TRUST BOARD 27 OCTOBER 2011 QUARTERLY CUSTOMER CARE REPORT D Summary The Trust Board at its 28 July 2011 meeting (minute TB/11/192) approved a quarterly high level customer care report be developed for presentation to the Trust Board. This report provides the proposed format for the quarterly customer care report for the Trust. The purpose of a quarterly report is to provide a triangulated update on customer insight identifying an overall picture of our services from the perspective of those who use them on a day-to-day basis. Recommendations Trust Board is asked to: 1. Receive and note the contents of this report 2. Approve the future format of the report outlined in paragraph 8. Implications for consideration Strategic implications Enables delivery of: Our ambition to advance health and well being through the development of communities rights and inclusion, providing the best quality care to all who need it; Main Strategic Goal (description in full) Financial (funding discussed and confirmed as available with Finance Department) Consultation Risk (risk reference from the trust risk register if applicable) CQC Registration This paper covers all strategic goals. Funding implication contained within this report have been approved as part of the Trust enabling services reorganisation. Consultation is underway with people who use our services, their carers and families surrounding information they feel the Trust Board should be aware of when considering customer care. Poor customer care increases the risk profile for the Trust in respect of quality, clinical safety and reputation. Page 1 of 9
Applicable Regulated Activities Regulations 17 & 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Applicable Registration Outcomes Outcome 1: Respecting and involving people who use services. Outcome 17: Complaints. Applicable Division(s) All Divisions Applicable Registered Location(s) All registered locations (if a particular care setting please specify) Author Richard Chester Head of Patient Experience and Partnerships Presented by Jackie Ardley Director of Quality and Innovation /Chief Nurse Page 2 of 9
TRUST BOARD 28 OCTOBER 2011 QUARTERLY CUSTOMER CARE REPORT Introduction 1. This report provides the proposed format for the quarterly customer care report for the Trust. The purpose of a quarterly report is to provide a triangulated update on customer insight identifying an overall picture of our services from the perspective of those who use them on a day-to-day basis. 2. In understanding customer care within the Trust it is important to fully consider the customer insight as a key foundation for this level of care. Recommendation 3. The Trust Board is asked to: Receive and note the contents of this report Approve the future format of the report outlined in paragraph 8 Background 4. The notion of customer insight is not new to the NHS; the Trust has always gathered information from people who use our services, their carers and families. This information has come from consultations, individual feedback to clinicians, compliments and complaints and more recently from the programme of increased and more proactive engagement by Trust Board members. However, this information often goes untapped or remains fragmented across the Trust. 5. This untapped and fragmented approach has meant we are not always successful at drawing out the insights of those who use our services on a day-to-day basis, which is essential when redesigning those services so they meet the needs they are designed for. 6. In 2007 the NHS Confederation published the report Great Expectations, which identified the need to become more focused on the customer ; the then Chief Executive Dr. Gill Morgan said: Customer focus is about doing everything we can to make the patient s experience as pleasant, straightforward and unstressful as possible. 7. Achieving a customer focus is about the Trust having the right culture and not solely monitoring data sets, such as complaints and compliments. There is a need to institutionalise the right culture and behaviours that ensures a person entering our care has a journey that is pleasant, unstressful and straightforward. Page 3 of 9
8. Work underway across the Trust on care pathway redesign offers a unique opportunity to take the insight of the person using the pathway to positively influence its design. The importance of this insight for the Trust is significant as Divisions begin integrating community, mental health and learning disability services. This integration sits not only within Divisions but also across them. Proposed Format 9. It is proposed that the following structure be used for future reports: i. Quarterly Context ii. Leadership and Policies* iii. Customer Insight* iv. Quantitative data set: complaints etc. v. Responding to Customer Insight * examples provided within this report. 10. Quarterly context a person s expectation of experience for one of our services will always be set within a wider context. It is important to reflect on national, regional or local developments when considering customer insight. 11. Leadership and policies - it is recognised that strong leadership and the right systems and processes for frontline staff to follow are key in improving a person s experience. This includes training relative to their role in relation to answering queries and concerns. This section of the report would focus on those aspects of leadership surrounding customer care and training delivered etc. 12. Customer Insight This provides an opportunity to bring together the range of information sources allowing the Trust Board to have an open discussion based on their own experiences coupled with those compiled for the report. It will also be possible to segment customer insight allowing views from particular communities, services or protected characteristics to be drawn out. 13. Quantitative data set A number of metrics are presented to the Trust Board each month through the Integrated Quality Performance report, there is also reporting through the Trust Board subcommittee structure, e.g. Quarterly PALS reports. However, a quarterly report showing trends by service or subject area coupled where possible with benchmarking data will help identify trends beyond those identified in the IQPR and areas where the Trust is an outlier in terms of complaints received etc. 14. Responding to Customer Insight This section is designed to provide the Trust Board with assurance that the insight from customers is being heard and acted upon consistently across the Trust. It will by a valuable route for providing tangible examples of differences that have resulted from customer contact, such as complaints. The NHS Constitution includes the pledge: The NHS commits to ensure that the organisation learns lessons from complaints and uses these to improve NHS services. Page 4 of 9
15. Through the section responding to customer insight the Trust will be able to publically demonstrate delivery of this pledge. 16. This report from hereafter provides examples of what the leadership and policies, and customer insight sections could look like using live reporting. Leadership and Polices Leadership 17. The NHS has seen a steady year-on-year increase in the number of complaints received. It is recognised nationally that the growing number of people treated by the NHS, stricter reporting arrangements, more information about how to complain and a general involvement in consumer rights awareness may have contributed to this rise in the number of complaints nationally. 18. The Trust whilst recognising this picture has continued to place an emphasis on improving the experience of people who use our service, their carers and families, with a key part of that improvement being a person s concerns, are dealt with informally and immediately where possible without the need to formally complain. This approach can be likened to the retail sector where a person who has a complaint or is dissatisfied with their service is dealt with by the assistant, customer services department or manager the default is not to raise a formal complaint, although the person has a number of consumer rights. 19. In seeking to improve local resolutions it is important to have Executive accountability and leadership as well as measurable outcomes. As part of the annual appraisal system at the Trust the Chief Nurse/ Director of Quality and Innovation has been set the following objective: Sub-objectives Measurable outcome(s) Key Risk Patient Voice: To improve satisfaction with local/informal Quantifiable reduction in complaints leading to benchmarked average. Capacity and capability of individuals within divisions to resolution of concerns Annual open culture-check locally resolve concerns or or complaints. by people who use our services. complaints. 20. As Executive lead for complaints the Chief Nurse/ Director of Quality and Innovation receives copies of all complaints received by the Trust. However, it is accepted that responsibility for investigating and resolving complaints rests within Divisions. The Patient Safety Officer emails a spreadsheet of all active complaints each Friday to Divisional Directors, Clinical Directors, Divisional Leads, the Medical Director, Chief Operating Officer and Chief Nurse/Director of Innovation. Standards and Benchmarking 21. The Trust currently has metrics in place regarding complaints and compliments; these are reported through the Integrated Quality Performance Report to the Trust Board Page 5 of 9
each month. In understanding that good customer service extends beyond these two measures a meeting has been arranged for 19 October 2011 with the Institute of Customer Service to discuss industry standards regarding customer services and potential benchmarking within and without the Public Sector. 22. The Institute of Customer Service in addition to being a membership organisation also provides a service looking at best practice on internal processes, staff awareness and training. Organisational Changes for delivery of Customer Services 23. A review of the Trust s Complaints and Patient Advice and Liaison Service (PALS) organisational form was undertaken as part of the Enabling Services review. This considered the structures and processes in place from the three predecessor organisations and the House of Commons Health Select Committee Sixth report of Session 2010-11: Complaints and litigation that was published on 22 June 2011. 24. The creation of a single Customer Services team builds on the experience of Leicestershire County and Rutland Community Health Service and responds to the Select Committee report, which states: The Committee finds that one single point of access for the entire local resolution of a complaint is valuable and that integration of complaints and advice teams can provide this. Paragraph 63. 25. The job descriptions for posts within this team are currently being drafted for evaluation under Agenda for Change. 26. In addition to the single Customer Services team resulting as part of the review; the responsibility between Enabling Services and Divisions for complaints was consulted upon. The table below shows this responsibility. Enabling Trust Complaints Policy and Strategy Trust coordination of complaints Trust Board reporting on complaints; to include both trust and divisional complaints analysis and trends Facilitation of complaint resolution meetings Quality Assurance of complaint responses; to include open culture reviews Customer Services; to include complaints training for divisional staff Ombudsman liaison Division Immediate local resolution to concerns or queries Provision of information to people who use our services, carers and families Complaint investigations Implementation of action plans arising from complaints Ward forum facilitation Complaints governance within each division Page 6 of 9
Customer Insight 27. In considering the customer care and experience people using our services receive it is important to consider all sources of customer insight. Using Heather Ward as an example of bringing together a number of these sources; it helps identify an overall view. As we develop new systems for qualitative and quantitative information such as real-time monitoring and the Net Promoter Score more accurate conclusions can be drawn. 28. Consideration to the potentially valuable insight that can be provided by organisations that provide advocacy services needs to be explored. The Trust Shadow Governors will also have a perspective from the constituencies they are elected from, for example the view of carers. Complaints 29. It was reported at the Performance and Assurance Executive meeting 21 June 2011 (minute PAE/ 11/112) and included in the Trust Board performance briefing paper for June 2011 that the wards with the highest number of complaints were Heather and Ashby. 30. The Assistant Director for Patient Safety has been working with these wards to better understand the complaints and issues surrounding them. This has helpfully identified the need to consider in the round all sources of information relating to the insight of those persons admitted to the wards. Compliments 31. As part of the changing your experience for the better the Partnerships and Community Involvement Manager visited Heather Ward to undertake the compliments analysis; it was found the ward had received 27 compliments which had not been reported to the Trust Board through the Integrated Quality Performance Report due to a failure to report them to the Complaints Team..Section 2.2 of the Complaints Policy and Procedure states General manager should ensure their service areas forward any compliments to the Complaints Department at the end of each month. Inpatient areas have been reminded of this requirement. 32. The wordle below shows those compliments received for Heather Ward. Page 7 of 9
Trust Board Visits 33. On Tuesday 30 August 2011 an unannounced visit by a Non Executive Director to Heather Ward provided a very positive visit and the majority of patients had much praise for the Ward staff. The usage of bank staff was mentioned with patients stating they wanted continuity of care by the same staff. 34. During the visit two key areas were identified; feeling scared on admission and needing to feel they are being listened to in their care. These comments evidence the approach of active listening being taken through the changing experience for the better programme is right. 35. The Board are aware that as part of the programme; turning values into action specifically includes welcoming and addresses the experience a person has when they are admitted to our service and defines behaviours and promises to improve that experience. Patient Advice and Liaison Service (PALS) 36. In Quarter 1 of the 2011 financial year the PALS office received 5 enquiries relating to Heather Ward; this equates to 4% of all Mental Health and Learning Disability PALS enquiries. i. Two were in relation to missing property; one was resolved and one became a formal complaint. ii. One request was for a change of consultant iii. One person was unhappy with a formal complaint response they had received and asked PALS to arrange a resolution meeting which is in progress iv. One was about another patient on the ward that was causing distress to other patients the Ward Matron dealt with it and resolution was reached Ward Forums 37. In line with other inpatient Adult Mental Health Wards a ward forum is held monthly on Heather Ward. This forum provides patients the opportunity to discuss issues that are relevant to them at that time; these are minuted and reported to the Acute Care Action Page 8 of 9
Group as part of the service improvement process. A review is underway, led by service users and supported by staff, to ensure the opportunity these forums present in improving the experience of patients and the role they can have in service redesign is being properly exploited. Mental Health Act Panels 38. The Trust Board through a separate paper to this meeting has seen the development of extending insight and experiences to the Mental Health Act panels, which for Q1 would have offered insight from 2 Hospital Managers panels. A national pilot to identify experience of Mental Health Act Tribunals is under development; if this was also used an additional 4 sources on information would be available. Conclusion 39. The unique insights that can be created at each Trust Board session when taken within activity between Boards and a robust reporting of experience through an integrated high level customer services will create a strong foundation upon which the Trust Board, Directors and staff throughout the organisation can make judgments and decisions. Page 9 of 9