Archive | September, 2014

Should the public have access to written patient complaints and is it time to re-badge “patient complaints”?

30 Sep

by Rahul Alam, Research Associate in General Practice theme

Rahul Alam blog picture_Sept 14

Affording patients the opportunity to “complain” regarding the care they receive is now seen and recognised as an essential part of improving patient safety. The Francis report described the short comings in patient safety when patient complaints are not heeded [1]. “Provide every patient with a pen and paper by their bedside to provide comments and concerns” was one recommendation for improving patient safety in another recent government review [2].

Recognising these concerns, the NHS has embraced and pro-actively encouraged the collection of complaints, which have soared from 148,200 written complaints in 2010-2011 to 174,872 in 2013-2014. Over 60,500 were reported from primary care and they contribute to a staggering 3,300 written complaints a week within the NHS in England and Wales alone! [3]

Given the wide-ranging healthcare services that are available and the varying levels of patient interactions, it is likely that complaints vary in their properties and dimensions. Currently, patient complaints are not easily accessible to the public, so there is no easy mechanism for identifying and acting on complaints raised by patients. Concerns have been raised around patient consent and confidentiality which means that only some senior NHS staff can access and act on these complaints. However, should anonymised patient complaint data be made available to the public? Benefits could be considerable. For example, second-hand experiences could empower patients to act, if and when they experience similar events themselves. Healthcare organisations can learn from each other, foresee potential problems from previous complaints and adopt examples of good practice. And finally, the research community, with input from patients and the public can explore salient issues in an attempt to improve patient safety and minimise harm.

Issues around confidentiality and consent could be mitigated if “complaints” are used as an opportunity to tap in to patient’s feelings, experiences and knowledge and used to drive patient-driven improvements. The complaint could be seen as an opportunity not only to say “what went wrong” but also to emphasize and ask “what can be done” to prevent future episodes of failure.

When health, well-being and patient safety is at stake, the patient complaints can be used to make improvements from the perspective of the patient. Complaints from patients and their families can often be emotionally charged but at the same time, patients and their families are probably best positioned to answer these key questions around improvement. Asking patients for a “suggestion for improvement” is likely to funnel patient emotions and discontent. This may lead to patients producing material that can be useful to improve care and patient safety at the same time as addressing their concerns and reassuring patients that preventative efforts are being made. We need to think of mechanisms of how we can harness these views for improvement.

Given the increasing numbers of patient complaints, it seems prudent to capture as many patient suggestions as possible. I would argue that a complaint coupled with a “suggestion to improve” is better than a complaint alone. There may be occasions when a “suggestion to improve” is not possible or some may argue that they do not wish to provide a “suggestion to improve”. My counter argument would simply be that we all have a shared responsibility to contribute to the system’s well -being, just as the system has a responsibility for our own well-being.

  1. Francis, R., The Mid Staffordshire NHS Foundation Trust. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. ID 2535334 01/13, ISBN: 9780102981476. London: The Stationery Office, Crown copyright. 2013.
  2. Clwyd, A. and T. Hart, A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. Final Report. Crown copyright 2901299. 2013.
  3. HSCIC, Workforce and Facilities Team, Health and Social Care Information Centre. Data on Written Complaints in the NHS 2013-14. 2014.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Research Rookie finds her feet with medication safety

26 Sep

by Faith Mann, member of the Greater Manchester PSTRC Research User Group, affiliated to Medication Safety theme

Faith Mann blog photo_Sept 14

“Why on earth am I doing this? Whatever possessed me to apply for this?” Those were some of the thoughts running through my mind as I prepared to attend my first meeting of the RUG back in May this year. After almost three years of blissful retirement with no deadlines to meet, no meetings to attend and no blogs to write, I began to question why I had signed up to take part in anything as structured and potentially demanding as the RUG appeared to be. Yes, I was interested in and committed to the concept of patient safety, but was this going to be a good use of my time, and could I really make a positive contribution to the work of the RUG?

Those doubts began to evaporate in the course of the meeting. The established RUG members warmly welcomed the three new members, of whom I was one, and the Chair of the meeting took the trouble to explain the background and import of some agenda items that would otherwise have been bewildering to a newcomer. Most importantly, the meeting ran to time! At the end of it I felt that I had gained a good understanding of the RUG and how it relates to the research themes and I was beginning to see how I could make a contribution to its work.

I was pleased to be aligned with the Medication Safety theme because some members of my family have suffered from mistakes in prescribing so I’m powerfully aware of the need for health professionals to maintain high standards in the prescribing and dispensing of medicines. Likewise, I believe that the patient has a responsibility to check prescriptions and to take medication according to the doctor’s or pharmacist’s instructions, so there is work to do from both the health professional’s and the patient’s perspectives.

There’s a lot happening in the Medication Safety research theme and I’m still in the process of getting to grips with it all but, already, I’ve been able to assist with identifying some patient focus groups to be interviewed for the research about their experiences with medication and I’m involved in the planning for an event that will highlight the issue of medication safety as part of the Manchester Science Festival. I feel that I have been welcomed by the research theme lead and the research assistants and that my perspective as a member of the public and occasional patient is valued by them.

It seems to me that PPI is still a fairly new concept to the NHS and is something that is put into practice to different degrees across the organisation as a whole. That’s one of the reasons why I applied to join the RUG in the first place – so that I could take part in the debate and help to develop a better understanding of the benefits of PPI and the opportunity that it presents for a true partnership approach between patients and health professionals which can only lead to better understanding between those groups and better outcomes for service users. I’m looking forward to the next couple of years to see how the RUG, of which I’m now a part, will influence health services across Greater Manchester, and possibly beyond.

Research Rookie: Reflections on the Symposium

18 Sep

by Carolyn Gamble, Research User Group (RUG) member affiliated to General Practice theme

Carolyn G - Sept 14 blog photo

As a Research User Group (RUG) representative on the Patient and Public Involvement Evaluation Advisory Group (PEAG), I had the chance to co-present at the Greater Manchester PSTRC Research Symposium held in June about the internal and external evaluation process currently taking place in the Centre and my involvement as a RUG member.

I had the opportunity to work with Sally Giles, (Research Fellow, Core Theme) to formulate and present at the event. Even though I have experience in public speaking, presentations and delivering training – I was still very nervous! It was new material for me and a new audience too.

Once I arrived, I realised there were many familiar and friendly faces, researchers the RUG have been working with, and other RUG members in the audience, which enabled me to relax a little as I knew I was in a supportive environment.

The event was chaired by Dr Maureen Baker, Chair of The Royal College of General Practitioners and who was also the clinical director for patient safety at the former NHS Connecting for Health. She did a stellar job keeping the audience focused, and introducing all the speakers.

The researchers delivered presentations on their respective works (Presentations can be found here: http://www.population-health.manchester.ac.uk/primary-care-patient-safety/presentations/) and they elicited a range of reactions and questions from the audience – who were noticeably engaged in the subject of patient safety!

Sally and I delivered our presentation on the importance of evaluating the impact of PPI activity, some examples of our impact. We spoke about the internal evaluation activity undertaken by Sally and Jill Stocks, paired with the external evaluation by Jonathan Boote, the methods used to evaluate the impact and some of the interim findings.

I had the chance to present about my experience as a RUG member and my involvement in the PEAG. I spoke about the selection process we undertook when applying for the RUG, what my motivations for joining the project were, and how I found out about it in the first instance. I talked about my experiences of being affiliated with the GP theme, and highlighted some of the areas that we have been involved in, for example helping to undertake systematic reviews, and opportunities to gain new skills. I always feel encouraged to get involved, at whatever level suits me, and I feel I have excellent communication with my research theme leads and research assistants.

The keynote speaker, Richard Roberts (GP and Professor from the University of Wisconsin) wrapped up the day and spoke about patient safety in the US entitled “Reflections on Patient Safety: Shattered, or a one way Mirror?”

He was engaging and entertaining as a speaker. I subsequently discussed the day with Cara Afzal, the current Vice Chair of the RUG who also thought he was great and commented “He challenged many of the assumptions about patient safety, offering a fresh perspective.”

When the symposium ended, I realised how far we have come in the past year or so, and I felt a sense of belonging, and I felt proud to be a part of this important project.

“More important than knowing the disease is knowing the person with the dis-ease.”
– Richard Roberts (GP and Professor from the University of Wisconsin)