ANALYSIS
As an independent review calls for a revolution in the way complaints are handled, Kat Keogh asks whether nurses will be supported to deal with them
All NHS staff to be handed a role in dealing with patient complaints The RCN has pledged to help nurses deal with complaints more effectively in the wake of a critical report. Putting Patients Back in the Picture, which was published last week, calls for urgent action to improve complaints handling in NHS trusts in England. The report outlines the findings of a review, led by Labour MP Ann Clwyd and South Tees Hospitals NHS Foundation Trust chief executive and nurse Tricia Hart, which was set up following the Mid Staffs scandal. More than 2,500 patients, relatives, carers and friends responded to the complaints review, which reveals ‘deep dissatisfaction’ over the way complaints are handled, confusion around the process and concerns about staff attitudes. One relative said that they were left waiting while staff gathered around a nurses’ station, engrossed in the end of an eBay auction. The son of another patient wrote: ‘Mother had two broken wrists. No one would feed her when meals were delivered, despite the fact she had two arms strapped up in the air.’ As a result of the review, 12 organisations including the RCN, Health Education England (HEE) and the Nursing and Midwifery Council (NMC) have signed up to 30 actions to help improve the complaints culture. The RCN is planning to host a workshop with nurses to consider the findings and has pledged to produce new guidance on handling complaints by spring 2014. RCN policy adviser Mark Platt says trust boards have a duty to provide clear guidance on how staff can best 14 november 6 :: vol 28 no 10 :: 2013
deal with complaints. ‘Concerns and complaints are an opportunity to learn,’ he says. ‘An important element is about supporting people to handle critical feedback, and enabling them to
‘WE SHOULD ENCOURAGE PEOPLE TO FEEL CONFIDENT ENOUGH TO SPEAK UP’ cope with that. They need to find an early resolution where possible.’ The report cited a ‘significant’ number of respondents who felt the quality of nursing care was
in decline. A number claimed that some nurses lacked compassion and discipline. But the report conceded that nurses featured prominently because they were the most ‘visible’ member of staff to patients. Mr Platt says singling out nurses misses the point of the review, which calls for a ward-to-board overhaul of the way complaints are handled. ‘Most people’s interactions with the healthcare system will involve a nurse, so it is understandable that the largest workforce has the most comments about them,’ he says. ‘But every
HOW A CUP OF TEA CAN REFRESH CARE She may be a senior sister on a busy trauma unit at the Royal United Hospital Bath NHS Trust, but Liz Vowles always has time for tea. Yet a tea break is far from an excuse to put her feet up. Every Wednesday, Ms Vowles and her colleague ward manager Simon Andrews hold a drop-in session for patients, relatives and carers to discuss issues over a hot drink. The ‘tea with sister’ session was set up last year to address immediate concerns, including questions about treatment and what happens after discharge. ‘We put up a poster to advertise the session,’ explains Ms Vowles. ‘People give us positive feedback, as well as telling us their concerns, and we feed back all comments to staff. It allows us to put ourselves in the shoes of patients and their relatives, and instigate changes that can make a difference.’ So far, alterations have included changing the shift pattern for healthcare assistants (HCAs) working nights. A patient raised a concern that
their call bell had not been answered one morning so HCAs now finish their shifts later, which means they can answer any bells while nurses are completing handover. The idea is being trialled across four other wards at the hospital and was highlighted as an example of good practice in the Putting Patients Back in the Picture report. The trust also won praise for its ‘see it my way’ events for staff, where patients and families talk about how their lives have been affected by conditions such as dementia, Parkinson’s disease and deafness. Trust head of patient experience Theresa Hegarty says: ‘We are not complacent. The term “complaint” can be seen as negative in the NHS, but for people who take the time and trouble to complain, it is usually the last thing they want to do. ‘You have to treat everything as feedback, because the patient voice is so important.’
NURSING STANDARD
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ANALYSIS
Five common reasons why people complain about the NHS Lack of information. Not enough detail given about their own or a loved one’s condition, prognosis and expected treatment. Poor communication between staff means that concerns are not passed on, forcing patients to repeat themselves. Compassion. Criticisms include staff being ‘offhand’, ‘rude’ and ‘callous’, with some patients feeling they have become a burden. Dignity and care. Not being offered help at mealtimes, having toileting concerns and experiencing a lack of privacy, particularly among those who cannot speak up for themselves. Staff attitudes. Feeling that no one is in charge on the ward and that staff are too busy to care. Lack of resources. Staffing levels are a key concern, along with a lack of basic supplies such as extra blankets or pillows. Source: A Review of the NHS Hospitals Complaints System – Putting Patients Back in the Picture
oversees the training and education of nurses, says it will develop a new e-learning course to help staff deal with patient feedback and complaints. Professor Hart says front line staff need to feel supported, not only to deal with patient complaints but also to raise their own concerns about poor
MARTIN CHAINEY
member of staff needs to know there is a system for dealing with complaints, and that they all have a part to play.’ Ms Clwyd and Professor Hart’s report makes a variety of recommendations for addressing the causes of complaints and improving transparency. These include a requirement for trusts to publish annual complaints reports and for boards to include a staff member with responsibility for whistleblowing. The duo has secured pledges from organisations to make changes within the next 12 months. The NMC has pledged that complaints handling will remain an ‘integral’ part of the council’s code, which is currently under review. It has also vowed to improve the experience of patients involved in fitness to practise proceedings by giving them more information and support. HEE, which
care. ‘Staff training, continuous development and organisational culture should be about being open and transparent,’ she says. ‘It is about encouraging people to feel comfortable and confident enough to speak up.’ HEE says it will work with local education and training boards to encourage nursing students to develop a more positive attitude towards hearing, accepting and responding to complaints. This pledge is welcomed by Jessica Corner, dean of the faculty of health sciences at the University of Southampton. The university is praised in the report for a teaching method called ‘forum theatre’, where university staff pose as patients and hospital staff to see how nursing students react to difficult situations. Southampton has been using the method since 2004. Scenarios include a patient with a complaint and a colleague displaying challenging behaviour. Professor Corner, who is also vice chair of the Council of Deans, says: ‘Students do not know what is going to unfold, and they benefit from experiencing different scenarios in real time. They are fresh eyes in the NHS and we need them to be confident about knowing what to do if something is wrong. Their feedback is invaluable, especially in the wake of the Francis report’ NS To read and download the report, go to tinyurl.com/pp23c7q
NURSING STANDARD november 6 :: vol 28 no 10 :: 2013 15 Downloaded from RCNi.com by ${individualUser.displayName} on Dec 11, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
As an independent review calls for a revolution in the way complaints are handled, Kat Keogh asks whether nurses will be supported to deal with them
All NHS staff to be handed a role in dealing with patient complaints The RCN has pledged to help nurses deal with complaints more effectively in the wake of a critical report. Putting Patients Back in the Picture, which was published last week, calls for urgent action to improve complaints handling in NHS trusts in England. The report outlines the findings of a review, led by Labour MP Ann Clwyd and South Tees Hospitals NHS Foundation Trust chief executive and nurse Tricia Hart, which was set up following the Mid Staffs scandal. More than 2,500 patients, relatives, carers and friends responded to the complaints review, which reveals ‘deep dissatisfaction’ over the way complaints are handled, confusion around the process and concerns about staff attitudes. One relative said that they were left waiting while staff gathered around a nurses’ station, engrossed in the end of an eBay auction. The son of another patient wrote: ‘Mother had two broken wrists. No one would feed her when meals were delivered, despite the fact she had two arms strapped up in the air.’ As a result of the review, 12 organisations including the RCN, Health Education England (HEE) and the Nursing and Midwifery Council (NMC) have signed up to 30 actions to help improve the complaints culture. The RCN is planning to host a workshop with nurses to consider the findings and has pledged to produce new guidance on handling complaints by spring 2014. RCN policy adviser Mark Platt says trust boards have a duty to provide clear guidance on how staff can best 14 november 6 :: vol 28 no 10 :: 2013
deal with complaints. ‘Concerns and complaints are an opportunity to learn,’ he says. ‘An important element is about supporting people to handle critical feedback, and enabling them to
‘WE SHOULD ENCOURAGE PEOPLE TO FEEL CONFIDENT ENOUGH TO SPEAK UP’ cope with that. They need to find an early resolution where possible.’ The report cited a ‘significant’ number of respondents who felt the quality of nursing care was
in decline. A number claimed that some nurses lacked compassion and discipline. But the report conceded that nurses featured prominently because they were the most ‘visible’ member of staff to patients. Mr Platt says singling out nurses misses the point of the review, which calls for a ward-to-board overhaul of the way complaints are handled. ‘Most people’s interactions with the healthcare system will involve a nurse, so it is understandable that the largest workforce has the most comments about them,’ he says. ‘But every
HOW A CUP OF TEA CAN REFRESH CARE She may be a senior sister on a busy trauma unit at the Royal United Hospital Bath NHS Trust, but Liz Vowles always has time for tea. Yet a tea break is far from an excuse to put her feet up. Every Wednesday, Ms Vowles and her colleague ward manager Simon Andrews hold a drop-in session for patients, relatives and carers to discuss issues over a hot drink. The ‘tea with sister’ session was set up last year to address immediate concerns, including questions about treatment and what happens after discharge. ‘We put up a poster to advertise the session,’ explains Ms Vowles. ‘People give us positive feedback, as well as telling us their concerns, and we feed back all comments to staff. It allows us to put ourselves in the shoes of patients and their relatives, and instigate changes that can make a difference.’ So far, alterations have included changing the shift pattern for healthcare assistants (HCAs) working nights. A patient raised a concern that
their call bell had not been answered one morning so HCAs now finish their shifts later, which means they can answer any bells while nurses are completing handover. The idea is being trialled across four other wards at the hospital and was highlighted as an example of good practice in the Putting Patients Back in the Picture report. The trust also won praise for its ‘see it my way’ events for staff, where patients and families talk about how their lives have been affected by conditions such as dementia, Parkinson’s disease and deafness. Trust head of patient experience Theresa Hegarty says: ‘We are not complacent. The term “complaint” can be seen as negative in the NHS, but for people who take the time and trouble to complain, it is usually the last thing they want to do. ‘You have to treat everything as feedback, because the patient voice is so important.’
NURSING STANDARD
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ANALYSIS
Five common reasons why people complain about the NHS Lack of information. Not enough detail given about their own or a loved one’s condition, prognosis and expected treatment. Poor communication between staff means that concerns are not passed on, forcing patients to repeat themselves. Compassion. Criticisms include staff being ‘offhand’, ‘rude’ and ‘callous’, with some patients feeling they have become a burden. Dignity and care. Not being offered help at mealtimes, having toileting concerns and experiencing a lack of privacy, particularly among those who cannot speak up for themselves. Staff attitudes. Feeling that no one is in charge on the ward and that staff are too busy to care. Lack of resources. Staffing levels are a key concern, along with a lack of basic supplies such as extra blankets or pillows. Source: A Review of the NHS Hospitals Complaints System – Putting Patients Back in the Picture
oversees the training and education of nurses, says it will develop a new e-learning course to help staff deal with patient feedback and complaints. Professor Hart says front line staff need to feel supported, not only to deal with patient complaints but also to raise their own concerns about poor
MARTIN CHAINEY
member of staff needs to know there is a system for dealing with complaints, and that they all have a part to play.’ Ms Clwyd and Professor Hart’s report makes a variety of recommendations for addressing the causes of complaints and improving transparency. These include a requirement for trusts to publish annual complaints reports and for boards to include a staff member with responsibility for whistleblowing. The duo has secured pledges from organisations to make changes within the next 12 months. The NMC has pledged that complaints handling will remain an ‘integral’ part of the council’s code, which is currently under review. It has also vowed to improve the experience of patients involved in fitness to practise proceedings by giving them more information and support. HEE, which
care. ‘Staff training, continuous development and organisational culture should be about being open and transparent,’ she says. ‘It is about encouraging people to feel comfortable and confident enough to speak up.’ HEE says it will work with local education and training boards to encourage nursing students to develop a more positive attitude towards hearing, accepting and responding to complaints. This pledge is welcomed by Jessica Corner, dean of the faculty of health sciences at the University of Southampton. The university is praised in the report for a teaching method called ‘forum theatre’, where university staff pose as patients and hospital staff to see how nursing students react to difficult situations. Southampton has been using the method since 2004. Scenarios include a patient with a complaint and a colleague displaying challenging behaviour. Professor Corner, who is also vice chair of the Council of Deans, says: ‘Students do not know what is going to unfold, and they benefit from experiencing different scenarios in real time. They are fresh eyes in the NHS and we need them to be confident about knowing what to do if something is wrong. Their feedback is invaluable, especially in the wake of the Francis report’ NS To read and download the report, go to tinyurl.com/pp23c7q
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