the day, being disturbed by noise at night and services not being available at the weekends, specifically the gym and therapy sessions. In addition to the set questions, patients made 42 positive and 73 negative comments. The balance of positive to negative comments is shown in the graph below.
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Action taken to address areas of concern
Cleaning
It is acknowledged that the bathroom facilities are dated and therefore do not look fresh despite being clean. Directorate Management Teams are aware and a capital bid application has been submitted to renovate some of the bathrooms. A new cleaner started on the Unit in the autumn of 2017 and feedback on cleanliness has improved since that time. The annual deep clean was carried out in November/December 2017. Food and Nutrition on the Ward
Comment: Temperature of food. Action: The wards are aware of the reasons why the food is not always served
at the right temperature and are working on ways to rectifying this. One solution will be to ensure that the food trolley is not opened and staff do not start serving until the ward staff are able to assist to ensure the 15-minute food delivery target.
Comment Food not always served at the correct time. Action: A health care assistant has been allocated to help Housekeeping and
Catering staff to serve lunches at set times. Noise
Trollies and doors have been serviced and quieter bins have been purchased.
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Balance of Comments (Negative-Positive)
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12.4 Maternity
A total of 63 new mothers were surveyed in the reporting period. Consistently high results were achieved in all of the following areas:
Information provided about immunisations;
Support and encouragement in feeding baby;
Availability of services at the weekend. Less favourable results were achieved for:
continuity of care during pregnancy;
cleanliness of bathrooms and toilets. A total of 23 positive and 17 negative comments have been received. The balance of positive to negative comments is shown in the graph below.
Action taken to address areas of concern Food and nutrition on the ward
Comment: New mother on NICU queried food provision. Action: Staff have been reminded of the importance and process for new
mothers to obtain food whilst on NICU. Comment: Two new mothers said the food was cold but it could be due to
difficulties in timing. Action: Staff are not allowed to reheat food but efforts are made to ensure that
food is served at the correct temperature. Comment: New mother was very hungry during the night and would have liked a
snack. Action: Snacks and hot drinks are offered during the night on a case-by-case
basis which is assessed at the time. For example, a new mother who was awake would be offered a hot drink; a new mother back from a caesarean section would be offered toast. This has been reiterated.
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Staff
Balance of Comments (Negative-Positive)
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Cleanliness
In addition to routine ward cleaning, the cleaner now addresses areas of concern and any additional cleaning required between patients. The ward team pick up cleaning issues between patients once the cleaner has finished for the day. With these arrangements in place, patients should now always find bed spaces clean upon arrival. Communication Comment: After the third test for jaundice the midwife did not return with the results
as promised, or about weight loss of the baby. Action: Staff will ensure that new mothers’ expectations are managed in such
circumstances. Comment: New mother attended weekend clinics and saw a different midwife every
time. Action: Staff will ensure that new mothers are made aware that they will not see
a named midwife at these clinics. 12.5 Paediatrics
A total of 92 parents or carers and 33 children were surveyed during the year with 53 positive and 18 negative comments received. The balance of positive to negative comments is shown below:
Actions taken to address areas of concern
Food and nutrition Food is the main concern shown above. Action: Ensure all children/families are aware of the call-off menu so that substitutes can be made.
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Weekend
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Staff
Balance of Comments (Negative-Positive)
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12.6 Changes to Real Time Feedback Questionnaires
Each year the Patient Experience Analysis Group (PEAG) review the real-time feedback questions in light of issues being raised through national surveys, risk, litigation, complaints, concerns, real-time feedback and Friends and Family Test. Governors and volunteers who undertake real-time feedback are represented on the group. The questionnaires for 2018-19 have been amended as follows:- All questionnaires
‘Do you have any concerns about the information we hold about you?’ to include ‘for example, in your patient record’.
Adult inpatients (including spinal)
Reference to call bells changed to ‘If you need attention, are you able to get a member of staff to help you within a reasonable time?’
Help with meals amended to read ‘If you ask for help with food do you receive it?’
Noise disturbance – reference to mobile phones replaced with reference to televisions.
Spinal inpatients
Therapy question changed to read ‘Do you understand what you are working towards in your therapy sessions?’
Maternity
Questions removed: o During your first appointment with your midwife, were you given enough
information to make choices about screening? o Do you feel that staff listen to your wishes or concerns? o Have you been given the advice and support you need about infant feeding? o Were you (and/or your partner or a companion) left alone by midwives or
doctors at a time when it worried you?
Question amended: o ‘Throughout your pregnancy, have you felt involved in all decision-making
regarding the care of your baby?’ amended to ‘…regarding your care or concerns?’
New questions: o Were you offered choices about where to have your baby? o During your pregnancy were you given a choice about where your antenatal
check-ups would take place? o During your pregnancy have midwives provided relevant information about
feeding your baby? o During your pregnancy, did a midwife ask you how you were feeling
emotionally? o Have you been given enough information about any emotional changes you
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might experience after the birth? o Do you feel that midwives and other health professional are giving you active
support and encouragement about feeding your baby? o If your partner or someone else close to you has been involved in your care,
have they been able to stay with you as much as you wanted during the antenatal or labour period?
o Is there anything else we could have done regarding the facilities, e.g. water / bathrooms?
13.0 Friends and Family Test
The Friends and Family Test (FFT) was introduced on the inpatient wards and in the Emergency Department in April 2013. It was later introduced in Maternity Services from October 2013, and Outpatient and Day Case areas from October 2014. Patients are asked whether or not they would recommend the hospital to friends or family and are invited to make other comments if they so wish. Responses for the period are as follows:
Rating#
To
tal R
esp
on
ses
Receiv
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Extr
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Lik
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likely
n
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likely
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likely
Do
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kn
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*Rec
* N
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Rec
Day Cases 2652 2450 163 27 4 4 4 99% 0%
Emer Dept 1126 1008 98 8 2 7 3 98% 1%
Inpatients 3134 2689 354 72 10 2 7 97% 0%
Maternity 295 262 26 7 0 0 0 98% 0%
Outpatients 6751 6020 562 126 16 15 12 97% 0%
# Please note the score measures the % Recommended (Likely + Extremely Likely) and the %
Not Recommended (Unlikely + Extremely Unlikely) to show the percentage of responses that would or wouldn't recommend the Trust. Don't Know and Neither Likely or Unlikely responses are excluded from this measure The majority of free-text comments are very complimentary. All comments are fed back to the relevant areas and improvements are made where possible. Comments made by those patients who stated they would be unlikely or extremely unlikely to recommend the hospital have been categorised as set out in the graphs below together with actions taken to address concerns.
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The main area of concern is waiting times. Emergency Department
A six-month pilot was undertaken in the Emergency Department (ED) whereby paramedics would act as ‘navigators’ at the front door to redirect patients who did not need to attend ED. The pilot was a success and is now being recruited to substantively. A business case has been partially agreed to use ED staff for this role rather than paramedics.
An additional Band 2 has been rostered to assist the triage nurse with observations on patients in the waiting room between 11:00 and 22:00 hours.
The IT system to prompt staff to update the board hourly to show current waiting times is to be re-instated. The TV screen set up in the waiting area to allow feeds from reception staff will also be re-established.
Outpatients
Waiting times continue to be displayed on screens in outpatient areas and staff always address enquiries regarding delays, doing their best to alleviate any anxieties which arise.
14.0 National Patient Survey Programme 14.1 Maternity Survey
Questionnaires were sent to 300 mothers who had given birth during January or February 2017. The response rate was 54%. The benchmark results show that Salisbury scored ‘about the same’ as most other Trusts in England. Salisbury’s results are available on the Care Quality Commission’s website under three categories: Antenatal http://www.nhssurveys.org/Filestore/MAT17_Benchmark_reports/AntNat/MAT17_AN_RNZ.pdf
An action plan is in place, approved by Clinical Governance Committee. Labour and Birth http://www.nhssurveys.org/Filestore/MAT17_Benchmark_reports/LabBirth/MAT17_LB_RNZ.pdf Postnatal http://www.nhssurveys.org/Filestore/MAT17_Benchmark_reports/PostNat/MAT17_PN_RNZ.pdf Benchmark reports for the rest of England are available at: http://www.nhssurveys.org/surveys/1132
14.2 National Inpatient Survey 2017
Questionnaires were sent to 1250 patients who had at least one overnight stay in Salisbury District Hospital during the month of July 2017. The response rate was 61%. The benchmark results will be published on the Care Quality Commission’s website in late Spring 2018.
15.0 Training 15.1 Further training and support has been provided to wards for their patient
experience action plans, however more work needs to be done to evidence changes to practice.
15.2 Bespoke training for wards and departments has been delivered. 15.3 Investigator Training workshops to highlight key responsibilities for staff who
undertake any form of investigation have been delivered over the last year by the Head of Customer Care and Head of Risk. A number of workshops had to be cancelled due to late cancellations. Staff are being offered the opportunity to sit and observe a clinical review panel investigation, which has proved a useful development tool.
15.4 Customer Care and Complaints training has been delivered to the F1 and F2
doctors. 16.0 Customer Care Team 16.1 The Customer Care Team has been fully staffed since the end of February 2018,
following a vacancy in August 2017: Head of Customer Care 1.0 wte Customer Care Advisor (Patient and Public Involvement) 0.8 wte Complaint Co-ordinator 1.6 wte Customer Care Administrator 1.0 wte Friends and Family Test Administrator (Bank) – varies depending on number of responses received.
16.2 Volunteers and Governors undertake real time feedback across the inpatient areas and they are valued members of the Customer Care Team.
16.3 Senior managers and executives continued to support the Helpdesk model which ceased at the end of March 2018.
17.0 Priorities for 2018-19
17.1 Improving the Complaints Process
A half day Complaint Process Workshop was held on 1st May 2018 with all investigators and Complaint Co-ordinators invited to attend. The main objectives were to identify areas for improvement; identify the root cause for complaints happening; and explore solutions to ensure the process is:
o User friendly; o Staff friendly; o Efficient; and o Able to stand up to scrutiny by Internal Audit, the Care Quality
Commission and the Parliamentary and Health Service Ombudsman.
An action plan has been developed and will be implemented over 2018-19. 17.2 Electronic system for Real Time Feedback (RTF)
The annual report for 2017-18 noted that work was being undertaken to develop a system whereby users, particularly children, could answer real-time feedback questions via iPads. Emoji would be used where appropriate to encourage more feedback from children and young people. This work has proved successful and the system has now been rolled out across all areas within the Trust where RTF is undertaken (inpatients, spinal, maternity and paediatrics). The benefits are two-fold: a) cost savings on printing and stationery; b) patients may feel more able to express any concerns if they can do so directly
onto the iPad rather than through discussions with the interviewer which can be overheard by others on the ward.
The Helpdesk Manager model has changed so that all senior managers and
executives now visit patients on the wards to undertake electronic real time feedback. One directorate management team requested not visiting the areas they have managerial responsibility for, so that they could be fresh eyes in other areas, whereas another directorate management team requested that they visit their own areas in order to resolve any concerns raised more quickly.
17.3
Outpatient Real Time Feedback Electronic real time feedback will be developed in outpatient areas over the next year to help manage concerns in a timely manner and to inform service improvement.
17.4 Telephone Interpreting To work with Directorate Management Teams and departments across the Trust to
21 Hazel Hardyman Head of Customer Care
June 2018
promote the use of telephone interpreting. 17.5 Patient Experience Action Plans
To work with the ward teams to ensure they evidence changes to practice from patient experience feedback.
17.6 Investigator Training To reinstate training with the Head of Risk.
17.7 Patient Flow Support the Trust key objective of improving patient flow through patient and public involvement.
