NHS Tayside s Annual Feedback Report

Transcription

1 NHS Tayside s Annual Feedback Report A report on the learning, action and improvements made or proposed in response to feedback, comments, concerns and complaints about NHS Tayside healthcare services

2 Executive Summary Within NHS Tayside, person-centred care is a key strategic priority with a broad definition that includes family, carers and staff. The ambition of NHS Tayside s Clinical Governance Strategy is that every day every one of us delivers, sees and experiences standards of care that we would want for our own loved ones. This can only happen by putting the patient at the centre of everything we do, working as a team and making sure we have the information and data we need to deliver excellent treatment. Creating the right conditions for staff to provide safe, effective person-centred care is vital. To achieve this we need to pay attention to staff wellbeing and create cultures that facilitate them to flourish by reflecting and improving their practice and relationships with colleagues, patients and families. Therefore NHS Tayside has developed in partnership with staff, patients, carers and the public a Vision, Aim, Values and Behaviours to express what it believes to be the best environment to deliver person-centred, safe and effective clinical care. Underpinning the Clinical Governance Strategy is NHS Tayside s Care Governance Measurement and Monitoring Framework which details eight specific ambitions and key actions to improve quality. One ambition focuses on improving patient experience Patients, carers and members of the public will increasingly feel like they are being treated as vital and equal partners in the design and assessment of their local NHS. They should also be confident that their feedback is being listened to and see how this is impacting on their own care and the care of others. In 2016/17, NHS Tayside s feedback workstream identified three key priorities, as detailed below, and this report seeks to share the progress NHS Tayside has made in these areas as well as services continued focus on learning and improving services as a result of the feedback received 1. Identification and implementation of accessible feedback mechanisms that are advertised increasing awareness of the availability and use of these mechanisms 2. Undertake and act on a whole systems review of the complaints procedure, ensuring the implementation of quality assurance mechanisms and objectivity of investigations, and implementation of all key elements of Can I Help You? 3. Building capability (through strong leadership, role modelling and professional supervision) in staff at the point of care to optimise patient and carers experiences and to react appropriately when individuals raise dissatisfaction or make suggestions 1

3 Introduction Section 1 - Encouraging and Gathering Feedback How NHS Tayside Encourages Feedback Right Time Patient Feedback National Sources of Feedback Patient Opinion Local Online Feedback Mechanisms How Feedback is Obtained from Equality Groups NHS Tayside Public Partners Network What Support is available to People who wish to give Feedback or Complain? 29 Section 2 Encouraging and Handling Complaints Complaint Numbers and Response Times Themes Identified from Complaints Complaints Handling Approach Linking the Management of Complaints with Serious and Adverse Events Independent Contractor Complaints GPs, Dentists, Opticians and Pharmacists 37 Section 3 The culture, including staff training and development Developing NHS Tayside s Culture through our Vision and Values Training and Education 42 Section 4 Improvements to Services (as a result of complaints and feedback) Learning and Improvement resulting from Complaints Learning and Improvement resulting from Feedback 58 Section 5 Accountability and Governance 68 Page 2

4 Introduction The Patient Rights (Scotland) Act 2011 introduced a right to give feedback, comments, concerns and complaints about NHS healthcare and services. In NHS Tayside feedback encompasses comments, concerns, complaints and compliments. NHS Tayside has local processes and procedures in place for encouraging feedback to improve patient care and promote learning and improvement. NHS Tayside also utilises services such as Patient Advice and Support Service (PASS), Care Opinion (formerly Patient Opinion), advocacy and alternative dispute resolution services. This report 1 describes the opportunities and mechanisms in place within NHS Tayside to encourage and gather feedback. It also provides a summary of the issues raised, the learning and the actions and improvements made, or proposed, in response to the feedback received between 1 April 2016 and 31 March The report covers NHS Tayside services and those provided by local health service providers (eg GPs, dentists, opticians, community pharmacists and ophthalmic medical practitioners). Ways in which NHS Tayside seeks patient feedback NHS Tayside values and welcomes any comments or suggestions for improving services provided and wants to hear about anything patients, carers and families liked or disliked about the service or care given. NHS Tayside wants to know if there is or might be a better way of providing services or care and wants to hear people s ideas. There are many ways in which patients and their families can get involved to help shape and improve local health services. This includes participating online. Patients, carers and families can provide comments and feedback to the person involved in their care or people can visit: for all the latest consultations and to give feedback about NHS Tayside Services. The NHS Tayside website also provides information on how to give feedback and contains a link to NHS Inform Your Rights, NHS Scotland feedback and complaints for information about the support available to help people make their views known. Information on how to make a complaint is available via People can also contact by phone on or in writing to: NHS Tayside, Complaints and Feedback Team, Ninewells Hospital, Dundee, DD1 9SY. NHS Tayside also has a Facebook page and a Twitter page People can also provide feedback on NHS Tayside services via Care Opinion 1 This report can be made available in other languages and formats on request 3

5 Section 1 - Encouraging and gathering feedback This section aims to describe the methods NHS Tayside uses to encourage and gather feedback from patients, carers, relatives and the general public, about their experience of the services we offer. Within this section the report will demonstrate how NHS Tayside has met public sector equality duty and engaged with patients and carers who may find it difficult to communicate feedback, how NHS Tayside publicises the methods of providing feedback available and what support is available to those who wish to provide feedback. 1.1 How NHS Tayside encourages your feedback NHS Tayside continues to offer a diverse range of methods to patients, carers and families for the provision of feedback. These have been developed to support people to provide feedback both at the time care is being given as well as afterwards. These methods have been shared in previous annual feedback reports produced by NHS Tayside, and include methods such as: Daily conversations Healthcare staff interactions with patients, relatives and carers which provide opportunities for obtaining feedback Questionnaires in the format of How Are We Doing? Improvement Tree where patients write comments on post-it notes regarding their experience for display on the tree Approved or validated patient experience surveys for doctors, specialist nurses and allied health professionals (AHPs) which support their appraisal and revalidation are in place eg Consultation and Relational Empathy (CARE) measure; Picker Patient Experience Questionnaire (PPE15) Patient engagement forums Comments Cards / Suggestion Boxes Conversations with people with dementia conducted by volunteers 4

6 Specific forums to gain feedback from patients and carers who cannot communicate in the spoken language of English, who are hard of hearing and / or have other sensory impairment(s) which may cause barriers to communication Some more detailed examples of how services across NHS Tayside are collecting and using feedback are provided below: Example One: Paediatric Complex Disability Service The paediatric complex disability service has used a variety of methods for gathering feedback from families as follows: Feedback is collected using questionnaires issued by the Care Inspectorate. A stakeholder questionnaire is also used to gather wider feedback. Feedback is gathered during team / family activities such as coffee mornings and sessions with families. Family members are invited to add comments on flip charts. Feedback is shared through displays in service locations and schools, such as feedback trees, flowers. Questionnaires are used in schools You said, we did style board Suggestion boxes Example Two: Centre for Brain Injury and Rehabilitation (CBIR) The Centre for Brain Injury and Rehabilitation collect post discharge feedback from patients via "How are we doing? questionnaires which are also sent out to relatives after the patient s discharge from hospital. Information from these are collated and shared with the Multi Disciplinary team on a six monthly basis or as required. One recent example of an action from feedback was to create a pictorial sign for the shower room stating that the shower room is engaged to enable all people to recognise that the shower room is in use. Within CBIR a monthly community meeting is held with staff, patients and relatives to discuss "real time" feedback and actions are taken from this meeting and fed back to patients and relatives on a "you said we did" board. 5

7 Example Three: Enhanced Community Support in Perth and Kinross Patients and family being supported within Enhanced Community Support service were provided with the opportunity to feed back about their experience of care through a series of semi-structured interviews. Feedback was overwhelmingly positive, and demonstrated effective person centred care. o Example of Patient Feedback: "They allow everything that happens to be my decision" o Example of Carer Feedback: We have felt that we have been listened to, and have felt relaxed. It makes you feel that you can cope and you are confident" Example Four: Angus Voice Angus Voice represents the views and experiences of people in Angus who have mental health problems. Angus Voice is for and led by people who have personal experience of accessing mental health services. The aim is to build the capacity and involvement of people who use mental health services. It enables us to contribute to improving the services that affect us. The project does this by building partnerships and challenging stigma and discrimination. The first Open Space Session was held in June 2016 providing people with the opportunity to gain information but also share their views, experiences and feedback which could then be shared with Angus Health and Social Care Partnership (HSCP) that delivers Mental Health services. The session in June covered the following topics: Advanced Statements; Inpatient Service Provision; and Community Support and Activities This session provided lots of feedback and a range of actions were agreed including the development of a communication group, promotion of the Angus recovery network, sharing of activities and support currently available in the community and raising awareness of advance statements with people who use mental health services Example Five: Video Relay Interpreting This service, which is operated by contactscotland, means that people who are profoundly deaf can contact NHS Tayside using the online relay system and staff in NHS Tayside can contact deaf people using an app. This service has been highlighted to British Sign Language (BSL) users, NHS staff and deaf organisations through the Health and Deaf 6

8 Action Group, interpretation & translation awareness sessions, Vision and Hearing Support Officer, and the Leaflet Group. Feedback on the system has been sought from BSL users via the Health and Deaf Action Group, and also from individuals. Additionally this app has been downloaded onto the phones of two British Sign Language users to enable them to use the system. Others have been encouraged to download and access the app. NHS staff are aware of this service to allow communication with BSL users regarding appointments and related services. Compliments Clinical areas continue to receive compliments in a variety of ways such as cards, chocolates and letters. Some services display the thank you cards and letters they receive. Compliments that are received by the Complaints and Feedback Team are recorded centrally and shared with the relevant service area(s). During 2016/17, 333 compliments were recorded by the Complaints and Feedback Team in comparison to 373 in 2015/16. Figure 1 below compares the number of compliments received per month between April 2015 and March Compliments covered a variety of topics but the majority related to Attitude and Behaviour, Clinical Treatment and Communication. Table 1 shows the number of compliments received per directorate during 2016/17. Figure 1 The number of compliments received each month 7

9 Table 1 Number of compliments received between 1 April 2016 and 31 March 2017 by directorate Directorate Compliments Received Medicine Directorate 128 Surgical Directorate 72 Access Directorate 26 Specialist Services & Specialist Surgery 65 Dundee Health and Social Care Partnership (HSCP) 3 Angus Health and Social Care Partnership (HSCP) 19 Perth and Kinross Health and Social Care Partnership 14 (HSCP) Operations Directorate 0 Chief Executive's Department 1 Directorate of Primary and Community Services 2 Mental Health Services Right-Time Patient Feedback NHS Tayside, with support from Healthcare Improvement Scotland (HIS) person centred health care programme, has been testing the use of right-time patient feedback. Right time patient feedback is locally defined as telephone administered surveys of patients by volunteers up to two weeks post discharge from hospital. Within this test, NHS Tayside has been using the Patient Picker Experience 15 (PPE15 2 ) survey tool when contacting patients for their feedback. Trained volunteers are administering the surveys. PPE15 is an internationally recognised and used survey, designed from interviews with people about what matters to them about their health care experience. NHS Tayside consulted with managers across the organisation to agree which tool the organisation would use, asking them to consider which tool best fits what they hear from patients about what matters to them. Two volunteers worked alongside the facilitators, initially with staff and patients to test the tool and process in two inpatient wards to ensure this way of obtaining feedback was appropriate and rated positively by patients, staff and the volunteers. During the interviews, the volunteers sought feedback from patients about the process and if they would have preferred to be contacted in a different way or be asked any other questions. Volunteers continue to do this at the end of every call and this information is readily available. The majority of people contacted found the surveys on the phone to be convenient and the questions relevant, with a low proportion of patients advising they would also have been content to complete an online form or be contacted via . 8

10 In July 2016, a Patient Feedback Coordinator commenced a one year secondment to support NHS Tayside in delivering the right time patient feedback programme with an aim to: Establish sustainable mechanisms so that all inpatient areas can gather, report and act on formal patient feedback about their health care experience. Evaluate the impact and value of right time patient feedback for quality improvement in two wards post-natal maternity and renal ward. During 2016/17 NHS Tayside has been able to successfully implement the use of right time patient feedback using PPE15 within six inpatient wards. This represents 15% of the total number of wards for which PPE15 has been identified as an appropriate tool. In addition, NHS Tayside now has 10 trained volunteers who are able to gather right-time patient feedback using this tool. Some of the volunteers are continuing to buddy others and be supervised until fully competent and confident to interview patients. In two wards where practice development facilitation support is being provided to collect and act on patient feedback, the feedback indicates: Aspects of care most positively rated by patients include: providing care that is dignified and respectful providing good emotional support pain management provision of sufficient information from staff involving family in care decisions and information provision accessibility of medical staff Aspects of care least positively rated by patients include: use of jargon sufficient details relating to medication prescribed and danger signals staff availability for patients to discuss their () concerns sufficient opportunities to be involved in care and care decisions adequate information prior to discharge inconsistency in treatment / condition information from health care practitioners 2 PPE15 is a shortened version of the Picker patient experience survey and consists of 15 questions 9

11 These wards have prioritised the following areas for improvement: reducing conflicting information given to patients reducing use of jargon improving information given on discharge from hospital in relation to the purpose of medication prescribed and their side effects The wards are currently progressing actions in relation to the above, aiming to improve future patient experience and feedback. The Patient Feedback Coordinator has been integral in not only supporting the growth of the project across inpatient wards but also the following: Developing training materials / programmes for medical student volunteers in conjunction with the University of Dundee simulated patients; Training volunteers to conduct telephone surveys and providing them with guidance and support; Working with colleagues to ensure that the patient feedback data (quantitative and narrative) obtained by volunteers is available to the service areas within 24 hours of being entered; Raising awareness of the project and the importance of right time feedback throughout NHS Tayside; Engaging with further wards and key staff across NHS Tayside to start to explore what is required to spread and sustain this method of obtaining patient feedback across all inpatient areas of NHS Tayside. Following funding from HIS, NHS Tayside is exploring how existing resources can be realigned to ensure all areas have a suitable method and process for routine collection and sharing of care experiences. 1.3 National Sources of Feedback During 2015/16 there have been two national surveys, Inpatient Experience Survey 2016 and the first Scottish Cancer Patient Experience Survey which had results published in June

12 Inpatient Experience Survey 2016 The Inpatient Patient Experience Survey (previously referred to as Better Together) is part of the Scottish Care Experience Survey Programme, a national programme to find out what patients think about their healthcare services in Scotland. This is the fifth survey of its kind. The survey s specific aims are: For local improvement provide NHS hospitals with feedback on the experiences of their patients, relative to previous surveys and other areas in Scotland provide NHS Boards with information on experiences in their respective Board areas and on variation within and between Boards National policy provide national results for the survey, identifying variation within and between local areas and if and how the level of positive and negative experiences have changed over time highlight areas of best practice and areas for improvement provide information for the National Performance Framework Indicator Improve the quality of the healthcare experience in Scotland explore the variations in the experiences of different groups of patients Survey packs were sent in January 2016 to 43,901 people across Scotland who stayed overnight in a hospital bed between 1 April and 30 September In Tayside the survey was sent to 2,184 people. The survey asked questions about people s experiences of admission, the hospital ward and environment, care and treatment, operations and procedures, staff, leaving hospital, care after leaving hospital and medicines. NHS Tayside results 994 NHS Tayside patients returned feedback on their experiences in Tayside; the response rate was 43%. The NHS Tayside Board report relates to previous inpatients across 14 hospital sites in Tayside. Site specific results are available for Ninewells Hospital, Perth Royal Infirmary (PRI), Royal Victoria Hospital (RVH) and Stracathro Hospital. NHS Tayside as a whole performed very well. 88% of patients rated their overall care as positive, which is statistically significantly higher than the Scottish average of 84%. 11

13 93% of patients rated their care and treatment during their hospital stay as excellent or good, a statistically significant positive difference compared with the Scottish average of 90%. Results for Tayside in 2012 and 2014 are 87% and 91% respectively. For all the overarching key questions, bar one, that indicate overall experience NHS Tayside performed above the Scottish average. The question that falls below the Scottish average is in relation to care or support services after leaving hospital (Question 64). The table below shows the results for the Board compared with Scotland, and the specific sites from specific questions within the survey that provide an indication of overall experience. The results are in percentages of those respondents who rated very positive or positive. Table 2 - Results, as a percentage of very positive and positive responses, from key questions in the national survey which provide an indication of overall experience Scotland NHS Tayside Ninewells Hospital PRI RVH Stracathro Hospital Staff (Q49) 91 94s 94s 95s 93* 98* Care and treatment (Q34) s * Hospital and ward environment (Q20) s 94s 87 98* Accident and emergency (Q9) s - - Admission to hospital (Q13) 82 88s 87s 90s * Care or support services after leaving hospital (Q64) * Leaving hospital (Q60) * Total number of respondents 17, s indicates significant difference to Scotland; *indicates that a significance test was not carried out because fewer than five respondents within this site selected a positive response or a negative / neutral response results in Tayside compared with 2014 results in Tayside In comparison with the survey conducted in 2014, NHS Tayside patients were significantly more likely to report a positive experience in a number of areas. These areas are listed below; figures in brackets refer to the percentage positive response, followed by the percentage change from 2014, where + indicates a positive increase: Patients knew which nurse was in charge of their care (57%; +9%). Patients had enough time with the people that matter to them (89%; +7%). 12

14 Patients got enough help with washing and dressing when they needed it (92%; +6%). Patients knew which nurse was in charge of the ward (47%; +6%). Patients were happy with the visiting hours (98%; +2%). In comparison with the survey conducted in 2014, NHS Tayside patients were significantly less likely to report a positive experience in the following areas, again figures in brackets refer to the percentage positive response, followed by the percentage change from 2014, where indicates a negative decrease: How patients felt about the time they waited to be admitted to hospital after they were referred (80%; -9%). Patients were not bothered by noise at night from other patients (48%; -8%). Patients didn t have to wait too long to get their medicines (66%; -6%). Doctors knew enough about patients' condition and treatment (88%; -5%). Areas for improvement As identified above, the results of the survey indicate areas that could be improved upon. The results have been shared with clinical and non-clinical areas to enable them to consider the results and the accompanying subjective comments received with the survey results, to identify improvements that might be made. For example, discharge teams can review results and comments relating to waits related to discharge from hospital, and how these differ between different areas. However, three areas have been identified to progress organisational learning and improvement because the results warrant deeper enquiry; these areas include: Providing feedback / complaints about care received Only 38% of patients in NHS Tayside reported positively to the question: Patients saw / received information on providing feedback / complaints about care received Whilst the Tayside result is consistent with other Boards and Scotland as a whole (37%), NHS Tayside is keen to improve on this. 13

15 Clinical errors Of the 72 NHS Tayside patients who answered the following question about clinical errors, only 18% answered positively to it: A member of staff discussed any clinical errors with patients Whilst the Tayside result is not significantly different to the Scottish result (21% of patients across Scotland answered positively to this question), this again is an area to improve upon. Of note when asked the associated question: Patients were satisfied with how these clinical errors were dealt with 32% of patients answered positively, a 12% increase from the last survey. Noise at night There is variation across the sites in respect to responses about noise at night in the survey. Overall noise caused by other patients is an area that NHS Tayside has significantly done less well in compared with the average across Scotland and also compared with figures for In particular, Ninewells Hospital and Perth Royal Infirmary have both done less well in this area. In both Ninewells Hospital and Perth Royal Infirmary 46% of patients surveyed were not bothered by noise from other patients, this figure compared with 58% in 2014 for Ninewells Hospital, 49% in 2014 for Perth Royal Infirmary, and 55% in Scotland. The comparisons with figures with Scotland are both statistically significant, and for Ninewells Hospital the comparison with 2014 is also statistically significant. In comparison, Stracathro Hospital has made statistically significant improvements in results from noise at night from other patients; 85% of patients were not bothered by noise from other patients, compared with 66% in Similarly, Royal Victoria Hospital has shown improvement on 2014 figures, but these are not statistically significant. In some sites noise at night from other patients may be due to a number of factors including: the open plan nature of in-patient areas; overnight movement and interventions with patients. There are opportunities for learning across Tayside in this respect but also from other Boards. Figures for noise at night from staff also require consideration; overall in Tayside 66% of respondents were not bothered by noise at night from staff, compared with 71% in 2014 and 69% in Scotland; these results are not statistically significant. 14

16 The outcomes of the survey have been shared and celebrated across NHS Tayside, and the three key areas of improvement have been noted for areas to identify learning and implement appropriate change. A copy of the full survey results and questionnaire can be obtained at: Scottish Cancer Patient Experience Survey 2015 The Scottish Cancer Patient Experience Survey was run for the first time in 2015, with results published in June The survey asked questions about people s experiences of diagnosis, treatment, support, operations, in / outpatient and home care / support. Survey questionnaires were sent to 577 patients in NHS Tayside who were diagnosed with cancer between 1 July 2013 and 31 March 2014 and who received cancer treatment and care between 1 January 2014 and 30 September NHS Tayside patients (66%) returned feedback on their experiences. Overall, the results were very positive with 97% of patients rating their overall care as positive. The questions with the highest percent positive response for NHS Tayside were as follows: 15

17 The questions with the highest percent negative response for NHS Tayside were as indicated below. It is notable that, whilst these areas have the highest negative response, and therefore present opportunities for improvement, all had a higher positive response level than that across NHS Scotland. What NHS Tayside have and continue to do in response to the survey findings: The National Survey results informed the recommendations of our completed Phase I Transforming Care After Treatment Project (TCAT) (completed May 2017). These recommendations will be followed up and monitored by the Cancer Overview Group as they are rolled out to all of the Cancer site specific groups for implementation. Phase II and III will continue with the survey results at the basis of improvements. As the majority of comments that could be identified as being specific to one Cancer site specific group were in relation to the experiences of breast cancer patient experience, NHS Tayside has been carrying out targeted improvement work with the Breast Cancer Specialist Nurses. In conjunction with the Macmillan Partnership Quality Manager in Tayside, holistic needs assessment training has been facilitated to support the recovery package aims. NHS Tayside will monitor future comments or complaints in relation to this particular aspect of care to determine if improvements have been sustained. Breast Cancer patients had a specific Health and Wellbeing Event in the Maggie Centre in March 2017 which was the largest of the 10 events organised over the last 18 months. It is envisaged that this will be repeated and evaluated in the next 12 months. Following the successful contributions of the patient panel facilitated by the TCAT Project, NHS Tayside is collaborating with the Maggie Centre Dundee to ensure the ongoing coproduction with this valuable group who will hold NHS Tayside to account in relation to improvements as a result of the National Cancer Patient Experience Survey Results. 16

18 NHS Tayside is working with Dr Maggie Cunningham from the Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling who will be attending the Cancer Overview Group to discuss the qualitative analysis of the questionnaires which will assist to identify any further areas of focus that may need to be considered. A copy of the full survey results and questionnaire can be obtained at: Patient Opinion Patient Opinion is an independent organisation which was founded in 2005 and offers a platform for the public to provide feedback to health services. Members of the public can visit the Patient Opinion website ( where they can share a story about their experience of the health care they, a relative or friend received. These stories are then shared with NHS Tayside who will respond to the feedback, and utilise it to support learning and improvements across our services. In acknowledgement of greater integration across health and social care services, from 1 May 2017, Patient Opinion has merged with Care Opinion into a single integrated service allowing stories to be shared and responded to whether it is about health or social care services. This service is now called Care Opinion and will be described as such in next year s report. NHS Tayside continues to raise awareness of Patient Opinion as a means of receiving feedback on our services. Over the past year this has included discussion at Clinical Governance and team meetings, with staff being identified to receive alerts to Patient Opinion posts specifically relating to their services. To ensure staff are empowered to respond directly to feedback and fully supported by the organisation in doing so, access for services to respond to feedback directly on Patient Opinion continues to be rolled out in a structured way with appropriate support in place. Stories from Patient Opinion are also shared with the public and staff via the NHS Tayside Facebook page. NHS Tayside works closely with Patient Opinion to develop its use and accessibility to all. This has included participating in discussions regarding the possibility of receiving and responding to a story in pictures. 17

19 Although effort has been made to enhance patients awareness of this service, this has not resulted in as large an increase in contributions as anticipated (see figure 2). During 2016/17 ninety-seven (97) stories were posted on Patient Opinion regarding NHS Tayside services, compared to ninety (90) in 2015/16. As at 5 April 2017, seven of the stories posted were still to be responded to, and 84 (87%) received a response within two weeks of the story being published. Figure 2 The number of stories published each month April 2015 March 2016 Source: Patient Opinion, Stories in Summary Tayside The feedback NHS Tayside receives through Patient Opinion offers us an opportunity to share positive experiences with staff, as well as supporting us to identify areas for improvements. To view the stories posted by patients and the response provided by NHS Tayside, please visit 18

20 1.5 Local online feedback mechanisms Your NHS Tayside website ( Your NHS Tayside is a website used to engage and involve patients, carers, families and the general public in shaping and improving services. People can get involved online by completing surveys, taking part in a quick poll, giving feedback on NHS Tayside services. Consultations zone Details of live and closed consultations and how people can give us their views can be found at: In the year from April 2016 to March 2017 there have been three online consultations: Managing Asthma in Children Managing Asthma in Adults Cleft Surgical Services for NHS Scotland The Human Immunodeficiency Virus (HIV) Service How did we do? Consultation is ongoing. The purpose of this consultation is to find out the views and opinions of the department s service users. The results are checked regularly by the Public Involvement Team and shared with the service providers to identify what improvements are needed and are acted upon as the website development and functionality continues to evolve. 19

21 Facebook and Twitter NHS Tayside launched our Facebook and Twitter sites in July 2010 as an additional way for communicating with staff, patients, carers and members of the public. NHS Tayside s Facebook page: currently has 9241 followers, an increase of 3770 in 2015/16, with a possible onward reach of 177,000 per month plus followers. The weekly reach averages around 85,500 with the bulk of followers coming from the 25 to 54 year old bracket. 82% of followers are female with 41% of them being aged 35 plus. NHS Tayside s Twitter page: currently has 8551 followers, an increase of 1374 followers in 2015/16, with many of them regularly re-tweeting posts or commenting on them. An average of 200 plus mentions / interactions are received per week. NHS Tayside s Instagram page currently has 947 followers. This page was set up in the last year and has steadily progressed in gaining followers in recent months. Feedback received via Facebook and Twitter is sent to the relevant service and the Complaints and Feedback Team for recording, taking action and responding to as required. 1.6 How Feedback is obtained from equality groups NHS Tayside recognises the need to ensure feedback mechanisms are fully inclusive, ensuring that all patient groups and population groups have an opportunity to give feedback. This can mean the need to adapt current feedback methods or establish new ones based on discussions with patients, carers and families about the best way to meet their needs. Procedures remain in place to ensure that surveys can be made accessible to non English speaking patients, either through the use of language line who will provide telephone interpretation or by identifying a relative / carer who can support the person. The Health and Deaf Action Group has had regular meetings over the last year. The group consists of third sector deaf organisations, people who are profoundly deaf and NHS staff. The purpose of the group is to let NHS Tayside know when there is a service or process that can be improved. The Chairperson(s) will make suggestions, recommendations and highlight any issues to the Clinical Quality Forum. The authority for the group will be delegated through the Chair of the Interpretation and Translation Governance Leadership 20

22 Team. The group will progress actions aimed at improving services for people who are profoundly deaf. The role and remit of the group is to provide advice, ideas and thoughts to NHS Tayside around caring for profoundly deaf / hard of hearing. Regular meetings of the group are an opportunity to receive direct feedback from a section of our community who might find conventional ways of giving feedback difficult. As a result of feedback from these meetings, there have been walk rounds in Ninewells Hospital concourse to identify improvements for people who are deaf and inform the future redevelopment programme. The following work has been progressed by the group: A hearing loop audit has been completed and a plan proposed to upgrade Progressing work to ensure that more appointment letters have a yellow sticker to advise that an interpreter has been booked and a mobile phone is available in order that BSL users can be sent a text advising of their appointment The group are making changes to the Dundee Translation and Interpretation Service (DTIS) booking form to ensure that all adequate information is noted for when an interpreter requires to be booked for an appointment The group are now aware that screening leaflets are available in BSL format The group are providing input on a BSL questionnaire in order that, after appointments, BSL users will be able to provide feedback on their appointment and interpreter. During 2016/17 NHS Tayside commenced a project, led by the Nursing and Midwifery Directorate, with the aim of identifying ways in which we can obtain care experience feedback from patients in hospital who have dementia or cognitive impairment as a step towards learning from their experiences, so care is more person-centred, safe and effective. The results of the project will influence how NHS Tayside obtains patient feedback in 37 inpatient wards (mainly Psychiatry of Old Age and Medicine for the Elderly areas) where this feedback will be obtained in real time at point of care using a variety of methods and communication tools. Work undertaken in relation to this project has been as follows: Literature review and phone interviews with Scottish nurse dementia consultants to understand current practice in collecting feedback from patients with cognitive impairment and / or dementia 21

23 A review of the literature and analysis of nurse consultant interviews highlights that this is an unexplored area, leaving this patient group with little voice and therefore limited control over how their care is planned, delivered or experienced. Much of the literature in this field covers issues regarding inclusion of those with dementia in research and how to optimise the encounter when engaging in an interview setting. The data has been synthesized for future publication and will underpin the methods and communication toolkit used. A Multi-Disciplinary Team (MDT) steering group has been established to guide this exploratory work Using practice development principles and processes we have been able to be collaborative, inclusive and participatory while engaging with healthcare team representatives from medicine, nursing, allied health professionals and spiritual care. Pertinent decisions have been addressed including the diversity of the patient population being considered initially, issues of choice of pilot wards and training considerations for the spiritual care volunteers. An initial toolkit has been developed and tested with community groups of people with language / cognitive impairment NHS Tayside has tested the tools with six Spiritual Care Volunteers in four varied community settings across Tayside including Speakability Royal Victoria Hospital Dundee, Glenloch support centre Forfar, Dementia resource centre Dundee and Monifieth stroke support group. This has provided an opportunity for the volunteers to hone their skills in using the communication toolkit and allowed engagement with this patient group on the design of methods for collection of their feedback. How the service users in these groups might contribute to the analysis of the data has been considered and agreed that feedback regarding their experience of being interviewed will be shared with the volunteers who interviewed them and be incorporated in the feedback to the researcher. Results will be shared back to the groups via their group leader who is familiar with the service users. Pilot wards have been identified based on having a high proportion of this group of patients and covers acute, rehabilitation and psychiatry wards from different areas of Tayside 22

24 Senior Charge Nurses from pilot wards have met with the researcher and volunteer participants to discuss and plan in detail the approach to be taken in obtaining feedback and to discuss how any feedback obtained should be communicated, if the patient would wish this. Initial exploratory interviews are to be carried out in April 2017 to allow any unforeseen issues to be addressed prior to more formal research commencing once ethical approval has been obtained. Working with spiritual care volunteers to help test the methods that have been identified NHS Tayside is working with spiritual care volunteers to interview patients, as they are independent to the care team. Care staff performing interviews will do so outwith their own ward for the same reason. As part of this project NHS Tayside is exploring what preparation and support volunteers and care staff need to be able to use these tools and methods to capture patient experience and indentifying, in a progressive manner with the volunteers, what it takes to prepare for this role. This will feed into future plans for training of staff and volunteers. We will be interviewing the volunteers straight after the patient interview to gain an understanding of how effective or otherwise the methods and toolkit were in obtaining care experience from this group. The semi-structured approach used for the interview is based on previous work which highlights main areas of concern to patients. Following this, there will be cycles of refinement of the methods and tools. Future plans to address issues of sustainability: NHS Tayside is currently in the research phase of a design project to create a video in collaboration with Dundee University Art and Design students highlighting the variety of ways that feedback can be given within NHS Tayside. The aim is that this will be used on the NHS Tayside intranet and internet on NHS Tayside websites alongside other avenues of communication. Plans are in process to use patient simulation within the Clinical Skills Department to train staff and volunteers in the art of obtaining care experience feedback from those seldom heard from, using the results of the research to underpin the process. As a result of research, an educational need among volunteers and staff who care for those with cognitive or language difficulties has been identified. Speech and Language Therapy services have offered to collaborate in sharing an existing training 23

25 and education package which focuses on the specific communication skills required to optimise encounters with those who have cognitive impairment or communication difficulties. An event is to be held in May 2017 to thank volunteers and staff involved and to increase awareness of feedback work amongst senior management. 1.7 NHS Tayside Public Partners Network NHS Tayside Public Partners are members of the public who have an interest in health and health related issues who give freely and willingly of their time to work in partnership with NHS Tayside. They do not require to have specialist skills, knowledge or experience of health care. Public Partners act as a sounding board for NHS Tayside by giving their views in the development of strategies and policies and in the redesign of services. They have the opportunity to challenge proposals, contribute to decision making on service developments and participate in consultations. During the period of the report Public Partners have contributed to a range of issues including: Discussion groups led by NHS Officers to gather views and opinions on the following topics: Staff Recognition Awards - The aim of this focus group was to seek out the group s opinion and feedback on the proposed Annual Staff Recognition Awards for all staff in NHS Tayside, to agree the award categories and to seek public representation for a panel member to select winners from nominated staff from each category. Public Partners feedback was incorporated and shaped the Star Awards. A Public Partner was also invited to join the Star Awards Shortlisting Judging Panel. Palliative and End of Life Care This was an informal discussion with Public Partners to find out what palliative and end of life care means to them and to share examples of vision statements for a new Tayside Managed Care Network (MCN) for Palliative and End of Life Care and ask them to select the best option. The feedback gathered from Public Partners will inform the work of the project and MCN going forward. Automated Switchboard Service NHS Tayside has introduced a new automated switchboard system. NHS Tayside is committed to improving call waiting times for both internal and external callers. The Switchboard Services Manager met with Public Partners to share details of the changes but importantly to seek the views and 24

26 suggestions on these. Public Partners gave feedback on the changes and some updates have been made as a result. Consultation on Proposed Options to Improve and Assure the Nutritional Standards of Food in Hospitals This document invited views on proposed options to improve and assure the nutritional standard of food in NHSScotland hospitals, including the option to place nutritional standards for food in NHS hospitals on a statutory footing. Statutory footing means establishing minimum, legal standards which NHS Boards in Scotland have to achieve in terms of the nutritional content of the food served to hospital patients. Public Partners were invited to take part in the consultation and, at the suggestion of the Lead Officer, an explicit Public Partner response, independent of NHS Tayside, was submitted. Shaping Surgical Services - NHS Tayside is undertaking a review relating to delivery of some aspects of surgical services. Public Partners have contributed to discussion sessions and in particular have had a major input to the consideration and development of potential and proposed options. Adverse Event Management Learning from Events Health Improvement Scotland (HIS) and NHS Tayside were keen to know and understand the perspective of patient representatives on what they would like to see in the public domain around learning from adverse events. An adverse event is defined as an event that could have caused (a near miss), or did result in, harm to people or groups of people. A focus group was held with Public Partners, led by a Lead Officer from Clinical Governance and Risk Management. Health Improvement Scotland (HIS) will use the feedback gathered from Public Partners to inform the Adverse Events Learning Summaries Short Life Working Group for a consistent approach across NHSScotland for sharing learning points from adverse event reviews and to support openness and transparency. Healthcare Environment Inspectorate (HEI) Inspection Whitehills Health and Community Care Centre The HEI carries out safety and cleanliness inspections across NHSScotland hospitals and services and the aims are to provide public assurance and protection, to restore public trust and confidence, contribute to the prevention and control of Healthcare Associated Infections (HAI) and contribute to improvement in the healthcare environment. A Public Partner was invited to participate in this inspection. 25

27 Corporate Communications and Engagement Strategy NHS Tayside is developing a five-year communications and engagement strategy to set out how the organisation will communicate and engage with all our stakeholders. The Corporate Communications Department held a focus group with Public Partners to discuss our vision, aims and objectives and get their views on the way in which NHS Tayside will commit to communicating and listening to patients, families, carers and the public. Respect Us campaign to prevent violence and abuse against staff This campaign is about stamping out abuse against staff. Public Partners contributed to the discussion, making suggestions on aspects to be included. Public Partner Documentation As the Public Involvement Team was planning to undertake a recruitment campaign it was essential that all literature pertaining to NHS Public Partners was updated to reflect what the role of the Public Partners is. The purpose of the project was to gain the Public Partners perspective as to the content of the documents and to put forward suggestions for improvement. The feedback garnered was incorporated in the reviewed literature. Improving Patients Experiences of Care (IPEC) A study Improving Patients Experiences of Care (IPEC) that sought to understand the impact two improvement programmes had on patients and staff experiences of care was undertaken. The two improvement programmes were Releasing Time to Care (RTC Plus) and Caring Behaviours Assurance System (CBAS). These programmes were designed by external organisations and facilitated by NHS Tayside practice development nurses. They both had the explicit intention of improving patient care and experience and making the workplace an easier and more satisfying place for nursing teams to work. A discussion group with Public Partners was held to present the findings of the study and to discuss plans for gathering and using patient feedback within NHS Tayside hospitals. A draft newsletter which was designed for staff was also shared to get feedback. The feedback from the Public Partners has helped the Lead Officer understand that the language spoken to describe research may be inaccessible to most staff and has provided confidence that NHS Tayside s plans for seeking feedback are consistent with the public s expectations. As a result, changes are being made to the newsletter to simplify language and a Public Partner amended the layout to enhance understanding and presentation of materials. 26

28 Out of Hours (OOH) Service Communication and Engagement A focus group was held with Public Partners to get their views on the current understanding of the OOH Service. To help develop an awareness raising communication plan, Public Partners were also asked for their opinion on how best to share the message with the public regarding the role and function of the service. In relation to the Sir Lewis Ritchie review and the current programme of tests of improvements, Public Partners opinions were sought on how to share details and engage with the public regarding the tests of change. Angus Food Audit Whitehills Health and Community Care Centre Catering services aim to improve the standard of the Patient meal service by developing Public Partnership working. This objective would support the monitoring, evaluation and consultation plan within the Food Fluid and Nutrition Policy. Angus Catering services invited Public Partners as part of a Catering audit group which will meet on a quarterly basis to monitor, identify and share good practice and areas for improvement resulting from the audit. The group visited the production kitchen for a walk round and met with staff to hear about the facility, processes and layout. A tasting and feedback session then took place with the Partners being asked to complete a meal auditing tool questionnaire. Following the audit, the group was shown patient menus and discussed topics including nutritional information, inpatient experiences and portion sizes. There was also information available about policies and procedures. As a result of feedback from a Public Partner, the Menu Review Group has agreed to have fruit available on the patients breakfast menu. National Care Standards Consultation Discussion Group The National Care Standards are a set of Standards for care in Scotland. They help everyone understand what they have a right to expect when they access health and social care services. The new Standards represent a significant development for the people of Scotland. They comprehensively set out what care and support should actually look and feel like for people every time they use health and social care services. A consultation on the new Standards was undertaken and Public Partners were given the opportunity to learn about the development of the Standards and to give their thoughts on what they stand for. They were asked to give specific feedback on the consultation questions which helped to inform the NHS Tayside response to the consultation. For those who were unable to attend on the day but were keenly interested in this subject, they were provided with a link to access the consultation online whereby they could provide an individual response. 27

29 Replacement of Existing Patient Administration System Discussion Group The purpose of this project is to replace the existing Patient Administration System (PAS), TOPAS, with the nationally mandated system TrakCare. In addition to the PAS system, NHS Tayside will also be introducing functionality for Emergency Department and Maternity. A discussion group with Public Partners was held where the Lead Officers shared information on the project and gave them reassurance on the need for this change and the future benefits this will bring to patients in the future. The feedback received will be incorporated into the existing Communication and Engagement Strategy and suggestions will be prioritised and actioned based on resources available to ensure suitable engagement / awareness activities are incorporated into the plan. Public Partner Engagement and Consultation Group A small group of Public Partners has been developed to build up an expertise in the understanding of engagement and consultation. An introductory meeting was held where they were given a presentation on NHS Boards duty to involve and the related legislation and guidance which included CEL 4 - Informing, engaging and consulting people in developing health and community care services. A workshop / training session has also taken place. Public Partners were given a couple of exercises to look at before being presented with a consultation document and asked to consider who the stakeholders would be and also the methods of engagement. Scottish Ambulance Service New Clinical Response Model The Scottish Ambulance Service is engaging with all key stakeholders throughout the 12 month pilot, including public partnership forums across Scotland. The model is continuing to be developed based on clinical data and feedback received from all stakeholders. This discussion and presentation was held to increase understanding of the new pilot model and to engage and receive feedback. The Ninewells Energy Centre The Head of Environmental Management invited Public Partners to visit the centre to learn more about how it works and to find out how NHS Tayside is meeting its requirements around Sustainable Development and in particular energy efficiency. The centre provides the hospital with all its electricity and the vast majority of its heating. During the visit, Public Partners were given the opportunity to ask questions about the functionality of the centre. This enhanced their knowledge of the work that has gone into making NHS Tayside, and Ninewells 28

30 Hospital in particular, more energy efficient and focused on reducing its carbon footprint. 1.8 What support is available to people who wish to give feedback or complain? Anyone wishing to speak to someone for advice or help with giving feedback or making a complaint is given details about the independent Patient Advice and Support Service (PASS) which is available through the local Citizen s Advice Bureau (CAB). Contact details for the Patient Advice and Support Service (PASS) are provided in leaflets and through the NHS Tayside website; this information is also included in posters and pocket cards. A leaflet providing complainants with details of who the Patient Advice and Support Service (PASS) are, the service they offer and how to contact them is included with all complaint acknowledgement letters. In addition, members of the Complaints and Feedback Team speaking with complainants are able to signpost them to the appropriate Patient Advice and Support Service (PASS) Adviser. Senior Charge Nurses / Charge Nurses through the Leading Better Care programme were introduced to complaints and early resolution. This equips nursing teams to be confident to seek feedback from patients and their families through engaging at the earliest opportunity with those who wish to give feedback or complain. Nursing and medical staff are signposted to the NHS Tayside LearnPro module on Customer Care and the NHS Education for Scotland (NES) Complaints and Feedback Learnpro module and encouraged to undertake these and ensure their staff access them. This training includes information on the role of the Patient Advice and Support Service (PASS). New staff within the Complaints and Feedback Team undertake training on the role of the Patient Advice and Support Service (PASS) as part of their induction and attend a presentation to understand their role in supporting members of the public to provide feedback or make a complaint. 29

31 Section 2 Encouraging and Handling Complaints This section aims to demonstrate how NHS Tayside responds to complaints, the improvements that have been made in responding in a timely manner to complainants and the links being made between the management of serious and adverse incidents and complaints. 2.1 Complaint numbers and response times Complaints are a form of feedback that offer NHS Tayside valuable information about the experience of patients, carers and their families. NHS Tayside aims to learn from this feedback and utilise it to inform improvements in the care and services provided. NHS Tayside has seen an increase in the number of complaints received this year from 1316 in 2015/16 to 1501 in 2016/17. It has been noted that the main area for the increase is in prison healthcare complaints. In 2015/16 NHS Tayside received 253 complaints from prison healthcare, however this has risen to 373 in 2016/17, an increase of 120 complaints which equates to an increase of 10 per month. This means that the increase in complaints across Acute Care and Health and Social Care Partnerships was 66 for the year, the equivalent of an additional 5-6 complaints per month. During 2016/17, a medication spot check process was implemented within the Prison Service which has resulted in an increase in the numbers of complaints received. The service are continuing to work hard to review the overall medicine process from prescribing through to administration. Staff within Prison Healthcare have recently participated in training sessions to enable them to identify and resolve concerns and complaints as early as possible. Further work is planned to improve the handling of complaints in line with the new NHS Complaint Handling Procedure (CHP) being implemented on 1 April During 2016/17, the Complaints and Feedback Team received and responded to 2102 enquiries, concerns and complaints. These figures relate to Acute Care and Health and Social Care Partnerships and show a decrease of 37 compared to the 2015/16 figure of The number of complaints received during 2016/17 (1501) equates to 0.11% (0.08% excluding prison healthcare) of all patient care episodes for the same period and compares to 0.10% (0.08% excluding prison healthcare) in 2015/16. 30

32 Below shows data in relation to complaints, concerns and enquiries received in 2016/17 compared to the numbers received in 2015/16. The number of complaints minus prison healthcare complaints is shown in brackets. Table 3: Volumes and types of feedback received in 2016/17 compared to 2015/16 Type of Feedback 2016/ /16 Complaints 1501 (1128) 1316 (1062) Complaints not resolved following initial response or where complainants have accepted an offer to meet to discuss/clarify further concerns (episode 2) 87 (78) 106 (91) Concerns 268 (230) 331 (331) Enquiries 246 (240) 387 (369) Total 2102 (1676) 2139 (1853) Figure 3 below shows the number of complaints received by NHS Tayside annually since 2006/07. The blue line demonstrates all complaints received, whilst the red line excludes complaints from prison healthcare. It should be noted that the data reflects the numbers and not nature and complexity of complaints. Figure 3 Number of annual complaints received by NHS Tayside from 2006/07 to 2016/17 31

33 Scottish Public Services Ombudsman (SPSO) The Scottish Public Services Ombudsman (SPSO) is the final stage for unresolved complaints about a number of public services, including the National Health Services. The SPSO will examine complaints referred to them that have already been through the formal complaints procedure of the organisation concerned. In 2016/17, 19 complaint cases from NHS Tayside were referred to SPSO, compared to 33 cases in 2015/16. The SPSO have recently made a number of recommendations to NHS Tayside specifically in relation to the handling of complaints. This has included the following: feed back to staff the importance of ensuring that complaint responses address the concerns raised review processes for clearing draft complaint letters, to ensure this does not cause undue delay remind staff of the importance of replying to complaints in a timely manner and communicating effectively regarding delays. NHS Tayside commenced a refresh of complaint handling during 2016/17, focussing on early resolution of complaints in preparation for implementation of the new NHS Complaints Handling Procedure in April This work has included training sessions for staff across the organisation on the power of apology and investigation skills. In addition, awareness sessions with services are ongoing to spread learning and ensure all staff are aware of the standards expected when handling complaints. Staff are encouraged to access the LearnPro modules on Customer Care, NES (NHS Education for Scotland) Complaints and Feedback module, including the Power of Apology, and NES Investigation of Complaints module. Ad hoc training sessions on early resolution skills (Complaints Awareness Raising and Value of Apology) have also been provided by members of the Complaints and Feedback Team. In addition, members of the Complaints and Feedback Team have recently attended national workshops on the new NHS Complaint Handling Procedure and the Duty of Candour. 32

34 Response Times NHS Tayside is aware of the need to continue to try to improve response times to complaints and has made positive improvements in 2016/17 with both acknowledgment and response times for complaints. In 2015/16 94% of all complaints received were acknowledged within three days, and this has improved to 97.5% in 2016/17. The percentage of complaints being responded to within 20 working days has risen with 51.5% achieving a response within 20 working days in 2016/17, compared to 46% in 2015/16. Work is continuing to raise awareness and provide training for staff to enable further improvements to be made to support a more timely response to the complaints that we receive. NHS Tayside anticipates a particular shift over 2017/18 with the implementation of the new NHS Complaints Handling Procedure which introduces a stronger focus on early resolution. Figure 4 below shows the percentage of complaints responded to within 20 working days by NHS Tayside, compared with the whole of Scotland, over the past 10 years. It should be noted that the NHSScotland position for 2016/17 is not yet available for comparison. Faceto-face meetings with complainants remains a key focus to enable resolution of complaints, with timely response to complaints a challenge whilst trying to ensure robust, high quality investigations and person centred responses to the concerns an individual has raised. NHS Tayside is aware that timeliness, communication and quality of response are important factors to the public when their complaint is being handled, therefore NHS Tayside will continue to focus on improving these areas of its complaints handling process throughout 2017/18. This work will be taken forward in line with the new NHS Complaints Handling Procedure implemented on 1 April Figure 4 - Percentage of Complaints responded to within 20 working days 2006/ /

35 2.2 Themes identified from complaints The top three themes raised consistently in complaints are shown below in figure 5. Further review of these themes demonstrates the following consistent sub-themes from complaints; Lack of clear explanation; Unacceptable time to wait for an appointment; Disagreement with treatment plan / care; Staff attitude; and Problems with medication. NHS Tayside has responded to these consistent themes through a number of education and training programmes, details of which are available in Section 3. NHS Tayside also shares learning from complaints, encouraging staff to reflect on practice and behaviours as well as consider service improvements that could be made in their areas. Figure 5 - Themes from Complaints received in 2016/ Complaints Handling Approach NHS Tayside staff are continuing to work to manage complaints more effectively, encouraging personal contact with complainants as soon as complaints are received and facilitating face-to-face meetings to ensure we fully understand the issues that require to be investigated to resolve concerns and produce better quality responses. In 2016/17, 101 complainants had a face-to-face meeting with staff to discuss and address their concerns; this is consistent with the number of meetings that were held during 2015/16 (72). NHS Tayside aims to resolve complaints at the earliest opportunity, to the service user s satisfaction. Wherever possible, early resolution of concerns at local level is encouraged, with ownership of complaints delegated to the service and improvements managed through professional management and leadership structures. Further work is required to develop robust systems to enable early resolution of complaints and the robust recording of this in 34

36 line with the requirements of the new NHS Complaints Handling Procedure implemented on 1 April During 2016/17, 288 complaints were closed within three working days of receipt with a further 34 closed within five working days. This represents 21% of the total complaints received. In addition, 268 concerns have been recorded during the same period, of which 237 were closed within three days of receipt and a further six within five working days, this represents 90% of all concerns received. Early resolution of complaints may also include alternative resolution methods (ie mediation or conciliation). During 2016/17 no cases were referred to the mediation service. During 2016/17, NHS Tayside staff, including members of the Complaints and Feedback Team, attended Workshops organised by NHS Education for Scotland (NES) on the new NHS Scotland Model Complaints Handling Procedure and Duty of Candour. In addition, training was provided to senior managers and front line staff across all services (including Health and Social Care Partnerships) to provide tools and techniques on early resolution, investigation skills and responding to complaints. The learning from this training is being cascaded and is informing the ongoing refresh of complaint handling. Assurance continues to be provided to the Board about the complaint handling process, by engaging the Chair of the Clinical and Care Governance Committee in a quality assurance process. The review focuses on review of randomly selected complaints to assess adherence to key aspects of the complaint handling process, including timeliness, informing complainants of their rights, communicating effectively with complainants, providing a robust response and evidence of learning from the event. During 2016/17, NHS Tayside has been supported with a Feedback and Complaints Refresh in preparation for implementation of the new NHS Complaints Handling Procedure on 1 April The key messages for the organisation as part of this process are: We value feedback in all formats Listening and learning from feedback is everyone s business We will focus on putting things right by early contact face-to-face, telephone or facilitated meetings More serious complaints will be investigated and used for service improvement Our written responses will be person centred and demonstrate that we listen and learn from complaints 35

37 NHS Tayside recognised that, to make this possible, support for staff was needed for developing confidence and the right skills. A number of full day and half day workshops were arranged to enable staff to recognise concerns and complaints at the earliest opportunity and be empowered to use early resolution skills, including the power of apology. Further details regarding these Masterclasses can be found in Section 3. In addition, workshops for administrative staff to provide tools and techniques to help manage telephone conversations and de-escalate challenging situations and avoid complaints were completed and clearing the backlog sessions were held which brought a variety of staff together to help review and respond to some long standing complaints. This not only helped to reduce the number of open complaints NHS Tayside had, but provided an opportunity to learn and reflect on how complaint responses were written with a focus on demonstrating compassion and being person centred. In addition, the Complaints and Feedback Team have provided training to prenursing students, administrative staff within General Practice, staff within the Out of Hours Service and clinicians on complaint handling and the power of apology. This work has focused on all areas of NHS Tayside, including our Health and Social Care Partnerships, with a view to ensure, where appropriate, an integrated approach to the management and response to complaints. This is an area that will be further developed in 2017/18 through implementation of the new Complaints Handling Procedure. 2.4 Linking the management of complaints with serious and adverse events The DATIX system is an electronic system for the recording of complaints, risks, adverse events, legal claims and requests for information. In the management of complaints, adverse event reviews will be used as part of the investigation process to inform our response, actions to be taken and learning. NHS Tayside considers complaints to be adverse events and as such must be managed in the same way. The Adverse Event Management Policy is applied to relevant complaints, ensuring that Local Adverse Event Review (LAER) and Significant Clinical Event Analysis (SCEA) methodologies are applied to enable local and organisational learning. Communications with the patient / family / carer are vitally important to ensure they are kept informed of the process and receive direct and accurate responses. During 2016/17, 36

38 patients, families and carers were provided with the opportunity to contribute to the Significant Clinical Event Analysis (SCEA). Family members or carers are contacted in advance by the appropriate clinician / manager to determine any concerns they would wish raised at the SCEA. Where patients, families and carers have indicated they wish to receive feedback following a SCEA, this will be done through a meeting with the SCEA lead supported by the appropriate service manager or known clinician. The SCEA report will be discussed and a copy passed to the patient, family and carer. All SCEA reports are redacted and the final report is shared with those involved in the review and the Chair of the Clinical Group where the adverse event arose. The identified leads and relevant committees will be responsible for ensuring the follow up, completion and feedback of action points. Organisational learning from the feedback from SCEAs is a crucial component of reducing harm and improving safety. This learning is shared across the wider organisation through communications such as the Getting It Right Newsletter. In addition, the use of one page summaries highlighting both good practice and areas of learning are distributed to all Clinical Governance forums. Adverse event data is also considered as part of the Performance Review process. During 2017/18 NHS Tayside is undertaking a review of the Adverse Events Management Policy which should receive approval in September The outcome of this review and its link to the Complaints Handling Procedure will be shared within next year s annual report. 2.5 Independent contractor complaints General Practices, Dentists, Opticians and Pharmacists CEL8 Guidance on Handling and Learning from Feedback, Comments, Concerns and Complaints about NHS Health Care Services set out the requirement for NHS Boards to gather and report on information on health service providers within their area from April Mechanisms were put in place and information obtained for the period 1 April 2016 to 31 March 2017 is provided below. 37

39 Table 4 - Complaints Received by Independent Contractors between 1 April 2016 and 31 March 2017 Type of Independent Contractor GP Dental Pharmacy Opticians Totals No. of Complaints received No. of Complaints Responded to within 20 working days No. of Complaints where mediation was used No. of Complaints Still Open % 73% 85% 95% 89% 15 < % 4% 20% 0% 4% % 28% 12% 5% 9% Main Issues GP Dental Pharmacy Opticians Totals Access/Appointment System Advice/Treatment Provided < Communication 72 9 < Prescribing/Dispensing Issues Staff Comments/Attitude Charges <5 <5 28 Other 37 < To protect the identity of individuals involved, small numbers have been suppressed using <5 where the value of statistics falls below five but is greater than zero. As a requirement under the Patient Rights Act (Scotland), independent contractors are themselves responsible for managing and responding to feedback, including complaints, about their services. The procedures within General Practice have been in place for a number of years and are well developed. Dentist, Optician and Community Pharmacist 38

40 systems were introduced at a later stage and are still maturing but are evolving to support complaints and feedback. People raising complaints are encouraged to seek resolution with the contractor, and have access to the Scottish Public Services Ombudsman (SPSO) where they feel this has not been achieved. All independent contracting groups have their own procedures underpinned by their professional bodies complaints handling standards. Dental and ophthalmic practices clearly display their complaints procedure within the practice. General Practices have their own complaints procedure which is clearly visible within their practice leaflet or advertised within their premises and they also have a range of mechanisms that support the sharing of learning from complaints and feedback: Several practices in Tayside have well developed patient participation groups Learning opportunities during Protected Learning Time Scottish Public Services Ombudsman (SPSO) reports are shared and attendance at organisation wide Significant Clinical Event Analysis (SCEA) reviews is encouraged. Some examples of how patient feedback has been used to improve patient services during the last year are shown below. Scenario 1 Following feedback indicating that eye tests felt rushed, the contractor made changes to the diary and implemented ways of working to make sure the optometrist was able to spend as much allocated time with the patient as possible to provide the best care to that patient. The patients who had provided the feedback were offered a retest. Scenario 2 Concerns from patients highlighted two issues, which were discussed at the Practice team meeting and the Practice agreed to revise their processes in the following manner: All children's blood sample requests were to go through a General Practitioner (GP) to ensure correct procedures are in place Appointments for venapuncture would be made well before 3.00 pm to avoid a wasted journey for patients as the hospital driver can be slightly earlier or later than this time. 39

41 Scenario 3 Feedback regarding travel advice provided to patients was considered at a Protected Learning Time (PLT) session. Reception staff were made aware of the reasons behind the timescale set by the Practice and a patient information leaflet was produced, which was replicated on the Practice website. 40

42 Section 3 The culture, including staff training and development This section describes how NHS Tayside is continuing to develop a culture that values all forms of feedback, and supports its staff to use this information to learn from and improve the patient experience. The need to build capacity in staff at the point of care, through strong clinical leadership, role modelling and professional supervision is recognised in order to optimise patient and carers experiences and to react appropriately when individuals raise dissatisfaction or make suggestions. It is recognised that, until this becomes embedded in the culture and behaviour of all staff it will be difficult to fully implement all the changes required to ensure our approach to feedback and complaints is truly person centred. As a result, this section describes some of the national and local work and training NHS Tayside is taking forward and has available to support a culture that encourages feedback and responds openly to concerns. 3.1 Developing NHS Tayside s culture through our Vision and Values NHS Scotland s Everyone Matters: 2020 Workforce Vision sets out some key priorities for implementation, one of them being imatter. Research evidence demonstrates that good management of staff within the NHS leads to higher quality of care, more satisfied patients and lower patient mortality. It has been widely demonstrated that, the more positive measures of staff experience are in a particular organisation, the better outcomes there are for the organisation generally. This is not limited to staff related outcomes such as absenteeism and turnover; where staff report wellstructured appraisals, supportive leadership, opportunities for learning and training there is an effect on patient related measures such as satisfaction, mortality rates and infection rates. For example, working in well-structured teams is a predictor of patient mortality as well as staff absenteeism and turnover. It has also been demonstrated that it is positive employee experience that leads to positive patient experience, not the other way round. It might make sense that, where patients were having a better experience and having better outcomes, then the staff would gain more satisfaction from their roles. The evidence demonstrates that it is actually staff wellbeing that leads them to perform better in their roles and leads to better outcomes for patients. 41

43 During the period 2016/17 NHS Tayside has continued to be at the forefront of taking forward the imatter initiative, which is a tool designed with staff in NHSScotland to help individuals, teams and Health Boards understand and improve staff experience and aims to embed a culture that actively encourages and welcomes employee feedback. Evidence shows that the better the experience of staff at work, the better the experience of patients and their families. By focussing on staff experience at work, imatter will help to have a positive impact on patient experience too. Teams are asked to complete a short online or paper questionnaire and provide information on their experience of working for NHS Tayside. Awareness sessions and managers development workshops have continued to be rolled out during the last 12 months. NHS Tayside Board has responded to this national initiative with tremendous enthusiasm and commitment, with the first cohort of teams demonstrating an 87% return rate on completion of the questionnaire. This bodes well for the mainstreaming of imatter across the organisation in early With robust action plans now being developed by Team Leaders and staff, this will enable joint ownership and provide opportunities for staff to be more open and confident in relation to giving and receiving feedback with a research based framework / toolkit which the imatter model provides. 3.2 Training and education In conjunction with current staff / team training plans, there are key strategic areas of training that continue to be identified and taken forward, to facilitate the feedback agenda. As noted in Section 2 of this report, NHS Tayside has undertaken a refresh of complaints handling during 2016/17, focussing on early resolution of complaints in preparation for implementation of the new NHS Complaints Handling Procedure in April NHS Tayside aims to ensure people who use local services are heard and have concerns and complaints made right at the earliest opportunity. NHS Tayside wants feedback to support service improvement and enhance people s care experience and it is recognised that, to make this possible, staff with vision, confidence and the right skills are needed. As a result, masterclasses were held focused on the following areas: 42

44 Early contact and putting things right Attended by 206 staff The Power of Apology Communicating at our best Attended by 63 staff Investigation skills and writing person centred responses Attended by 71 staff These masterclasses were open to staff from across all service areas, including Health and Social Care Partnerships. Participatory Learning Session In 2016/17 NHS Tayside reviewed the format of the Clinical Quality Forum to include a participatory learning session on the agenda. The purpose of this was to allow staff from across the organisation to share their learning, whether in respect of adverse events, complaints, feedback or patient safety. At the session in November 2016, Sam s story was related by his wife, a local GP. This session offered an opportunity for staff to hear about the experience of Sam and his wife, the things that made a difference to their experience, both good and bad, and to reflect on how our practice and behaviours impact on our patients and their loved ones. Sam s story was also shared through NHS Tayside s Getting it Right Newsletter via the personal reflection of a member of staff who attended the learning session. This reflection demonstrates the powerful nature of sharing feedback in this format and the learning opportunity this offers. Below we share this reflection: Sam was diagnosed with a brain tumour and received inpatient, outpatient and palliative care in Tayside before he died last year. Their aim throughout Sam s illness was to maintain his dignity. His wife shared his story because she passionately believes that everyone should be treated with dignity and respect, especially people receiving care and treatment in hospital our patients. This was not how Sam was always treated. She was keen to point out that whilst there were many excellent examples of times when dignity and respect were shown and how that vastly improved the care experience for Sam and his family, sadly, sometimes, the care we provided fell short, and her examples were uncomfortable, distressing and difficult to listen to. I was embarrassed hearing her examples of staff providing care which fell well below professional and acceptable standards, showing little or no compassion, describing 43

45 actions and attitudes of staff that were upsetting to hear; and which left them both feeling disempowered and vulnerable. Many inpatient episodes were provided by staff who she felt did not seem to feel, or work, as part of a Team. In clinical areas where the care was compassionate and helpful there was much more evidence of team working and Sam felt safe and comfortable, they both felt safe. She described this feeling of safety as being enveloped in a blanket. At the learning session all in the room were moved by Sam s story, some staff were visibly emotional in discussing what they heard and what needed to happen to change actions and attitudes in some parts of our service. There were a variety of staff there including senior management, staff at the point of care and support teams present. We recognised this was about leadership and culture, team work, addressing and challenging inappropriate behaviours and paying attention to what is going on in the moment. All those who were present were asked to share the story with others and to commit to an action following the meeting. I feel we get a lot of things right across NHS Tayside, the inpatient patient experience survey demonstrates that, as do all the positive comments and compliments we receive. However, in some parts of our organisation we don t get it right and it is up to every one of us to deliver care with compassion and empathy as well as reinforcing excellent standards of care, reinforcing excellent attitudes and behaviours and rooting out poor standards of care that none of us would have wished for Sam or any of our loved ones. In addition to these specific Masterclasses and the Participatory Learning Sessions, NHS Tayside runs a variety of training and development programmes to support staff in responding appropriately to feedback, concerns and providing early resolution. Some particular examples worthy of highlighting include: LearnPro modules Involving Patients & Carers and the Public elearning Module NHS Tayside has a duty to involve people in designing, developing and delivering health care services they provide for them. 44

46 The Public Involvement Team have designed a beginner s guide to involving Patients, Carers and the Public for staff who have a role in improving how services are delivered and to do it in partnership with service users. The aim of the module is to raise awareness of the need to involve people when considering a service change or improvement and covers: why you need to ensure you involve people understanding your responsibilities to ensure that your service area involves people understanding when to involve people and know what appropriate action to take how to involve people and where to find additional advice Supporting Disabled People to Provide Feedback As part of the NHSS / Glasgow Centre for Inclusive Living (GCIL) Equality Academy Professional Careers Programme, we are now into the second year of our disabled graduate s placement. The aim of this programme is to provide a 2-year employment opportunity for disabled graduates providing them with a challenging and rewarding experience of employment, thus helping to set up long-term sustainable careers. The evaluation and feedback from this placement will be invaluable in shaping future employment programmes and we have benefitted greatly from the extensive feedback received to date from this employability scheme. At weekly Corporate Induction programmes NHS Tayside continues to signpost all new employees to key training materials that are available nationally and locally. Carer awareness sessions have been introduced for all new staff at Induction, delivered in partnership with the Carers Centres throughout Tayside. Approximately 700 new staff attended these sessions during 2016/17. A carer s information webpage has been developed for staff and is available on Staffnet, which is also highlighted at Induction. The following resource links are all highlighted at Induction and during any other relevant learning and development programmes The Patient Rights (Scotland) Act Scottish Government website 45

47 The NHS Education for Scotland (NES) Patient Rights (Scotland) Act 2011 leaflet for staff - Can I help you? learning from comments, concerns and complaints - NHS Inform website describing care, support and health rights, including giving feedback and making complaints - Information on the Patient Advice and Support Service - Staff Governance Standard - Teach Back methodology to support health professionals check a patient s understanding of the information they have given to the patient - Sage and Thyme Communication Skills Programme The highly successful Sage & Thyme training programmes that were introduced into NHS Tayside in 2013 continue to be delivered. This is an evidence based approach programme to enable practitioners to engage with patients / service users / carers who are in distress, and it provides a framework for practitioners to engage with, identify concerns, support the person to manage their distress and bring the conversation to a conclusion. The courses are being very positively evaluated, with staff reporting increased willingness and confidence to support people who are in distress. 169 staff have attended programmes during 2016/17. 46

48 Following the continued success of the Sage & Thyme Communication Skills Programmes, NHS Tayside has committed to a further 17 courses to support staff and teams from across all localities in undertaking this programme during 2017/18. Carers Awareness Training Carer Information Strategies (CIS) Plans: has set out guidance and key priorities, workforce training being one of them, it states that Health Boards are to continue to take steps to ensure that the Equal Partners in Care (EPiC) Principles are embedded in practice and extended to cover the whole of Health and Social Care workforce. This includes promoting the EPiC framework at strategic level where senior managers can influence significant change. NHS Tayside has introduced the EPiC e-learning modules levels1-3 onto the LearnPro platform. Level 1, for any staff or volunteers who may come in contact with public and therefore carers Level 2, for staff who come into regular contact with carers and families Level 3, for anyone in a leadership role in relation to involving carers in planning and shaping services. Carer Feedback In NHS Tayside staff, and the important role each and every one provides to support good person centred care for all, are valued. NHS Tayside recognises the importance of supporting staff who not only give a great deal of themselves at work but are also caring for people outside work. An Information Pack has been developed to provide staff and managers with a resource which will provide the opportunity for discussion around their personal needs, balanced with service delivery. The guidance document Supporting NHS Tayside Staff who care for someone outside work was a part of the application for Carer Positive Employer in Scotland recognition, Level 1 Engagement received in The organisation hopes to continue in 2017 to apply for recognition at Level 2, Established and then Level 3, Exemplary. However, while these awards are significant in recognising the organisation as caring for all staff, it is essential that 47

49 a plan is in place to ensure ongoing care of staff who support others outside work at all times. The Carers (Scotland) Act 2016 will be implemented on 1 April In anticipation of the Act, work is underway to embed the Equal Partners in Care Carers Learning Framework within Dundee City Council and NHS Tayside. This will support training to practitioners on the new duties and requirements of the legislation. The ongoing awareness raising regarding carers continues across NHS Tayside to every new member of staff at Corporate Induction training, approximately 700. In October / November 2016, awareness sessions were held on Person Centred Effective Communication; these were delivered to 150 newly qualified nurses across two sites. This was as a result of direct feedback from a carer who had wanted to tell their story to staff in order to make a difference. The sessions were delivered over several days and the newly qualified nurses fed back that the sessions were very powerful and appreciated that having a real carer at the sessions relaying their story was more authentic, rather than someone just reading out the story. Child and Family Communication Programme A bespoke communication course has been developed by NHS Tayside. The course was designed to equip staff to communicate more effectively and sensitively with children and families with complex additional support needs, particularly when sharing difficult news or helping a family after they have received difficult news. NHS Tayside commissioned a review of services for children and families with complex additional support needs, in response to national policy direction outlined in: Getting it Right 48

50 for Every Child (GIRFEC); palliative care pathway; and work from the Children with Exceptional Needs (CEN) Managed Clinical Network (MCN). Engagement with parents of children with complex additional support needs was central to the review. Their views were sought through a mix of survey questionnaires, telephone interviews and discussions with a Parent Advisory Group. One of the key priorities that emerged from the feedback from parents was the need for good communication and interaction styles that were family centred, collaborative and sensitive to the child and family needs, especially around sharing difficult news, or receiving a new diagnosis. Parents also highlighted that they needed ongoing support to come to terms with and understand the difficult news. Priority was given to developing communication skills training for NHS staff within the children s complex needs service, incorporating the key principles as set out within Getting the Right Start (2003). The courses are delivered by two trainers - a lead trainer and a trainer with expertise in delivering difficult news. However, a more innovative aspect has also been built into the course, where parents are also involved in providing input. For example, they talk through the experiences of their journey with their child in relation to receiving both good and difficult news. In addition, parents from Parent to Parent a local parents organisation that provides support to families with children with additional support needs get involved in role playing scenarios, providing realistic feedback on communicating difficult news in safe settings. Courses were initially targeted at practitioners from a wide range of professions within multidisciplinary teams across NHS Tayside. More recently courses have been offered to partners in other organisations and agencies, for example, social work and education colleagues and voluntary sector partners, as a way of encouraging better multi-agency working. Courses are currently run four times a year. Between 2011 and 2016, over 300 participants have taken part. This includes NHS, local authority officers (including teachers) 49

51 and staff from voluntary organisations. The course has now been found to be relevant to all children s service practitioners, and not just those who work with children with complex additional support needs. Feedback gathered from participants has shown that they have found the course helpful and relevant to their work. Many felt more confident in using motivational interviewing to communicate with children and their families, particularly in relation to delivering difficult news. An evaluation of the programme showed that there was a statistically significant positive shift in confidence to engage in conversations. Participants felt that the course provided a safe and supportive learning environment. We now have more people skilled up to communicate effectively and sensitively with children and their parents. Interpretation & Translation NHS Tayside delivers a range of interpretation and translation training and awareness sessions. These sessions include information on staff s legal duties, roles and responsibilities and additional communication needs. In 2016/17 there were 828 staff participants in these sessions. NHS Tayside has also taken the opportunity through these sessions to gain feedback from staff and, as a result, the following changes have been made to practice: Staff have been made aware that they must retain appointment letters until confirmation of the interpreter has been received. Staff then write interpreter booked and the name of the interpreter on the letter and highlight. Staff are encouraged to contact BSL (British Sign Language) users directly either using contactscotland-bsl or by getting in touch with the Appointments Office to send a text to the BSL users. 50

52 Staff have been asked to contact the Vision and Hearing Support Officer when a BSL user is given a date for a procedure or planned admission to ensure all staff involved discuss beforehand exactly when an interpreter is required both pre- and postoperatively, and that this is booked. 51

53 Section 4 Improvement to Services Through the report we have explained how we collect feedback and complaints, how we are encouraging feedback and the support we are providing to our staff to enable them to use and learn from this information. We have already provided some examples of learning and improvements as a result of feedback and complaints received from patients, carers and families, however this section aims to provide more examples of the actions we have taken throughout 2016/17 in response to both feedback and complaints. 4.1 Learning and improvements resulting from complaints Adult Care Older People s Team Feedback was received regarding a lack of decision making and ownership to secure a care package to enable a patient to leave hospital when they were declared medically fit to do so. In addition, concerns were raised regarding inpatient staff s knowledge and skills in respect of managing and supporting a patient with dementia. As a result, a number of recommendations were made and key actions taken as follows: A dementia care mapping exercise was undertaken in the inpatient ward with the Dementia Nurse Consultant to identify improvements that could be made both to the environment and care of people with dementia Nurse dementia champions have been identified for wards who work closely with the dementia nurse consultant to improve staff skills and knowledge in working with people with dementia Staff training and guidance to be made available relating to the rules of ordinary residence and effective collaborative working with other local authorities Systems to be reviewed to ensure timely and accurate recording of delayed discharges Inpatient services to ensure discharge planning meetings are held and include representatives from all relevant agencies, this will ensure clear communication, action planning and a co-ordinated approach to the discharge process All services to ensure regular communication with the patient s family regarding the care they are receiving and actions being taken to enable a timely discharge. 52

54 Surgical High Dependency Unit A Standard Operating Procedure (SOP) was developed to prevent the loss of personal property for patients. This SOP was circulated across the Surgical Directorate for consultation, consideration and implementation. In addition to the SOP, improvement work within Theatres has seen the introduction of a check for patients jewellery on the Theatre Ticket. Active Patient Urology Inpatient Services, Ninewells Concerns regarding aspects of patient care within Urology inpatient services identified areas for improvement in respect of communication with both patients and family members, and mobility and independence of patients. As a result, the ward decided they wanted to be an Active Ward where patients and family members are actively involved in and control their own care, therefore the active patient initiative commenced. The active patient initiative aims to create a ward environment where patients remain as active within the hospital setting as they would be outwith; physically, mentally and as partners in their care. The process and tools used were developed using the Plan, Do, Study, Act model and gathering patient feedback on the initiative along the way helped shape the project into what it is today. Being an inpatient can be daunting for patients and many come into hospital unaware of what to expect or what is expected of them. Patient feedback and complaints have shown that many patients dislike the passive nature of being in hospital. Alongside this, there is growing evidence that suggests that approaches to person centred care that include shared decision making and self-management support can improve a range of factors, including patient experience, quality of care and health outcomes (The Health Foundation, 2014). The active patient initiative involves; INFORMING the patient about ways they can be physically and mentally active whilst they are inpatients, as well as specific ways in which they can be involved in their care. This is done using a simple orientation sheet, which has been produced by a student of design from Duncan of Jordanstone College of Art & Design, and has been informed by testing with patients and incorporating their feedback into the design. 53

55 MEASURING the patient s activity levels in these areas using a simple tally sheet, with space for patient feedback or queries. This allows the ward team and the patient to learn about the patients activity levels and also their preferences around activities. The comments and themes coming out of this should be shared with the ward team. DISCUSSING the patients tally sheet with them on a one-to-one basis. This allows the healthcare team to promote activity, such as getting up and going for a walk around the ward, or directing patients to reading materials or puzzles if they are feeling bored, or providing them with information and education around their healthcare. It also aims to ensure that nurse-patient conversations are based on what matters to individual patients and the unique experiences they have had. 54

56 LEARNING; the whole process allows the healthcare team to learn about ways in which they could make their ward more person centred. The tools to support this are: A poster for displaying in the ward which explains what Active Patient is 55

57 An orientation sheet which provides patients with information about ways in which they can be active and actively involved in their care. This can be customised with individual wards visiting times. A tally sheet which the patient completes, documenting the activities they take part in each day A standardised script to support staff / students / volunteers in explaining the initiative to patients and relatives. The initiative has been implemented over time using the Model for Improvement and iterative tests of change, always ensuring that patient and staff feedback were used to inform the project. This project was initiated and led by the Senior Charge Nurse, Ward 9, Urology, Ninewells Hospital, NHS Tayside and has been developed in partnership with Students of Environmental Design, Duncan of Jordanstone College of Art & Design and an Improvement Advisor from NHS Tayside s Service Improvement Team. Theatres and Anaesthetics Across theatres and anaesthetics, patient feedback is received through a variety of methods including face-to-face verbal communication and formal complaints. The below provides some examples of the improvements made in response to complaints: The service has revised the information sent to all patients in advance of admission to advise them that it is not safe to drive home following a general anaesthetic. This is also re-iterated to patients during their admission and display notices have been added to the Theatre Admission Suite (TAS) / Day Case Area. The service displays posters in patient areas to articulate the expectations of arriving into TAS and the actual time to theatre The service is revising the information sent to patients in advance of surgery to explain the expectations and reduce confusion for patients on arrival at TAS In response to concerns regarding poor communication between members of the multidisciplinary team and base ward All staff were reminded of the importance of consistency and co-ordination of communication and documentation within patient records 56

58 Patients relatives are now invited to contact the TAS who will signpost them to the appropriate ward or staff will offer to contact the carer or family member on behalf of the patient Prison Healthcare Prison healthcare are reviewing processes for improving the appointments system and ordering of repeat prescriptions and also how information is shared with the prison service. Staff focus groups have commenced, supported by Royal College of Nursing (RCN) representation, and monthly groups are planned to explore hot topics for change in the service. Early Supported Discharge (ESD) / Prevention of Admission (POA) A number of recommendations were made as a result of concerns regarding delays in arranging appropriate care and access to physiotherapy following a hip replacement. This included the following: A review of the processes involved in the ESD and POA services should take place. This should include a review of the criteria regarding who can access each service as well as who can complete an assessment and the referral process. This review should focus on a person centred and outcome focused approach, as opposed to a procedural and process led approach, ensuring the needs of the individual are at the heart of the process and ensuring that the person receives the right support at the right time. A wider review of the ESD / POA service should also be undertaken which considers service and team functions as well as who can access service information and these services Any review of the POA / ESD service should have an integrated approach involving relevant professionals and disciplines. This review should focus on patient need rather than a diagnosis. As part of the review process, consideration should be given to how any changes to the POA / ESD services can be communicated widely and consistently to both community and hospital staff and to what guidance and reference documentation should be available 57

59 The review of the POA / ESD service should take into consideration the current Out of Hours cover That the issue of workers being able to access and record on MIDIS (the information system used by community healthcare staff) when required is resolved and / or one system for both health and social work staff accessing and recording information is established and implemented That the wider integrated team involved prioritise spending time becoming familiar with each other s roles, responsibilities and the ways in which they can work more seamlessly and in a more integrated manner. Consideration should be given to establishing any processes which will aid effective communication and team working as a wider integrated team. This should include reflecting on the patient s journey and care pathway experience to identify where duplication of processes and efforts can be minimised or stopped. This should also include establishing effective ways of raising awareness of the services and support available, identifying who needs this information and the best way to communicate this. 4.2 Learning and Improvements resulting from Feedback Clinical Radiology The clinical radiology service obtain feedback through a range of formats including formal complaints, suggestion boxes in the waiting areas, notes of thanks and direct verbal feedback. During 2016/17 patient feedback highlighted the following: Patients would like the ability to request a male or female chaperone The service now display posters in the waiting areas about the chaperone Patients would prefer to have the choice of changing into a gown or not Radiology now gives patients this choice Patients do not always appreciate being helped eg to transfer to the examination table This is now discussed clearly with the patients and there is never a presumption that all patients automatically want help Through regular investigation, review and discussion with staff regarding feedback, the service have also identified that staff can be uncertain how to react towards patients when 58

60 things go wrong. Also when presented with some feedback scenarios, staff members are at times disbelieving or sceptical of events. As a result, assistant and new registrant staff now participate in 'Effective Communication' workshop sessions. Using real feedback and complaints case studies, the aim of these sessions is to raise awareness and stimulate discussion around better communication strategies. The service has also developed a live Guidance for Consent and Intimate Examinations in Radiology document for all staff to acknowledge annually. This provides guidance to assistant and registrant staff on how to seek informed consent and carry out intimate examinations. It also discusses the role of a chaperone. This is updated with patient case studies as they are highlighted to us. Clinical radiology has seen a decrease in negative feedback from patients in the last year, which reflects the continued evaluation of patient feedback and emphasis on communication awareness within the service. Children and Young People s Occupational Therapy The Children and Young People s Occupational Therapy service wanted to improve the experience of patients and their families by providing easy access to information, for example, self care, productivity, leisure, etc. As a result the service decided to develop a website. As part of the development of a Children and Young People s Occupational Therapy Website, feedback was gathered from Occupational Therapy staff, teaching staff, paediatricians and service users (parents / carers) using the website in order to inform the content of the website. Across Tayside, we approached five members of teaching staff and 59

61 five service users per locality area (Angus, Dundee & Perth) as well as paediatricians in each area and voluntary agency workers (Parent to Parent) with four key areas for feedback and a general comments box. This was carried out throughout April to July and the key questions for feedback were: 1. The look of the website and comments 2. The usefulness of the information and comments 3. If they felt they would use this resource 4. Any information or other resources that they would want which were not currently on the website 5. Any other feedback that would be helpful for us in developing the website further. The methods used were the questions with a mix of face-to-face contact and contact and the feedback was used to shape the content of the website. The paediatric occupational therapy staff were presented with the website at a staff meeting and everyone given opportunity to feed back on all areas. Information regarding the newly launched website was then marketed and shared in the following ways - Business Cards for all staff with website details Website details on all staff s Links website from colleagues Facebook Page e.g speech and language therapy Website Marketing Links website from colleagues websites e.g. Image Courtesy of AKARAKINGDOMS at FreeDigitalPhotos.net Website details in all CYP Occupational Therapy documentation e.g. leaflets, reports etc Image Courtesy of AKARAKINGDOMS at FreeDigitalPhotos.net 60

62 Tayside Adult Weight Management Service Tayside Adult Weight Management Service (TAWMS) routinely seek feedback from patients in relation to the interventions offered by each discipline within the Service; dietetics, physiotherapy and clinical psychology. At the end of each stage of the group-treatment programme, patients are given standard feedback forms and are asked to comment on four specific aspects of their patient experience. Feedback is sought on each of the following areas: what has been learned what was enjoyed what specific changes will be made to daily practice what could be improved / changed in the programme The feedback is collated routinely and the findings shared with patients via the service website patient stories word clouds All suggestions for improvement / change are considered and where appropriate implemented by the service. For example, changes have been made to the process of managing and processing referrals as a direct result of patient feedback and by listening to the voice of the customer. Previously referrals were received and processed and the patient was sent information to opt-in to the service. However, multiple telephone calls were received from patients seeking clarification about their stage in the referral-administration process. It was suggested by some of these people that if a standard letter was sent to inform them of the details of the administration process for arranging initial assessment appointments that would have negated their need to call. This feedback has been taken on board and patients now routinely receive a standard letter advising them that their referral has been received and that, once they have opted-in, they will then receive an out-patient appointment. As a result of this change, not only are fewer telephone enquiries received but also the levels of distress and irritation that this caused to patients has also been reduced. Visual feedback, in the form of word clouds has been produced from the information on the feedback forms and has been shared on the Service website. Each of the word clouds 61

63 relates to the positive aspects of the feedback form. Specific clouds have been produced for physiotherapy and clinical psychology interventions also. TAWMS have captured positive patient experiences and what can be regarded as success stories. Individual patient stories have been compiled and are shared on the Service s website as video files. The aim is that these will serve to motivate and inspire others to achieve successful weight loss. Attention has been paid to the geographical area the patient lives in to ensure that each of NHS Tayside s three geographical areas are equally represented. Consideration has also been given to ensure there is a gender balance in the stories. Mental Health Inpatient Services The Patient Safety Climate Tool (PSCT) is a national tool which has been developed as part of the Scottish Patient Safety Programme in Mental Health (SPSP-MH). The tool and questions have been developed by mental health service users and carers, and are designed to enquire about environmental, relational, medical and personal safety. The tool is made up of 20 questions: 18 questions that ask for a score with supporting narrative and two further open questions that ask what safety improvements could be made and what the individual does to keep themselves safe. It is immediate and provides responses based on feelings and issues that are important to the patient while on the ward or unit, not on reflections. In terms of frequency, it is recommended that the PSCT be completed at least once a year by all wards participating in the SPSP-Mental Health or more often as required. The survey has been completed in four of the five in-patient acute adult psychiatric wards and we are in the process in Tayside of completing another cycle alongside the staff safety climate questionnaire. We are also including all units during this cycle. It should be noted that the ward not included in the last cycle was part of another project in which patient and carer feedback was sought through a different method. The teams gathered patient stories and produced a film, showing feedback from patients captured through the surveys that we can share with others. In summary, the surveys provided the following information and improvement / learning: Common themes were identified eg around medication, staff visibility and the environment 62

64 Further to the common themes a patient story led to work being undertaken to reduce medication errors on the ward Changes were introduced to medication rounds with patient feedback sought as changes were tested A poster was co-produced between staff and patients defining what it meant to keep the ward safe A promoting sleep hygiene programme has commenced in the ward as a result of patient feedback Peer support worker reported the climate survey work was giving the patients a voice, knowing their voice was being listened to through the actions taken via the programme to improve safety. Psychiatry of Old Age A programme of Focus Groups has taken place in all localities to capture feedback from patients on community caseloads. An action plan is in place both from a team / service wide perspective, and a "You said, we did" poster created with details on what actions are being taken forward by the service. Some examples of these are: 63

65 Patient would like more guidance on how we can adapt lifestyle to make things for their wife the best they can be. Looking for tried and tested things to support ie clocks white boards most agreed this would be useful. Information leaflet to be developed for patients outlining what is available The time to get diagnosis could be improved Process reviewed to include identified personnel to run planned memory clinics, allowing allocation of appointment on referral Is there dementia research I can be involved in? Dementia research often discussed at diagnosis. To reinforce this we will include within initial information packs for patients to read in their own time. Research session built into team day for raised staff awareness. Dementia research leaflets sent to those who wished from group. Ophthalmology Patients fed back to staff in Outpatient Area 6a (Ophthalmology Outpatients) that they could not read the information about clinic delays because they were written on a white background this has been changed and information is now written on yellow background notice boards which makes it easier for partially sighted patients to read. Breast Screening Breast Screening have reviewed their return appointment booking processes for patients attending assessment clinics and subsequently needing additional imaging / investigations. Now, rather than lengthy waits for these additional investigations on the one day, patients will be offered an option to book these on another date / at a time more convenient to them. Dermatology In response to concerns raised regarding cleanliness within the department, changes have been made to the times the domestic cleans the clinic. Patients have also requested some more magazines which are now in clinic waiting areas. 64

66 Dundee Health and Social Care Partnership - Specialists Services - The Sexual & Reproductive Health Service and The Corner A variety of methods are used to obtain feedback including whiteboards on the back of toilet doors, survey monkey and voxbox (video feedback). This feedback has led to the following improvements: Free wifi which was installed; Provision of sub-dermal implant fitting; Psychosexual clinic users did not associate with the name of the clinic, so the name has been changed; and Information leaflet about testicular self-examination being produced and patient comment is being sought to finalise this. Maternity Services NHS Tayside s Maternity Services are delivered across both community and hospital settings. These services use a variety of methods to collect feedback, including involvement in the inpatient survey right time feedback programme mentioned in Section 2, paper surveys / questionnaires, survey monkey online questionnaires and birth stories. The services use this information to share good practice and positive experiences, as well as to support identifications of improvements that could be made. The below highlights some of the feedback received and the actions that have been taken in response to this: Ward 38 90% of women felt they had important questions regarding postnatal care answered, 10% felt this only happened sometimes. 70% of women were able to speak to a member of staff about any concerns regarding postnatal care, whilst 10% yes, to some extent, 10% said no and 10% had no concerns Care rounding has been tailored to each woman s needs and daily Senior Care Midwife rounds are held to ensure all questions individual women may have can be answered and all concerns discussed 65

67 90% of women felt their pain was controlled, 30% said yes to some extent Roll out self administration of medicines to all postnatal women who meet the criteria A questionnaire for antenatal and postnatal women demonstrated that most women wanted more information regarding meal times, parking, how long they would stay in hospital, the discharge process and what they would need at home Patient information leaflet to be developed which includes the requested information. Website being developed for women to access. Community Midwifery Feedback suggested that the majority of information regarding place of birth was being provided but there could be further promotion of the leaflet and place of birth app that is available. Also, discussion about the choice of a home birth could be improved. Results shared with all midwives, team leads discussing at regular huddles with staff and information session to be part of the midwifery annualised training Emergency Department (ED) Ninewells Hospital and Perth Royal Infirmary The Emergency Departments in Ninewells Hospital and Perth Royal Infirmary collaborated with the University of Dundee in 2016/17 to look at patient experience and mapping patient journeys. This is an area that the service had wanted to look at for a long time but have never found a suitable questionnaire or had the resource to develop one. In collaboration with the University of Dundee, a group of third year selected study component students worked with the department to adapt an Emergency Department patient experience questionnaire currently in use in England. Over a four week period they managed to condense a very long questionnaire into a much shorter, easy to use version. The students achieved this change using small tests of change, following the methods of the Model for Improvement. They were able to sample patient views from different streams of work within 66

68 the department and the service have found the feedback tremendously useful. A total of 53 patients were surveyed and provide a cross section of views. Traditionally the service has relied either on complaints or compliments to gather patient feedback. Whilst valuable, this only provides a sample of the best or the worst examples of our service, and they were aware that there may be a host of patient generated ideas about the day to day running of the department that was being missed. This project helped fill in this gap. The feedback received from patients was overwhelmingly positive about staff attitudes, cleanliness of the environment and the journey through the department. There was, however, also very helpful feedback to emphasise the need for a better waiting experience. As a result of this, the service aims to take forward work to improve the environment of the waiting room and provide helpful information so patients know how the service prioritise work, how long they might wait and what to expect when they are seen. 67

69 Section 5 Accountability and Governance NHS Tayside values the opportunity to learn from patients and carer experience and recognises the importance of paying attention to feedback and complaints at all levels as part of its clinical governance system. As described within last year s report, NHS Tayside has a clear governance and accountability framework in place for the management, monitoring and assurance associated with feedback and complaints. This framework is described within NHS Tayside s Clinical Governance Strategy 2013 and documents the responsibilities from patient, ward / department to Board. Feedback and complaints are reported through the Person Centred domain of the Clinical Governance Strategy. NHS Tayside Clinical Governance Strategy is due for review in 2017 therefore any relevant changes will be described within the 2017/18 Annual Feedback Report. At Ward / Department Level Person centred care is everyone s business and every member of staff in every ward or department must always put patients and their families at the heart of everything they do. The first NHS Tayside Value is Putting Patients First and states clearly that Everything we do is for you, our patients. 68