Trainer’s Notes

Welcome

At the start you will need to give participants information including:

• Explain the mobile phone policy;

• Availability of refreshments;

• Location of toilets;

• Emergency procedures for venue;

• Explain aims of the training programme/sessions;

• Agree ‘rules of engagement’ for the training session (not interrupting each other, keeping confidentiality, etc).

Overview

You may wish to cover the following points, drawing on your own

experiences and bringing in local information where relevant. Prepare a flip chart in advance with key words or phrases and use these to guide the presentation.

Alternatively: With more experienced participants, you can introduce each theme and ask participants to brainstorm their views.

Theme 1: Why are comments, concerns and complaints important?

We are all ‘patients’ at one time or another. Staff should be helped to appreciate that what they provide for ‘others’ is essentially what they would want for themselves and their family when they receive care.

When any of us use a service or buy something, we expect to be able to express our views and, if we make constructive suggestions, to have them taken seriously. The right to make complaints, to have them taken seriously, and to expect better services in future is essential if the public is to retain its confidence in the NHS.

Handling comments, concerns and complaints well contributes to overall service quality by providing feedback about services. Patients, relatives and carers often have important information about their experiences that we need to know. If you don’t invite people to say why they are dissatisfied, how will you ever find this out?

Complaints provide feedback and an opportunity for us to establish better patient relations and improve services. Here are some examples:

• Complaints about an outpatient service led to a major reorganisation of the way in which appointments were handled and notified to patients;

• Complaints about the continence service led to an NHS Trust arranging additional training for staff to help clients who were experiencing difficulties;

• Complaints to a commissioning body about delays in elective orthopaedic surgery led to additional investment to employ an additional surgeon for knee and hip operations;

• Complaints about GP practices have led to changes in how patients experience the service, such as:

o How patients access the out of hours telephone service to request home visits;

o Practices taking a different approach to telephone enquiries from parents concerned about MMR immunisations;

o Dealing with repeat prescription requests from patients who have been recently de-registered because they have moved out of the practice’s catchment area.

Theme 2: Why do people complain?

One of the most important lessons that healthcare staff need to learn is how to listen and react appropriately when patients, carers or relatives express a concern or make a complaint. Not everything that patients, relatives and carers raise as a concern is necessarily a ‘complaint’ even if it is made in an anxious or strident manner. ‘Niggles and grumbles’ need not automatically be shunted into a formal complaints process if they can be handled well and promptly by staff as they arise and if everyone is satisfied with the outcome.

People complain for many different reasons. The vast majority of people receiving NHS healthcare do not set out to become complainants, so when they do express a concern or a complaint it is usually a highly significant thing for them to do.

You might suggest that participants consider the view that:

‘A complaint is an emotion wrapped up in a process’

Get them to discuss what is more important - understanding the emotion and dealing with it, or focusing on administering the complaints process? If the latter is their first course of action, it may inflame the emotion, extend investigation time and considerably escalate the complaint.

Theme 3: What is a successful resolution of a complaint?

Understanding why someone complains and what they hope to achieve by voicing their concerns is essential to good complaints handling. Talking with people about what they want to come out of their comment, concern or complaint is important. What does success look like to them? To achieve patient satisfaction is to address what is on their mind and then to leave them ready to let the matter go.

Participants need to consider what a ‘good result’ might look like from the patient’s or relative’s perspective, for example, receiving a prompt and sincere apology or explanation. That may not be possible, but it should always be explored.

Sometimes patients, and particularly relatives, have unrealistic expectations about what healthcare and the NHS can achieve and this may lead to dissatisfaction and complaints. Where people understand what to expect from their care and from the NHS and how to use services appropriately, anxieties, concerns and complaints may be less likely.

Exercise 1

What do you think about complaints and people who complain?

Activity Instructions: Below is a list of ten statements about complaints and people who make them. Read through all of the statements first. Then go through them one by one again. Using the box to the left of the statement, rank each one on a scale of 1-10

1 is the statement you most strongly agree with 10 is the statement you most strongly disagree with

After you have finished, the Trainer will ask everyone to give their rankings from 1-10 so the group’s views can be discussed.

There are no right or wrong answers so say what you really think!

Rank Statements

NHS users should be encouraged to complain if they aren’t happy because we don’t complain enough in this country

These days people seem too ready to complain about the smallest things

People who complain make me feel negative about the NHS NHS patients shouldn’t complain because it’s a free service We can learn from complaints if we take the time to understand why people are raising particular issues

Patients aren’t health professionals, so we shouldn’t take their complaints too seriously

Most people don’t know what they want when they complain Some patients can never be satisfied so it’s best to ignore them We don’t hear from people who really have something to complain about

Front line staff should not have to deal with complaints

Exercise 2A

Hospital role play – Making and receiving a concern made in person

In the role play, one person is James’ relative (male or female) and one person is the ward sister/charge nurse/ward manager.

The relative makes the concern known to the staff member orally based on the facts of the scenario.

The ward sister receives the oral concern, summarises it back to the relative to get their agreement to the facts and tells the relative what s/he will do next.

The rest of the group observes the action and participates in the following discussion.

Roles: 1) James’ cousin

2) ward sister/charge nurse/ward manager

Scenario

James, a widower in his late 60’s, was admitted to the local general hospital for surgery to correct a common urological problem. He was welcomed to the ward and shown where the washing facilities and toilets were.

James had a drip inserted in his hand when he retired to bed. The drip was attached to a wheeled stand so he was able to move around. Later that night James felt an urgency to visit the toilet. He called for assistance, but there were no nurses available to help. As he was unable to get a nurse to help him, he got out of bed to find the facilities.

As James was preparing to go to the bathroom his need became urgent and in his haste to reach the toilets he did not have time to put on his slippers.

He reached the toilet, only to find it in total darkness. In the gloom he only just managed to reach the pan. He turned around in the toilet cubicle to find a means to switch the light on. He pulled the alarm cord instead of the light.

As he did this, however, he slipped on the wet floor and went crashing down hitting his head on the wall as he fell.

The nursing staff had been alerted by the alarm in the toilet and they helped James back to bed; they asked him how he was feeling and told him to stay in bed and they would assess him again in the morning. They gave James urinal bottles to use for the rest of the night in case he needed them.

When he awoke the following morning, James’ leg was extremely painful and bruised and he was unable to bear his own weight on it. His left side was also badly bruised and he was in considerable discomfort. He was taken for x-rays and a decision was taken not to continue with his surgical procedure because of the trauma he had suffered. His operation was cancelled and re-arranged.

A relative visited James on the ward the following day and became very distressed by what s/he saw of his injuries. S/he raised concerns with the Ward Sister in an emotional manner asking for something to be done.