Improving your local
complaints process:
Setting the standard for complaints handling
in your service
Dr. Kieran Mullan
Independent Advisor to the review of NHS complaints & Past Project Director Patients Association
In the next 30 minutes…
Speaking Up Project
Principles of the methodology
Standards
About me
Trained as a doctor but before practising
worked at the Patients Association and
then worked there part time as I
continued clinical training
Project Director of the Speaking Up
Project
Served as an independent advisor to the
Clwyd/Hart review of complaints handling
Still working as A&E doctor now
Speaking Up Project
Funded by the Health Foundation
Working with Mid Staffordshire NHSFT
and other Trusts
Improving complaints handling
Advocates
Survey
Peer review process
NCEPOD methodology
Develop a mixed quantitative/qualitative
scorecard
Detailed standards
◦
8 ‘markable’ standards
Peer review process
Individual cases
Reviewed by mixed groups
Discussion encouraged but individual scoring
maintained
Some sub standards hard quantitative
standards-clear objective yes or no
Some more subjective judgement
Substandards inform but don’t dictate the
overall score for that standard and the case
overall
Peer review process
Unreliable for individual cases
Based on the records
But use individual case and performances
on sub standards and standards to build
picture of performance
We found correlation with the early
The Standards
12 overall standards
4 organisational “traditional”
Francis Recommendation113 states that “the
recommendations and standards suggested in
the Patients Association’s peer review into
complaints at the Mid Staffordshire NHS
Foundation Trust should be reviewed and
implemented in the NHS.”
Standard 1: The Complainant has a single point of contact in the Organisation and is placed at the centre of the process. The nature of their complaint and the outcome they are seeking is established at the outset.
Standard 2: The complaint undergoes initial assessment and any necessary immediate action is taken. A lead investigator is identified.
Standard 3: Investigations are thorough (Regulation 3 (2) (b) and Regulation 14 (1)), where appropriate obtain independent evidence and opinion and are carried out in accordance with local procedures, national guidance and within legal frameworks. Standard 4: The investigator reviews, organises and evaluates the investigative
findings.
Standard 5: The judgement reached by the decision maker is transparent, reasonable and based on the evidence available
Standard 6: The complaint documentation is accurate and complete. The
investigation is formally recorded, the level of detail appropriate to the nature and seriousness of the complaint.
Standard 7: Responding adequately to the complainant and those complained about (Regulation 14 Investigation and response).
The complainant was given contact details for a named person with whom they could liaise
throughout the process.
Yes □ No/Not recorded □
Best thought of as a ‘case worker’, complainants should be able to establish a working relationship with a named person who can act as their liaison throughout the process. References to “on behalf of the team” or similar would not constitute a named person. If a case worker is absent then ideally complainants should be informed of an alternative point of contact.
There is evidence of a clear management plan for the investigation.
Yes □ Partly□ No/Not recorded □
It is critical that one person be responsible for the conduct of the
investigation and thus for establishing the framework for the investigation. Ensuring that the planning stage is well done will have a major influence on the ultimate success of the investigation. Has the investigator
identified what questions need to be answered, what information is required to answer those questions and the best way to obtain that information? If there is evidence of an individual simply dividing up the complaint and requesting responses from the relevant departments or individuals (for example through internal emails or proforma) select
‘Partly’. A ‘Yes’ requires evidence of an overall and complete plan in terms of evidence required from each area and bringing that together for
There is sufficient evidence to show that statements were obtained from relevant members of staff involved with (or witnessing) the complaint.
Yes □ Partly □ No/not recorded □
Statements will form a key part of an investigation and are relatively easy to obtain in comparison to interviews. They may include accounts of events but also opinions on the appropriateness of treatment provided. Collecting statements from all those involved or able to act as witnesses is particularly important where there is an apparent dispute over events. In some circumstances where accounts are provided on behalf of a junior (e.g. Consultant giving a view on behalf their registrar who gave treatment) you may select ‘Partly’ but only when the statement is complete and comprehensive and has no apparent need for further clarification. However generally, the threshold should be high for selecting ‘Partly’ or ‘Yes’. If the
investigator was unable to obtain a statement from a key member of staff, this should have been recorded with reasons why. A staff member being on night duty is not an acceptable reason for not conducting an interview. Where they are a crucial witness the organisation should evidence they have made efforts to contact ex-employees. Where they are regulated professionals (e.g. nurses and doctors) they have a duty to cooperate.
Where necessary, there is sufficient evidence to show that relevant members of staff involved with (or
witnessing) the complaint were interviewed.
Yes □ Partly □ Not applicable □ No/not recorded □
In certain circumstances, an interview may be warranted. This may be because of a serious complaint with conflicting accounts being provided by staff or third party witnesses. Use your
judgement as to whether an interview was warranted for this complaint. Where only some people who think should have been were interviewed select ‘Partly’. Where you think an interview was not warranted select ‘Not applicable’.
Appropriate further independent opinion was secured on complaints relating to clinical issues
Yes □ Partly□ No/Not recorded □ Not applicable □
This sub standard relates specifically to independent opinion from those divorced from the handling of the complaint and the issues complained about. Where the complaint relates to serious harm or death, opinions from clinicians from outside the Trust (e.g. another Trust, a medico legal review, a Royal College review) will likely be required to secure a ‘yes’-for lesser complaints a Consultant
colleague providing an opinion on an anonymised scenario may suffice. Where, in your opinion, insufficient attempts have been made select ‘partly’. If you feel independent opinion of some form was warranted but none obtained select ‘no’. If it was not
Scored
Level 1 Poor practice
Level 2 Less than satisfactory
Level 3 Satisfactory
Level 4 Good practice
Common pitfalls
Lack of investigation=poor response
Conflicting accounts stated but not
acknowledged/tackled
‘X doesn’t happen/wouldn’t happen here’
Meaningless apologies-sympathise not
apologise
‘All staff have been reminded/it has been
reiterated’ Evidence of that?
Lack of detail-person X who is Y and has
Good practice
Initial phone call-use your judgement
Independent investigators
Internal proforma’s which evidence senior
involvement and independent review
Sharing of documentation e.g. minutes of
meetings with staff to review complaints
Reference to best practice/treatment
Contact the Patients Association for
latest on survey and peer review work
http://patients-association.com/Portals/0/Complaints%20
Management%20Scorecard%20-%20Guidance%20notes%20Version%2011.