Patient Association Peer Review Panels

Patient Association Peer Review Panels

Complaints Management Scorecard - Guidance Notes Version 10

October 2012
Introduction

The aim of these guidance notes is to support peer review panel members in undertaking complaint file based reviews of resolved NHS complaints. You will be presented with complaints files from different organisations. There will be a cover sheet providing you with a summary of the complaint which also explains any specialist terminology. Files contain a mixture of proformas, emails, statements, complaint logs and health care records. We have worked with the NHS organisations to ensure that files are completely anonymised but tried to allow you to recognise individuals in terms of their role (e.g. names are removed and replaced with “A hospital consultant” or “a nurse”). If you notice any identifiable details, please alert a member of the project team so we can remove them.

There is no time limit for completing a file; it will depend on your experience as a panellist, the degree of discussion that takes place and the complexity of the case.

It is important to remember that as well as providing resolution for complainants, a key aim of the complaints process should be to improve care for other patients as a result. Whilst this is not something that can be practically assessed through the panels, it is important to always keep this in mind.

To begin with, we advise you read the file in its entirety.

Completing the scorecard

Please start by completing the three identification (ID) boxes. Firstly, the type of reviewer you are (clinician, magistrate, social worker, complaints manager, lay) followed by your unique reviewer ID code which will be provided for you. This enables us to analyse inter-rater variability. Finally, the complaints file ID number (just the short number e.g. case 8 or case 9).

Moving onto the scoring of a complaint, you are asked to complete an entry for every single question; the options available should enable you to do this. Each standard is divided up into a number of sub standards and an overall score. The sub standards should inform your thinking and give a helpful indication as to whether the complaint has been managed well in that area. The sub standards are also helpful in giving the organisation very specific feedback on areas in which they can improve. Use this guidance document to ensure that you have a good understanding of what each sub standard relates to and how it should be scored. Referring to it frequently as you score will help, particularly when you are new to the process.

For the overall score, there is no strict relationship between the sub standards and the overall score given. It may be that the organisation has “ticked all the boxes” for a standard but for a reason not captured by the sub standards, you think that the score should be low. The reverse may also be true where, technically, there have been failings but you feel the score should be high. It can be helpful to read the summary description of the standard again just before scoring to refresh your thinking.

At the end of the complaint review, you will be asked to give your opinion and an overall score on how well the complaint has been managed. Again, there is no strict relationship between the individual scores for each standard and the overall score which will allow you to exercise your opinion flexibly.

Providing feedback

At the end of each standard, there is space provided for you to include some feedback. This feedback provides valuable learning for the participating organisations. We would encourage you to note things that have been carried out well in addition to areas identified for improvement.

Panel makeup

Each panel consists of approximately four people from a variety of backgrounds including magistrates, NHS complaints managers, lay people and consultant clinicians. Each panel will usually be balanced with at least one person from each background.

Working with your panel colleagues

The aim of the panel based process is to encourage discussion and the sharing of opinion to support each individual in completing the scorecard. However, you must ultimately decide on your own individual score. We encourage panellists to discuss any areas of uncertainty and to participate in a general discussion when completing the numerical score for each standard. Different viewpoints and experiences of others may inform your score. The person with a clinical background on your panel will also be helpful in informing you about the usual customs and practices that exist in the NHS. It is important to respect each other’s opinions and be courteous in your discussions.

How the results are used

We aggregate the results from the sub standards and scores across all of the results for the organisation. Using these, along with your written feedback, the Trust is provided with a report on where it has performed well and where there are areas for improvement. We distil this into a number of recommendations and use this information at repeat panels to measure progress. .

Proportionality
Proportionality is a key element of using the scorecard. The sub standards usually ask direct questions where proportionality is not relevant. For example, was the complaint risk assessed or not or was the complainant notified if there was a delay to their response?

However, when you come to score the standard overall, take proportionality into account when deciding what impact failing to meet a substandard has had. For example, a lack of a clear investigation plan may not negatively impact the score if the complaint was minor, straightforward and resolved easily. It probably would not have been necessary to have a detailed plan as such. On the other hand, if a complaint was of a serious nature and there was no investigation plan, you would reduce the score by a greater amount.

Reporting serious concerns!!

Towards the end of the document, there is an opportunity to escalate any concerns related to professional misconduct and patient safety. The emphasis here is on serious issues as this process is not intended to play a role in ensuring action is taken in relation to particular cases. Panels could not feasibly take responsibility for reviewing lots of complaints in that way.

Panel members are requested to highlight and discuss such concerns with the project team at the time the panel sits. This enables the Project Director an opportunity to discuss your concerns directly and puts him in a better position to give detailed feedback to the Chief Executive Officer where appropriate..

Frequently Asked Questions

Why does it say no/not recorded - should that not be separate?

The peer review methodology is based on using case files. It may be that events that were part of the complaints process were not recorded in any way that we can capture. However, it is very difficult for you as panellists to try and guess when this might be the case. As such, for the purposes of the score card, no record of something is the same as no. However, when we feed back to the organisation, we highlight that there may be positive action taking place which is not being written down. They will need to review their practices further to determine if this is the case.

There is an information point where I don’t think any of the answers are right. What should I do?

We have tried to design the scorecard so that you can always answer. If you feel this is not the case, please bring it to the project team’s attention. It may be a misunderstanding of the information point or we may need to add a new answer option.

My panel members are not discussing things as much as I would like. What should I do?

Different panel members will have a tendency to review cases at different speeds and discuss things more or less. Simply asking your colleagues if they wouldn’t mind discussing their opinions for an information point or score should be enough to generate further discussion. Where this doesn’t work, we will seek to rotate panel groupings to match people with similar approaches to discussion and scoring.

I am a bit worried that on one case, we all had very different views. In fact, I really think one of the panel members is scoring very differently to everyone else. Will this distort the results?

It may well be the case that for a number of information points and scores, there are different views, particularly ones where partly is included as an option. If you think an information point is misunderstood, it can help to suggest your group review the guidance notes again and/or ask a member of the project team for their opinion. Keep in mind though, that the individual scores for all the individual cases are aggregated. Themes are extracted from the data so individual variation or even occasional misinterpretation should not affect the feedback given to the organisation as a whole. We also value the different perspectives brought by panellists. However, we are developing a programme of monitoring scoring to see if there are any significant outliers and to ensure our training is giving everybody the right perspective on how to use the scorecard.

One of the cases I reviewed described pretty poor care for a patient but I thought the complaint was handled well. I don’t want to give the wrong impression by giving the case a good score - the care was poor. What should I do?

The panels are specifically looking at complaints management, not the quality of care As long as the organisation recognise the failings and respond appropriately, they can score well. When publishing the results, we make it clear about what the scores apply to. In that way, no false impression is given about the quality of care provided by an organisation.

Meetings are often used to resolve complaints; how does the scorecard cover that?

Whilst envisioned for use with the more typical method of resolving complaints through writing, the scorecard should be compatible for reviewing complaints resolved by meetings. This is because meetings should be minuted and all the issues of substance recorded so as to allow others to review what happened. Where meetings are not minuted then select no/not recorded as usual.

Type of reviewer Unique ID Complaint Case No

Complaints Management Scorecard

Draft document (v10): The Patients Association

Standard 1: The Complainant has a single point of contact in the Organisation and is placed at the centre of the process. The nature of their complaint and the outcome they are seeking is established at the outset.

Complainants should be provided with a named individual, a single point of contact with whom they can liaise. There is equality of access for all complainants, with particular consideration for those people who may find it more difficult to use the process.

1.1 The complainant was given contact details for a named person with whom they could liaise throughout the process.

Yes □ No/Not recorded □

Best thought of as a ‘case worker’, complainants should be able to establish a working relationship with a named person who can act as their liaison throughout the process. References to “on behalf of the team” or similar would not constitute a named person. If an assigned case worker is away, ideally, complainants should be informed of an alternative point of contact.

1.2a. Sufficient attempts were made to contact the complainant verbally.

Yes □ Partly □ No/Not recorded □ Not applicable □

Unless explicitly asked not to, it is good practice to try and establish verbal communication even if just at the outset. This is typically carried out by phone. We would define ‘sufficient’ as a minimum of three attempts. Where only one or two attempts were made, select ‘Partly’. Where the complainant makes the initial contact verbally or asks not to be contacted verbally, select ‘Not applicable’.

1.2b. If there was verbal contact, the person making the call accurately established the complaint aspects and the solutions the complainant wanted in order to resolve the complaint.

Yes □ Partly □ No □ Not recorded □ Not applicable □

If a complainant is contacted verbally, whoever speaks to them should record the details of their complaint and the outcome they are seeking to achieve. If there is any written record of a conversation (either on file or outlined in a follow on letter to the complainant) but it is largely inadequate select ‘No’. If you are confident that no verbal contact has occurred select ‘Not applicable’.

1.3. The complainant’s preferred method of communication was established at the earliest opportunity.

Yes □ No/Not recorded □

The legislation requires that the complainants preferred method of communication be established (Regulation 13 (1) – complaints may be made orally, in writing or electronically). . Complainants may wish to communicate in writing, over the phone, by email or through face to face meetings. At the point of initial contact the preferred method of communication should be established. It may be that the complainant states at the outset how they wish to communicate e.g. stating in a complaint letter that they wish to communicate by writing. In examples like this select “Yes”.

1.4 An explanation of how the complaints process at the organisation works was provided.

Yes □ Partly □ No/Not recorded □

Explaining how the complaints process works is the first step in ensuring the complainant is well informed about what to expect and how typically complaints are handled.

1.5 The complainant was offered a face to face meeting to discuss the issues raised early on in the process.

Yes □ No/Not recorded □ Not applicable □

It is good practice to offer face to face meetings, especially when complaints relate to more serious issues or complex circumstances. It may be that it was explicitly raised by the complainant that they would not like a meeting in which case select ‘not applicable’. In addition, you may judge that, for some reason, offering a meeting was inappropriate. Even so, select no but keep this in mind when allocating a score.