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LITTLE THINGS MAKE A BIG DIFFERENCE

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					          LITTLE THINGS MAKE A BIG DIFFERENCE
                  FRIDAY, 20 MARCH 2009


Introduction

Start by thanking the organisers for asking me to participate today

Ombudsman since 2002

Retiring at end of month

Last public engagement of this kind

I wanted to do this because:
    Believe passionately in theme for today - that little things can
      make a big difference
    I want to support what you do in your different organisations
      and different ways to delivery the Health Service in Scotland
    Whether delivering the service or in the Ombudsman’s office
      dealing with a complaint – we have the same objectives in
      mind
    We want to engender trust and confidence in the NHS and
      we want the users of the Health Service to have the type of
      treatment that we would want for ourselves and our loved
      ones and friends


I want to address the following questions:

   What is an Ombudsman and what do we do?

   What type of cases do we see in the Health Service

   What goes wrong and Why and What we can do about it

   What are my reflections on having been Ombudsman for
    almost 7 years




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What is an Ombudsman and What do we do?

Derives from a Swedish term – first Ombudsman established 200
years ago – for ‘agent’ or ‘representative of the people’

‘An official appointed to investigate complaints’ (Chambers
definition)

Basically we handle unresolved complaints when a person claims
to have suffered injustice or hardship as a result of
maladministration (poor administration) or service failure. In the
Health Service we can also look at clinical judgement.

We also promote good administrative practice and good complaint
handling

Lessons learned from complaints – fed back to improve the
delivery of public services

Features: Independent, Impartial, Free, Accessible, Confidential,
Powers to Report to Parliament

Our Office created in 2002 – ‘One-stop-shop’ - Covers most public
services in Scotland

Scotland has led the way – ‘joined up’ approach

Why Health matters so much – when people at most vulnerable –
trust and confidence – how to repair that when it breaks down if
things go wrong


What type of cases do we see in the Health Service

Last year – 4,200 cases – 750 enquiries and complaints about
Health (around 18%)

55% Hospital Services

18% GPs

5%   Dental and Orthodontic Services



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Others covered NHS 24, Scottish Ambulance Service and wide
range of other NHS services

Issued 182 Investigation Reports in 2007-8:
62% Fully or Partially Upheld; 38% Not Upheld

But we do see the same Issues and Recurring Themes


What goes wrong and Why and What we can do about it

I want to consider:
    what we hear from complainants;
    say something about the impact on staff working in the
      service; and
    argue that good complaint handling can benefit everyone –
      win/win

Essentially basis of an article I wrote last year for the magazine:
Curam

Curam. An old Scottish Gaelic word that means "caring", but
"caring" in its widest sense.

At the launch of the magazine, Paul Martin said ‘It doesn't just
mean the act of caring; it also means the responsibility each of us
holds to care for each other and our communities.

It's an ancient word that I believe perfectly captures the essence of
what we're trying to achieve in health care in modern Scotland.’

I very much echo that sentiment.


Start by quoting the opening sentence of my article in which I said:

‘I work on the assumption that most people get up in the morning
wanting to do a good job. You don’t wake up and say ‘Today I’m
going to upset that patient and I’m going to forget to write down
their medication’




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So this is my starting point: I know that NHS staff have chosen
their jobs because they want to support and care for people at
some of the most vulnerable times in their lives

However, Things can go wrong – that is real life – it is what people
do about it that matters – dealing with the problem well at this point
is crucial

But some times that does not happen and some times people
remain dissatisfied. It is then that the Ombudsman may be asked
to get involved. But I acknowledge that we see only a small part of
the patient experience.

Nevertheless, complaints are an important source of intelligence
and feedback – within the NHS and in the SPSO - where the
patient experience can be voiced and can be fed back into the
NHS to inform improvements (together with other sources of
feedback that the Government have established for capturing the
patients experience)


   (a)   What do we hear from complainants?

          Sometimes it is that the surgery or the diagnosis or the
           treatment received were poor, but far more often it is
           that the person or their family felt uncared for – and not
           respected when they raised concerns. Feeling of
           Powerlessness.

          The technical issues may have gone well but the
           patient or their family or friends can still be left feeling
           bewildered, angry, or upset because other issues were
           perceived as poor. These are usually around the softer
           issues - the dignity and respect afforded to patients
           (give examples)

          The top three areas of complaint are: communication in
           the broadest sense; poor record-keeping; and failings
           in nursing care (particularly for the most vulnerable)

          And it is - as the theme of this conference spells out -
           the little things that can make the difference – brushing
           the patient’s hair or cleaning his or her teeth; making

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            sure that the food tray or the bell are within reach.
            Being proactive in speaking to relatives who may be
            anxious

          The distress caused by poor nursing care or perception
           of poor nursing care is particularly acute at the end of a
           person’s life. It can have profound impact on the ability
           to move through the grieving process. I am struck by
           the percentage of cases we receive that cover such
           issues



   (b)   There is also a profound effect on staff who are
         complained about

    We are acutely aware that it is very difficult for staff, and I
     know of NHS professionals who have not felt supported and
     informed throughout the complaints resolution process and
     have felt raw and vulnerable about events years later.

    This is where it is so important that organisations support
     their staff and, crucially, empower them to resolve complaints
     as early as possible in the process.

    For example, the SPSO has done a lot of work around
     ‘Saying sorry’ – apologising early when things go wrong.
     Often, all the complainant wants is an explanation and an
     apology – this can be very powerful. (Mention Mr Waugh?) I
     know colleagues are giving a workshop later today about
     Apology, and will be speaking about the work we have done
     in this area.


My third point is about:

   (c)   How good complaint handling can benefit everyone

          We know from research that only a small proportion of
           people who are unhappy, complain – some feel it is a
           waste of time as nothing will be done.



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          We want to encourage a culture of Valuing Complaints
           because they are a source of learning and because
           good complaint handling has enormous benefits – it
           can be win-win situation for all (research supports this)

          The benefits of good complaint handling include:

          Free feedback on the level & quality of your service
          Identifies service improvements required
          Helps identify appraisal & training needs
          Can assist in the planning & allocation of resources
          Early warning of risks, litigation, media interest
          The earlier a complaint is resolved, the cheaper it is
          Leads to changes in policies, procedures, practice &
           culture
          Empowered staff feel positive
          Opportunity to demonstrate that you are listening –
           shows you care

It is about a change in Attitude and Behaviour which engenders a
Culture of Learning not one of Blame


What are my reflections on having been Ombudsman for
almost 7 years

Privilege to have been the lst SPSO

Just a pity that the confidentiality clause in our legislation prevents
me from writing a book of the cases we receive and the
experiences we have had!

Amongst the most serious and tragic of issues there are, of
course, lighter moments – extraordinary things that provoke some
people to complain (one man that his wife has been sold
unsuitable underwear! – not for us)

Safer to provide examples from other countries:

In Sweden – the home of Ombudsmen – Women Prisoners
complained that their human rights were being abused because
they were not allowed to wear Bikinis during recreational time


                                  6
An example of poor communication in Health Centre in Mexico
resulted in a man receiving a vasectomy when he presented with
an ear infection!
But it ended happily!!

And so on…………….

But more seriously

We have made considerable progress in working with the Health
Service in Scotland – shifting the culture to one of a ‘Culture of
Service’

By working in partnership - including with many of you here today
(give examples)

Relationship with allows feedback – lessons to be learned and
disseminated across the NHS in Scotland through our monthly
Commentaries, our website and other sources of information and
communication

Has required political and clinical leadership across the NHS and
at all levels – this is vital to bring about the changes we all want to
see

But it also requires people like us – individuals working in the NHS
and related bodies – to continue to value complaints and learn
from them

Key part of that learning and the message for today is indeed –
That Little Things Make a Big Difference

So my challenge to you is by the end of the day to think about the
little things you will do when you go back to work tomorrow to
make a big difference; but also how you will be a champion of that
approach and encourage your colleagues to do likewise (those
who are not here today)

Although I am retiring I will do what I can and will follow your
progress in taking that message forward. I will be watching to see
the big differences you make in the years to come



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