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Dr Anne Duggan
Acting Director Clinical Governance
Hunter New England Health Local Health District
Listening and Respond...
Clinical Governance – Pursuing, Quality, Safety and Excellence
1
SMH 22/9/12
Patients complain of spending
Clinical Governance – Pursuing, Quality, Safety and Excellence
2
SMH 22/9/12
Abuse of doctors
Clinical Governance – Pursuing, Quality, Safety and Excellence
3
Clinical Governance – Pursuing, Quality, Safety and Excellence
4
Clinical Governance – Pursuing, Quality, Safety and Excellence
5
Sir Luke Fildes, The Doctor, 1887, Tate Gallery
Clinical Governance – Pursuing, Quality, Safety and Excellence
6
Clinical Governance – Pursuing, Quality, Safety and Excellence
7
“If I had an hour to save the world I would spend 59
minu...
Clinical Governance – Pursuing, Quality, Safety and Excellence
8
19th century Medicine - Snow‟s Broad Street Pump 1854
Clinical Governance – Pursuing, Quality, Safety and Excellence
9
20th century Medicine Age of Discovery
• Aspirin -1900s
•...
Clinical Governance – Pursuing, Quality, Safety and Excellence
10
“Not for the good it will do but that nothing will be
le...
Clinical Governance – Pursuing, Quality, Safety and Excellence
`I don't much care where--' said Alice.
`Then it doesn't ma...
Clinical Governance – Pursuing, Quality, Safety and Excellence
12
Clinical Governance – Pursuing, Quality, Safety and Excellence
13
Healthcare Health
What is the matter with you? What matt...
Clinical Governance – Pursuing, Quality, Safety and Excellence
14
Clinical Governance – Pursuing, Quality, Safety and Excellence
15
“These medical advances often mean longer and more
fulfi...
Clinical Governance – Pursuing, Quality, Safety and Excellence
16
Benefits and Harm
Harm Benefits
Units of
benefit
No. of ...
Clinical Governance – Pursuing, Quality, Safety and Excellence
17
Patient Centred Care
Clinical Governance – Pursuing, Quality, Safety and Excellence
18
James Gillray illustrates the common practice of bloodle...
Clinical Governance – Pursuing, Quality, Safety and Excellence
19
The NSW Health Framework for managing the quality
of hea...
Clinical Governance – Pursuing, Quality, Safety and Excellence
20
Listening and responding effectively to patient
complain...
Clinical Governance – Pursuing, Quality, Safety and Excellence
21
• Building a systems based approach
• Capturing and resp...
Clinical Governance – Pursuing, Quality, Safety and Excellence
22
Hunter New England Health
840,000 population (12%)
130,0...
Clinical Governance – Pursuing, Quality, Safety and Excellence
23
Building a systems based approach
Clinical Governance – Pursuing, Quality, Safety and Excellence
24
Definition and framework
NSW Ministry of Health Complain...
Clinical Governance – Pursuing, Quality, Safety and Excellence
25
Principles
• Compliance with policy
• Consumer engagemen...
Clinical Governance – Pursuing, Quality, Safety and Excellence
26
Clinical Governance – Pursuing, Quality, Safety and Excellence
27
System for complaints management
• Register in IIMS via ...
Clinical Governance – Pursuing, Quality, Safety and Excellence
Executive Support Service
• Access for complainants 1800 li...
Clinical Governance – Pursuing, Quality, Safety and Excellence
29
Clinical Governance – Pursuing, Quality, Safety and Excellence
30
Framework
• At point of service acknowledgement
explanat...
Clinical Governance – Pursuing, Quality, Safety and Excellence
31
WEEKLY ACKNOWLEDGEMENT REPORT AS AT 18 SEPTEMBER 2012
In...
Clinical Governance – Pursuing, Quality, Safety and Excellence
32
Clinical Governance – Pursuing, Quality, Safety and Excellence
33
Capturing and responding to patient feedback
Clinical Governance – Pursuing, Quality, Safety and Excellence
34
Clinical Governance – Pursuing, Quality, Safety and Excellence
35
What do People Complain About?
Complaint Issues 2007-08
...
Clinical Governance – Pursuing, Quality, Safety and Excellence
36
Clinical Governance – Pursuing, Quality, Safety and Excellence
37
Clinical Communication -
Leads from Incidents and Compla...
Clinical Governance – Pursuing, Quality, Safety and Excellence
38
Complaints associated with Communication
reported throug...
Clinical Governance – Pursuing, Quality, Safety and Excellence
39
Incidents associated with Communication
reported via IIM...
Clinical Governance – Pursuing, Quality, Safety and Excellence
40
Comparison of RCA findings relating to Communication
wit...
Clinical Governance – Pursuing, Quality, Safety and Excellence
41
Clinical Governance – Pursuing, Quality, Safety and Excellence
42
Clinical Governance – Pursuing, Quality, Safety and Excellence
43
Clinical Governance – Pursuing, Quality, Safety and Excellence
44
Clinical Governance – Pursuing, Quality, Safety and Excellence
45
Values
NSW Ministry of Health CORE values
• Collaboratio...
Clinical Governance – Pursuing, Quality, Safety and Excellence
Standardisat
ion
AcceleratorsMust
Haves
SM
Performan
ce Gap...
AIDET ~ Five Fundamentals of Consistent Communication to Patients &
Carers
A Acknowledge Safety and respect
I Introduce De...
Clinical Governance – Pursuing, Quality, Safety and Excellence
48
QSP
Knowledge industry and we provide
healthcare
Clinical Governance – Pursuing, Quality, Safety and Excellence
49
Ongoing Challenges
• Open Disclosure
• Fear of litigatio...
Clinical Governance – Pursuing, Quality, Safety and Excellence
50
Prerequisites for successful open disclosure
Clinicians ...
Clinical Governance – Pursuing, Quality, Safety and Excellence
51
The evidence for good communication
Up to 80% of malprac...
Clinical Governance – Pursuing, Quality, Safety and Excellence
52
The evidence for good communication
These same "inept co...
Clinical Governance – Pursuing, Quality, Safety and Excellence
53
Open disclosure plicy NSW and National
An apology is an ...
Clinical Governance – Pursuing, Quality, Safety and Excellence
54
The six „R‟s of an apology:
• Recognition
• Responsibili...
Clinical Governance – Pursuing, Quality, Safety and Excellence
55
National Standards for Open Disclosure
Clinical Governance – Pursuing, Quality, Safety and Excellence
56
Dealing with difficult complainants
Clinical Governance – Pursuing, Quality, Safety and Excellence
57
Clinical Governance – Pursuing, Quality, Safety and Excellence
58
Four complaints:
Ms A
Her sibling‟s undiagnosed mental i...
Clinical Governance – Pursuing, Quality, Safety and Excellence
59
Measuring for quality improvement
Clinical Governance – Pursuing, Quality, Safety and Excellence
60
Complaint Performance Indicators
Two Performance Indicat...
Clinical Governance – Pursuing, Quality, Safety and Excellence
Number of complaints received by month - Comparitive
0
50
1...
Clinical Governance – Pursuing, Quality, Safety and Excellence
62
Clinical Governance – Pursuing, Quality, Safety and Excellence
Complaints about Communication by issue for HNE for 2011/20...
Clinical Governance – Pursuing, Quality, Safety and Excellence
64
Clinical Governance – Pursuing, Quality, Safety and Excellence
65
Clinical Governance – Pursuing, Quality, Safety and Excellence
66
Complaints Management
Summary
• Learning Opportunity – d...
Clinical Governance – Pursuing, Quality, Safety and Excellence
67
“If I had an hour to save the world I would spend 59
min...
Clinical Governance – Pursuing, Quality, Safety and Excellence
68
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Listening and Responding to Patient Complaints: A Health System Approach

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Anne Duggan, Acting Director Clinical Governance, Hunter New England Local Health District delivered this presentation at IIR’s 2012 Healthcare Complaints Management conference. For more information about our wide range of medical and health events covering a broad range of industry issues, please visit www.healthcareconferences.com.au

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Transcript of "Listening and Responding to Patient Complaints: A Health System Approach "

  1. 1. 0 Dr Anne Duggan Acting Director Clinical Governance Hunter New England Health Local Health District Listening and Responding to Patient Complaints: a Health System Approach
  2. 2. Clinical Governance – Pursuing, Quality, Safety and Excellence 1 SMH 22/9/12 Patients complain of spending
  3. 3. Clinical Governance – Pursuing, Quality, Safety and Excellence 2 SMH 22/9/12 Abuse of doctors
  4. 4. Clinical Governance – Pursuing, Quality, Safety and Excellence 3
  5. 5. Clinical Governance – Pursuing, Quality, Safety and Excellence 4
  6. 6. Clinical Governance – Pursuing, Quality, Safety and Excellence 5 Sir Luke Fildes, The Doctor, 1887, Tate Gallery
  7. 7. Clinical Governance – Pursuing, Quality, Safety and Excellence 6
  8. 8. Clinical Governance – Pursuing, Quality, Safety and Excellence 7 “If I had an hour to save the world I would spend 59 minutes defining the problem and 1 minute finding a solution” Einstein
  9. 9. Clinical Governance – Pursuing, Quality, Safety and Excellence 8 19th century Medicine - Snow‟s Broad Street Pump 1854
  10. 10. Clinical Governance – Pursuing, Quality, Safety and Excellence 9 20th century Medicine Age of Discovery • Aspirin -1900s • Blood transfusion – 1910s • Insulin - 1920s • Penicillin - 1940s • Dialysis- 1940s • Steroids – 1950s • Ulcer healing drugs -1970s
  11. 11. Clinical Governance – Pursuing, Quality, Safety and Excellence 10 “Not for the good it will do but that nothing will be left on the margin of the impossible” - T.S. Eliot
  12. 12. Clinical Governance – Pursuing, Quality, Safety and Excellence `I don't much care where--' said Alice. `Then it doesn't matter which way you go,' said the Cat. `--so long as I get SOMEWHERE,' Alice added as an explanation. `Oh, you're sure to do that,' said the Cat, `if you only walk long enough.'" “Would you tell me, please, which way I ought to go from here?' `That depends a good deal on where you want to get to,' said the Cat.
  13. 13. Clinical Governance – Pursuing, Quality, Safety and Excellence 12
  14. 14. Clinical Governance – Pursuing, Quality, Safety and Excellence 13 Healthcare Health What is the matter with you? What matters to you?
  15. 15. Clinical Governance – Pursuing, Quality, Safety and Excellence 14
  16. 16. Clinical Governance – Pursuing, Quality, Safety and Excellence 15 “These medical advances often mean longer and more fulfilling lives. There are, however, broader implications. Greater clinical uncertainty requires both greater professional judgement as to what is the right course of action for an individual patient and a more open and honest discussion of risks to enable patients to make informed decisions.” - Lord Darzi
  17. 17. Clinical Governance – Pursuing, Quality, Safety and Excellence 16 Benefits and Harm Harm Benefits Units of benefit No. of Affected Population treated
  18. 18. Clinical Governance – Pursuing, Quality, Safety and Excellence 17 Patient Centred Care
  19. 19. Clinical Governance – Pursuing, Quality, Safety and Excellence 18 James Gillray illustrates the common practice of bloodletting (“breathing a vein”) to help cure disease. 1804
  20. 20. Clinical Governance – Pursuing, Quality, Safety and Excellence 19 The NSW Health Framework for managing the quality of heath care provided in NSW is based on the Six Dimension of Quality. The six dimensions of quality health care are: - Safety - Effectiveness - Appropriateness - Consumer participation - Access - Efficiency
  21. 21. Clinical Governance – Pursuing, Quality, Safety and Excellence 20 Listening and responding effectively to patient complaints and feedback is one of the most important investment we can make to ensure a viable public health sector for the future.
  22. 22. Clinical Governance – Pursuing, Quality, Safety and Excellence 21 • Building a systems based approach • Capturing and responding to patient feedback • Dealing with difficult complainants • Measuring for quality improvement
  23. 23. Clinical Governance – Pursuing, Quality, Safety and Excellence 22 Hunter New England Health 840,000 population (12%) 130,000 sq kms 49 inpatient facilities 68 locations 3225 beds 55,600 operations annually 14,000 staff
  24. 24. Clinical Governance – Pursuing, Quality, Safety and Excellence 23 Building a systems based approach
  25. 25. Clinical Governance – Pursuing, Quality, Safety and Excellence 24 Definition and framework NSW Ministry of Health Complaint Management Policy PD2006_073 Definition A complaint is: 1. An expression of dissatisfaction with a service offered or provided, or 2. A concern that provides feedback regarding any aspect of service that identifies issues requiring a response
  26. 26. Clinical Governance – Pursuing, Quality, Safety and Excellence 25 Principles • Compliance with policy • Consumer engagement • Open while protecting confidentiality • Sensitivity and timeliness * • Fair to all parties, just outcomes • Quality improvement and risk management - record, review, aggregate to improve services • Health Service and staff accountability *NSW Ministry of Health benchmarks are: Acknowledgement within 5 calendar days 100% Resolution within 35 calendar days 80%
  27. 27. Clinical Governance – Pursuing, Quality, Safety and Excellence 26
  28. 28. Clinical Governance – Pursuing, Quality, Safety and Excellence 27 System for complaints management • Register in IIMS via the Complaint Notification Form. • If clinical incident link to the Clinical Incident Form. • Acknowledge within five calendar days (100%): • Explain the process • Identify contact person for the complainant • Explain expected timeframes • Assess and assign to the relevant person to co- ordinate management • Resolve within 35 days (benchmark 80%)
  29. 29. Clinical Governance – Pursuing, Quality, Safety and Excellence Executive Support Service • Access for complainants 1800 line • Clarity of process and responsibilities • Support for the process • Monitoring and accountability • Reporting framework • Improvement pathway • Senior Complaints Officer 28
  30. 30. Clinical Governance – Pursuing, Quality, Safety and Excellence 29
  31. 31. Clinical Governance – Pursuing, Quality, Safety and Excellence 30 Framework • At point of service acknowledgement explanation validation • Through a staged process (Unresolved or beyond delegation) • Through referral to an external body/agency
  32. 32. Clinical Governance – Pursuing, Quality, Safety and Excellence 31 WEEKLY ACKNOWLEDGEMENT REPORT AS AT 18 SEPTEMBER 2012 Incident Location Incident Id Date complaint received How was the complaint received Days Since Received Complainant first name Complainant last name Manager **URGENT** OVERDUE FOR ACKNOWLEDGEMENT > 5 DAYS < 14 DAYS LMSR 1321848-20 12-Sep-12 Direct from complainant - letter 6Crystal F Jude Cons FOR ACKNOWLEDGEMENT - MATTERS NEARING 5 DAY BENCHMARK Mental Health Banksia ( Northern Region: Tamworth) 1322604-20 14-Sep-12NSW Minister of Health 4Rosemary L Jude Cons Tenterfield 1322601-20 14-Sep-12NSW Minister of Health 4Rosemary L Michael Mo Tamworth BH Ward 4 Surgical 1322445-20 14-Sep-12 Direct from complainant - letter 4Ken M Brad Hans REMINDER - BENCHMARK FOR ACKNOWLEDGEMENT WITHIN 5 DAYS OF RECEIPT OF COMPLAINT Medirest Catering 1323406-20 16-Sep-12 2 Bob Epp
  33. 33. Clinical Governance – Pursuing, Quality, Safety and Excellence 32
  34. 34. Clinical Governance – Pursuing, Quality, Safety and Excellence 33 Capturing and responding to patient feedback
  35. 35. Clinical Governance – Pursuing, Quality, Safety and Excellence 34
  36. 36. Clinical Governance – Pursuing, Quality, Safety and Excellence 35 What do People Complain About? Complaint Issues 2007-08 0 50 100 150 200 250 300 350 400 Access Communication Corporate Services Cost Grievances Professional Conduct Privacy Discrimination Treatment Consent
  37. 37. Clinical Governance – Pursuing, Quality, Safety and Excellence 36
  38. 38. Clinical Governance – Pursuing, Quality, Safety and Excellence 37 Clinical Communication - Leads from Incidents and Complaints Data from calendar year 2006 • 403 incidents reported to involve clinical communication • 171 complaints involved clinical communication • 127 Root Cause Analysis (RCA) involved communication
  39. 39. Clinical Governance – Pursuing, Quality, Safety and Excellence 38 Complaints associated with Communication reported through IIMS in 2006 communicating at handover 3% policies communicated adequately 3% timely transfer of investigations to those in charge 1% communication on transfer between facilities 4% communication with patients and carers regarding clinical information 17% communication with patients and carers regarding processess 11% speaking up for safety regardless of status. 1% Relaying concerns about a deteriorating condition to a senior clinician 3% formal documentation systems of communication 4% interpersonal communication principles and processes 53%
  40. 40. Clinical Governance – Pursuing, Quality, Safety and Excellence 39 Incidents associated with Communication reported via IIMS in 2006 policies communicated adequately 8% timely transfer of investigations to those in charge 3% communication on transfer between facilities 34% Relaying concerns about a deteriorating condition to a senior clinician 6% communicating at handover 32%communication with patients and carers regarding processes 2% communication with patients and carers regarding clinical information 5% interpersonal communciation principles and processes 2% formal documentation systems of communication 1% speaking up for safety regardless of status. 7%
  41. 41. Clinical Governance – Pursuing, Quality, Safety and Excellence 40 Comparison of RCA findings relating to Communication with Initial Incident Report – 2006 76% 24% RCAs with Communication Identified as an ISSUE, but not by notifier Incidents with communication issues identified in RCA, and by Notifier
  42. 42. Clinical Governance – Pursuing, Quality, Safety and Excellence 41
  43. 43. Clinical Governance – Pursuing, Quality, Safety and Excellence 42
  44. 44. Clinical Governance – Pursuing, Quality, Safety and Excellence 43
  45. 45. Clinical Governance – Pursuing, Quality, Safety and Excellence 44
  46. 46. Clinical Governance – Pursuing, Quality, Safety and Excellence 45 Values NSW Ministry of Health CORE values • Collaboration • Openness • Respect • Empowerment Hunter New England Local Health District (HNELHD) • CORE Values • Excellence Program “Every Patient Every Time”
  47. 47. Clinical Governance – Pursuing, Quality, Safety and Excellence Standardisat ion AcceleratorsMust Haves SM Performan ce Gap Objective Evaluation System Leader Developme nt Foundation Agreed upon tactics and behaviors to achieve goals Re-recruit high and middle performers Move low performers up or out Processes that are consistent & standardised throughout the organisation Leader Evaluation Staff Evaluation Discharge Call Rounding Idea Express Aligned Goals Aligned Behavior Aligned Process Create process to assist leaders in developing skills and leadership competen cies necessary to attain desired results Implement an organisation- wide staff & leadership evaluation system to hardwire objective accountability Evidence-based leadership practices
  48. 48. AIDET ~ Five Fundamentals of Consistent Communication to Patients & Carers A Acknowledge Safety and respect I Introduce Decrease anxiety D Duration Increase cooperation E Explanation Quality T Thank You Value & respect
  49. 49. Clinical Governance – Pursuing, Quality, Safety and Excellence 48 QSP Knowledge industry and we provide healthcare
  50. 50. Clinical Governance – Pursuing, Quality, Safety and Excellence 49 Ongoing Challenges • Open Disclosure • Fear of litigation • “Second victim” • Problem practitioners • Communication training
  51. 51. Clinical Governance – Pursuing, Quality, Safety and Excellence 50 Prerequisites for successful open disclosure Clinicians need to: 1. be aware that they will be legally protected from liability 2. know that they are authorised by their employer and government to make an apology 3. be prepared to admit they have made a mistake 4. accept that making an apology is the right thing to do 5. believe that an apology may serve a good purpose 6. know when and how to make an appropriate apology
  52. 52. Clinical Governance – Pursuing, Quality, Safety and Excellence 51 The evidence for good communication Up to 80% of malpractice claims are attributed to failures in communication and/or a lack of interpersonal skills. - Chris Wheeler Deputy NSW Ombudsman - Physicians with the highest risk for lawsuits were poor listeners, often failed to return phone calls, and were rude and disrespectful to patients. Hickson et al. (2002) "Physicians are most often sued, not for bad care, but inept communication. JCAHO (2005)"
  53. 53. Clinical Governance – Pursuing, Quality, Safety and Excellence 52 The evidence for good communication These same "inept communication practices" result in the majority of patient safety issues. In 1996, JCAHO identified communication as one of the top five issues contributing to the generation of medical errors. A 2003 JCAHO study documented communications breakdowns as the root cause of over 60% of 2,034 medical errors, of which 75% resulted in the patient's death (COPIC, 2005). In other words, 915 people died as a result of a communication error.
  54. 54. Clinical Governance – Pursuing, Quality, Safety and Excellence 53 Open disclosure plicy NSW and National An apology is an expression of feelings – an expression of sorrow, remorse or regret and an acknowledgement of fault, a shortcoming or a failing. An apology is a communication of information – a message. It consists of words that are exchanged that pave the way for a reconciliation.
  55. 55. Clinical Governance – Pursuing, Quality, Safety and Excellence 54 The six „R‟s of an apology: • Recognition • Responsibility • Reasons • Regret • Redress • Release
  56. 56. Clinical Governance – Pursuing, Quality, Safety and Excellence 55 National Standards for Open Disclosure
  57. 57. Clinical Governance – Pursuing, Quality, Safety and Excellence 56 Dealing with difficult complainants
  58. 58. Clinical Governance – Pursuing, Quality, Safety and Excellence 57
  59. 59. Clinical Governance – Pursuing, Quality, Safety and Excellence 58 Four complaints: Ms A Her sibling‟s undiagnosed mental illness and treatment within a mental health model. Mr B His osteomyelitis post hip replacement. Mr and Mrs C Their baby‟s birth injuries Mrs D Her husband‟s chronic illness and suicide.
  60. 60. Clinical Governance – Pursuing, Quality, Safety and Excellence 59 Measuring for quality improvement
  61. 61. Clinical Governance – Pursuing, Quality, Safety and Excellence 60 Complaint Performance Indicators Two Performance Indicators for Complaint Handling are measured monthly: Acknowledgement within 5 days (benchmark = 100%) Resolution within 35 days (benchmark = 80%) Reports on Complaint Performance Indicators are provided to the Executive Leadership Team and the HNE LHD Clinical Quality and Patient Care Committee to monitor progress Quarterly and annual reports are disseminated to the Organization via the Clinical Governance Intranet
  62. 62. Clinical Governance – Pursuing, Quality, Safety and Excellence Number of complaints received by month - Comparitive 0 50 100 150 200 250 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012
  63. 63. Clinical Governance – Pursuing, Quality, Safety and Excellence 62
  64. 64. Clinical Governance – Pursuing, Quality, Safety and Excellence Complaints about Communication by issue for HNE for 2011/2012 0 20 40 60 80 100 120 140 160 Attitude Inadequate information Wrong/Misleading information Interpreter/special needs
  65. 65. Clinical Governance – Pursuing, Quality, Safety and Excellence 64
  66. 66. Clinical Governance – Pursuing, Quality, Safety and Excellence 65
  67. 67. Clinical Governance – Pursuing, Quality, Safety and Excellence 66 Complaints Management Summary • Learning Opportunity – define the problem • Early apology – bad news never gets better with time • Communication for understanding – a learned behaviour • Work together e.g. HCCC - Not every complaint can be resolved • Create the culture – measure to improve • Create the space
  68. 68. Clinical Governance – Pursuing, Quality, Safety and Excellence 67 “If I had an hour to save the world I would spend 59 minutes defining the problem and 1 minute finding a solution” Einstein
  69. 69. Clinical Governance – Pursuing, Quality, Safety and Excellence 68
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