Dorothy Armstrong

							Compassion, communication,
choice : analysing the themes from
complaints


     Dorothy Armstrong
     Programme Director, NES and
     Nursing Adviser
     Scottish Public Services Ombudsman
     NHS Lothian / Edinburgh Napier University International Conference on
     Compassionate Care, June 2010
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But things do go wrong..




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So perhaps they really should be treasured


   Complaints are a key source of feedback
    from users.
   And can be used to drive service
    improvement.
   Good complaints mechanisms can stop
    disputes escalating – saving time and
    money.

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Reasons why people complain

   Don’t want the problem to happen again
   Lessons to be learned
   A full explanation
   Commit to feedback
   They feel humiliated, betrayed and hurt
   Explain what happens next
   An apology



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A complainant interview




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Themes - communication




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Themes – care & compassion




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Themes – nursing care




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Connections in care

   Food fluid and nutrition
   Little things make a big difference
   Leading Better Care : the review of the Senior
    Charge Nurse role




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Ombudsman complaints




No weight taken on admission. A referral to a dietician was made but was
lost. No record of food likes or dislikes, high calorie drinks. No mention of
blindness or requirements for assistance with eating and drinking.

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Little things make a big difference

• a glass of water

• help to clean your teeth
• having your hair brushed
• holding your hand
• knowing your name
• saying bye at the end of the shift




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Little things…




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http://www.knowledge.scot.nhs.uk/making-a-difference/tour.aspx   14
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Themes – professional behaviours




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Reasons why people complain

   Don’t want the problem to happen again
   Lessons to be learned
   A full explanation
   Commit to feedback
   They feel humiliated, betrayed and hurt
   Explain what happens next
   An apology



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    The power of apology - The 3 R’s

   REGRET
       Sorry, unreserved, meaningful, genuine

    ‘I am so sorry.’

   REASON
       Explain, not defensive

    ‘This is what happened.’

   REMEDY
       YOUR commitment to put things right, next steps.

    ‘This is what I will do to prevent this happening again.’
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‘An apology is the
superglue of life. It can
repair just about anything.’
New South Wales Ombudsman, (2009).




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Delivering an apology

   Timing. Everyone’s responsibility
   Owned, active and unconditional
   Clear, plain and direct language
   Sincere and natural
   Should not question ‘I am sorry you were offended’
   Should not minimise ‘No one else complained’
   Ensure right person



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Who should apologise?

If on behalf of a ward/ department/ organisation
   The most senior person available at the time
   The most accountable person


    Front line staff should be empowered to apologise, even
    if they are not directly involved or responsible



Its everyone’s business!
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There were eleven patients given a contaminated solution which had
been injected into the heart during cardiac surgery. Five of the eleven
patients died following this error. One of the senior staff recalls the
events:


‘ One of my senior colleagues called all the families together and he
and I sat down with the eleven families and said “This is terrible thing
that has happened. It is awful. We are truly sorry that this has
happened. We are not going to do another operation until we have got
these patients out of the woods.” And we did not. We said “We are
going to leave no stone unturned until we find out what the cause
was.” We knew it was an infection, we knew it had occurred
somewhere in the processing of that solution, which was beyond our
control as individual clinicians. But we said sorry. None of those
patients took legal action.
Australian Ombudsman 2009

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Disclosure is not about apportioning or accepting
blame
It is about being truly professional.

The NHS needs to learn to apologise more
often.
And it needs to learn to mean it.


Sir Liam Donaldson, Chief Medical Officer for
England. BBC Feb 09

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Our challenge
                   High quality care
                   Leadership of caring
                   Role model professional behaviours
                   Value communication at every level
                   Little things make a big difference!




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Thank you


dorothy.armstrong@nes.scot.nhs.uk

darmstrong@spso.org.uk

www.nes.scot.nhs.uk

www.spso.org.uk

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