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TRANSCRIPT
Patient and Carer Experience report
Quarter 4 – January to March 2016
1
Quarter 4: Patient Advice and Liaison Service (PALS) Report
2
In quarter 4, PALS received 798 enquiries. This is a notable increase
from the same quarter last year when 630 enquiries were received.
The number of issues requiring resolution has decreased, however
increasing numbers of patients/carers are requesting information,
advice and sign-posting.
Staff across the hospital receive written compliments, from patients and
their carers and families, in the form of letters, cards and notes. Whilst
they are not recorded centrally, the ones received by PALS are. In
quarter 4, the PALS service received 74 compliments. Of these, 62
compliments were regarding staff attitude and behaviour across 14
areas in the Trust. 17 compliments regarding attitude and behaviour
referred specifically to staff in the Emergency Department. Below are
some example comments:
• My aunt … said to me how very ‘kind and patient’ everyone on
the staff were towards her (relative of a medical patient)
• I felt cared for (medical patient)
• My progress through the diagnostic process in the urology
department and then the treatment process in the radiotherapy
department could not have been smoother (surgical patient)
• The Midwives and Maternity Care Assistants are a credit to the
Trust. They were forever attentive with a smile and nothing
could be too much trouble; in fact they actively encouraged us
to call more! (Women and Children's)
Compliments received through PALS
Quarter 4: Patient Advice and Liaison Service (PALS) Report
3
Communication and information
Issues regarding communication and information continue to be the
main subject requiring resolution this quarter.
18 of the 89 contacts (20.2%) about communication and information
were in relation to difficulties in accessing Trust outpatient services and
appointment offices by telephone. This is a decrease from quarter 3
which was 36 of the 134 contacts (26.8%).
In particular, patients have had difficulty accessing the Pain Clinic by
telephone, with 8 patients contacting PALS. 5 RNHRD patients
reported difficulties in accessing the site in January and February,
however no patients reported difficulties in March. The other contacts
reporting difficulties in accessing services by telephone were shared
across 4 other outpatient departments.
A member of the Patient Experience Team attends the Outpatient
Steering Group and presents the themes and trends in patient and
carer experience to inform discussions and identify areas of
improvement.
The themes from PALS contacts will be used to support improvements
in outpatient communication which has been identified as a Trust
quarterly account priority in 2016/17.
Appointments
Of the 61 contacts about appointments 46 (75.4%) were regarding delays in outpatient appointments, none can be attributed to a particular
hospital service. The other contacts were regarding patients who had forgotten appointment dates or wanting to change appointment dates.
Care and treatment
There are no themes in the 29 contacts regarding care and treatment that can be attributed to a particular hospital service.
Top three subjects requiring resolution
Quarter 4: Friends and Family Test (FFT) responses
4
Response total for all services
During quarter 4 we received a total of 7625 Friends and Family Test
responses. This has increased from quarter 3 where the total was
7024. The distribution for quarter 4 across Trust services is as
follows:
Inpatient 2975 39%
Emergency Department inc: MAU & SAU 1265 16.5%
Outpatients 2728 36%
Maternity Services 657 8.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
ExtremelyLikely
Likely NeitherLikely orUnlikely
ExtremelyUnlikely
Unlikely Don'tknow.
Quarter 4 Trust Response Totals
Total
83% (6,333) would be Extremely Likely to recommend the Trust to
Friends and Family if they needed similar care or treatment. This
remains the same as in quarter 3.
Changes in recording and reporting on FFT and surveys
Information, collected from patients via FFT and patient experience
surveys, was previously ‘recorded’ within ‘Meridian’. However, as part
of ongoing work to integrate data collection and management tools,
Meridian was replaced by a new in-house system called ‘eQuest’ this
quarter.
From January 14th FFT responses were entered onto eQuest and
from 31st March all other Meridian services ceased.
This has caused some temporary disruption during quarter 4 whilst
surveys from Meridian were built within the new application. The
Business Intelligence Unit are continuing to develop the reporting
capability of patient experience to wards and departments through the
ward dashboard.
Due to the change from Meridian to eQuest, there is a small
discrepancy in the response totals due to a rounding error in excel
which cannot be adjusted. There is a discrepancy of 6 responses
between the monthly board reports and this quarterly report.
Quarter 4: Friends and Family Test (FFT) responses
5
Changes in Analysis of FFT free text comments
FFT cards provide respondents with the opportunity to give more
detailed information about their experiences in the form of written
comments.
With the implementation of eQuest the quantitative data (comments)
received for February and March have been assigned ‘sentiments’ -
Positive, Neutral, Negative and broad categories/ themes - Attitudes
and Behaviours, Care and Treatment, Communication, Cleanliness,
Facilities, Food, Timeliness, Resources and Over-all Experience. If
required, comments have been assigned more than one sentiment or
category/theme. This facility was not available when using Meridian for
January comments. If the category/theme does not appear on a chart
this indicates there were no comments related to them.
The following is a brief overview of the broad categories, including
some examples of the types of comments that could go into a
category and some sample comments:
Attitudes and behaviour – (Comments about any/all staff/
volunteers) ‘staff kind’, ‘team were professional’, ‘member of staff was
rude’.
Care and treatment – (Comments relate to quality of the overall
care/treatment) ‘well looked after’, ‘excellent care’, ‘I got left on a
commode for an hour’, ‘range of tests and overall thoroughness was/
is very impressive’.
Cleanliness – (Comments about the cleanliness of buildings,
rooms, equipment, staff, hospital grounds) ‘clean and fresh
environment’, ‘poor hand hygiene’.
Communication - (Comments about written, telephone and face
to face communication) ‘all information given in a clear manner’,
‘kept informed’, ‘told one thing and then they change their minds’,
‘explanation comprehensive’, ‘had to wait for appointment’.
Facilities – (Comments about buildings, wards, rooms,
environment including noise/ lights, accessibility, decor)
‘playroom was my favourite’, ‘no hot water in washbasin’,
‘parking dreadful’.
Food – (Comments about food) ‘food was excellent’, ‘a bit more
variety on the food menu front’.
Resources - (Comments about staffing levels, general
comments about staff, equipment) ‘staff are lovely’, ‘amazing
staff all around’, ‘everyone excellent’, ‘staff brilliant but
understaffed’, ‘too few staff’, ‘lots of lovely toys’.
Timeliness – (Comments about waiting, being seen quickly,
prompt treatment) ‘treatment was very swift’, ‘no time waiting’,
‘wait for medicine’, ‘respond quicker to the call button’,
‘appointment can take months’.
Overall experience – (Comments about overall experience)
‘good all around’, ‘perfect’, ‘it was ok’.
Quarter 4: Friends and Family Test (FFT) responses – Inpatient
6
Inpatient Experience
The majority of inpatient comments relate to the attitude and
behaviour of ward and support staff. The largest proportion of
compliments refer to the attitudes and behaviour of ward and
support staff e.g.
‘Everything was excellent, your colleagues have without exception
been courteous, thoughtful and reassuring. All information given was
excellent’
‘The staff have been absolutely wonderful, totally dedicated,
kind and understanding. It's been a very rewarding experience
to see saints at work!’
Care and Treatment is the next largest area of compliments e.g.
‘Very good care’
‘Treatment excellent, nursing very good’
Analysis of inpatient comments shows the overall theme for areas to
improve as ‘resources’ :– The largest proportion of the comments
refer to staffing levels e.g.
‘When short staffed difficult to get hold of a nurse’
‘Staffing levels at times poor’
‘Timeliness’ and ‘facilities’ are the next significant areas to
improve:- the largest proportion of comments within timeliness refer
to waiting for call bells to be answered, waiting for pharmacy and
waiting to be discharged e.g.
‘Respond quicker to the call button’ ‘Most satisfactory, except time
waiting, so long for pharmacy before discharge’
0100200300400500600700800900
Inpatient FFT Theme Totals
Positive
Neutral
Negative
The largest proportion of comments within facilities refer to the lack
of/condition of toilets, poor condition of bathrooms and noise levels
from equipment, noise from other patients and noise levels at night.
Further analysis of quarter 4 comments related to bathrooms shows
that these comments were received across 10 different areas,
however 4 comments related to the bathroom facilities on the
Cardiac Ward. This feedback requires further exploration and will be
a point of focus in the developing of the Matron’s patient experience
surveys starting in quarter 1 2016/17.
Quarter 4: Friends and Family Test (FFT) responses – Emergency Department and Maternity
7
Emergency Department (inc MAU & SAU) Experience
The majority of ED patient comments relate to the attitudes and behaviour of
staff working within ED. The largest proportion of compliments refer to
attitudes and behaviour of staff e.g.
‘Honestly, the people skills from staff are so lovely and
make people feel valued, listened to and with
lots of empathy shown, thanks so much’
Care and Treatment is the next largest area of compliments e.g.
‘Excellent attention, thorough examination and observation, well done!’
Analysis of ED comments shows the overall theme for areas to improve as
‘timeliness’ waiting times, however positive comments outweigh the negative
comments e.g.
‘Very quick and professional response’
Maternity Services Experience
The majority of Maternity service comments refer to the attitudes and
behaviour of staff working across the service – Antenatal, Labour
wards/Birthing Centres, Postnatal Wards and Postnatal Community support.
The largest proportion of compliments refer to the attitudes and
behaviour of staff e.g.
‘Very helpful friendly staff who are patient and caring.
Felt very comfortable here’
Care and Treatment is the next largest area of compliments e.g.
‘Care was excellent for mother and baby’
Analysis of comments show the overall theme for areas to improve as
Facilities:- Difficulty parking – Antenatal Clinic (RUH) continues from
quarter 3 e.g.
‘Over 30 minute queue to park car, so 5 minutes late for appointment
despite allowing extra time for parking. Extremely stressful’
020406080
100120140160180
Maternity Services FFT Theme Totals
Positive
Neutral
Negative0
50
100
150
200
250
300
350
Emergency Department FFT Theme Totals
Positive
Neutral
Negative
Quarter 4: Friends and Family Test (FFT) responses - Outpatients
Outpatient Experience
The majority of Outpatient comments refer to the attitudes and
behaviour of staff working within outpatient departments across the
Trust.
The largest proportion of compliments refer to attitudes and
behaviour of staff e.g.
‘Everyone was really friendly and supportive.
Made me feel better and safe’
‘I brought my mother in today, the staff were amazing, considerate,
kind and had real empathy. Exceeded my expectation. Thank you’
Overall experience is the next largest area of compliments e.g.
‘Very good service’
Analysis of comments shows the overall themes for Areas to improve
are Timeliness - Waiting times in clinic areas, e.g.
‘Bit of a long wait,1 hour 10 minutes’
In addition, Facilities - Difficulty Parking, e.g.
‘Absolutely no parking, drove around for 30 minutes’
These themes continue from quarter 3.
8
0
100
200
300
400
500
600
700
800
900
Outpatient FFT Theme Totals
Positive
Neutral
Negative
In conjunction with improving outpatient communication, a week long
event called “The Outpatient 15 steps challenge” will be undertaken in
the summer. Each outpatient department will undertake an
assessment together with patient representatives of every aspect of
the department. The “15 steps challenge” concept is derived from the
NHS Innovation and Improvement’s productive care work stream.
From car parking, signage and the welcome from the receptionist, to
the level of clinical care provided during a consultation – the whole
patient pathway during an appointment will be reviewed from a patient
perspective. During the week, full support will be provided to the
outpatient areas from estates and IT to fix problems first hand.
Quarter 4: Patient Experience Surveys – Inpatient and Outpatient
The overall percentage of patients that rated their care as ‘Very Good’ or ‘Excellent’ in quarter 4 was 93% (539). This has decreased
slightly from 96% (556) in quarter 3. The percentage displayed on the chart for Inpatients, is a combined score for inpatient and inpatient
carer surveys.
The total number of outpatient surveys completed in quarter 4 was 176. The total number of inpatient and inpatient carer surveys
completed in quarter 4 was 408.
During 2016 the Patient Experience Team will work with the Heads of Nursing and Matrons to review patient and carer experience surveys.
Historically the national patient experience surveys have been used as a basis for the in-house surveys, however these are lengthy and do
not focus on the areas patients and carers are telling us are important to them. The Patient Experience Team will support Heads of Nursing
and Matrons to develop a rota of short surveys focussing on e.g. privacy and dignity, communication and information, carer support, etc.
Results from the findings of these surveys will be included in future Patient Experience reports. 9
84
86
88
90
92
94
96
98
100
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
De
c-1
5
Jan
-16
Feb
-16
Mar
-16
Perc
en
tag
e o
f an
sw
ers
rate
d a
s
'Excellen
t' o
r 'V
ery
Go
od
'
Percentage of patients and carers who rated the care received as 'Very Good' or 'Excellent'
Inpatients
Outpatient
Overall
0
50
100
150
200
250
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
De
c-1
5
Jan
-16
Feb
-16
Mar
-16
Nu
mb
ers
of
resp
on
ses
Total number of Patient Experience Surveys Completed
Inpatients
Outpatient
Quarter 4: Patient Experience Surveys – Performance Maps
Performance Maps – created from data in the Meridian System
Each point plotted on the map represents an individual question, it shows the relative importance and rating of each question to the
inpatients/carers/outpatients that completed a survey in Quarter 4 and a relative measure of the Trust’s strong and weak performance
against those questions.
The importance rating is a score between 0 and 1 with zero meaning least important and 1 meaning most important. In general terms, the
further to the right a point is, the more important it is to the service user. Those points towards the left of the chart are less important. The
vertical axis gives the score for the point so the higher the point, the higher the score.
• Points shown in the top right quadrant are very important to service users and the Trust is scoring well on these
• Points in the bottom right quadrant are important to service users, but the Trust is not scoring as well on them – these are key areas to
focus on
• Points in the top left quadrant are less important and the Trust is scoring well
• Points in the bottom left quadrant are less important to service users but the trust is not scoring well – these should be secondary areas
to focus on
• The Meridian Performance Map uses a recognised statistical tool (Regression Analysis) to compare the results for selected scoring
questions in each questionnaire to the overall level of satisfaction in the questionnaire
• Each questionnaire requires a ‘seed’ or ‘key’ question, which is a general question providing a benchmark for the overall level of
satisfaction in the questionnaire. Examples of ‘seed’ or ‘key’ questions would be:
“Overall, how would you rate the care you received?”
10
Quarter 4: Inpatient Survey Performance Map – Based on 327 Surveys
Primary Strengths upper right quadrant, areas that are important to
patients and where patients have rated the Trust highly.
Q8. On the whole, are the staff kind and friendly?
Of the 327 inpatients that completed the survey 92.35% responded
‘yes definitely’.
‘They were very friendly and welcoming and kept me up to date at every
stage of my visit’
‘Can't speak too highly of them. Go above and beyond, lots’
The other questions in this quadrant are:
Q13. In your opinion, how clean is the hospital room or ward you
are in?
Q17. Were you told who to contact if you were worried about your
condition after you left hospital?
Q14. How clean are the toilets and bathrooms that you use in this
ward?
Primary Weaknesses – lower right quadrant, less important to
patients and where patients have rated the Trust less highly.
Question 11 has the lowest score in this quadrant.
Q11. How would you rate the hospital food?
35.78% rated the food as very good, 35.78% rated the food as good,
11.31% rated the food as fair and 5.81% rated the food as poor
(11.31% responded that they did not have food – nil by mouth, etc).
Question 9 is as equally important to patients as question 11 in this
quadrant, but does have a higher score.
Q9. Did you find someone on the hospital staff to talk to about
your worries and fears?
57.49% responded ‘Yes, definitely, 18.65% responded ‘Yes, to some
extent’, 6.73% responded ‘No’ and 17.13% responded ‘I have no
worries and fears’
Secondary Strengths – upper left quadrant where patients have rated
the Trust highly but are calculated as less important to them.
Q18. During this most recent hospital stay on this ward, have you
shared a sleeping area with patients of the opposite sex?
Secondary Weaknesses – lower left quadrant where patients have
rated the Trust less highly but are rated as less important to patients.
Q10. Were you involved in decisions about your care and
treatment?
Q12. Did you get enough help from staff to eat your meals?
Q16. If you have been given your medication to take home were
you told about medication side effects to watch for? 11
Quarter 4: Outpatient Survey Performance Map – Based on 176 Surveys
Primary Weaknesses – lower right quadrant, areas that are important
to patients and where patients have not rated outpatient services
highly.
There are no Primary Weaknesses for quarter 4.
Secondary Strengths – upper left quadrant where patients have rated
the Trust highly but rated as less important to patients.
Q10. Do you feel you were given enough notice for this appointment?
Q8. Have you had any issues with telephone contact with the RUH
for this appointment?
Q11. Once you arrived at the hospital, was it easy to find your way to
this department or clinic?
Secondary Weaknesses – lower left quadrant - questions that
patients have rated the Trust less highly and are calculated as less
important to patients.
As there are no Primary weaknesses, responses to Question 15 are
the lowest scoring and most important question to patients shown in
this quadrant.
Q15. If you were kept waiting more than 15 minutes were you
made aware of how long you would have to wait to be
seen? 8.43% responded ‘Yes’, 11.24% responded ‘No’ and
80.34% responded ‘N/A’.
Q9. Were you given a choice of appointment times?
Q13. In the reception area, could other patients overhear what you
talked about with the receptionist?
Primary Strengths – upper right quadrant, areas that are important to
patients and where patients have rated outpatient services highly.
As in quarter 3, Q16, Q17 and Q12 continue to be the primary
strengths in quarter 4.
Q17. Do you feel you were given enough time during this
appointment to discuss your queries or concerns?
Of the 176 outpatients that completed the Survey 94.94% responded
‘Yes definitely’
‘Staff very reassuring and kind. Helped me with my anxieties’
Q12. Do you feel you were greeted promptly and courteously on arrival
for this appointment?
Q16. In your opinion, how clean is this waiting room/treatment area? 12
Quarter 4: Inpatient Carer Survey Performance Map – Based on 81 Surveys
Secondary Strengths – upper left quadrant areas where patients
have rated the Trust highly but are rated as less important to them.
Q8 has moved from a primary strength in quarter 3 to a secondary
strength in quarter 4.
Q8. Have the staff made you feel welcome on the ward?
Of the 81 carers that completed the survey 95.06% responded
‘Yes definitely’, they had been made to feel welcome.
‘So warm and welcoming. Reassuring too’
Q9. Have you been as involved as you would like with the patient's
care during their hospital stay?
Secondary Weaknesses – lower left quadrant where patients
have rated the Trust less highly and areas that are rated as less
important to patients.
Q12. Have you been involved with discharge planning for when
the patient leaves hospital ?
Q10. Do you feel the doctors take enough time to talk with you
about the patient's care?
Q11. Have the staff on the ward pro-actively approached you to
communicate with you as a carer for the patient?
Involving patients and carers in the discharge planning process is
included in the Discharge Project and with the development of the
Discharge Passport. Scoping is also underway this year to develop
a carers policy and carers passport which will be developed by
carers and recognises their contribution to the care of their loved
one.
Primary Strengths – upper right quadrant, areas that are important to
patients and where patients have rated the Trust highly.
There are no Primary strengths in quarter 4.
Primary Weaknesses – upper left quadrant where patients have rated
the Trust highly but these areas are rated as less important to patients.
Q14. Have the staff talked with you to explain about the patient's
medication, including potential side effects? 4.94% responded ‘Yes,
completely’, 2.47% ‘Yes, to some extent’, 3.7% ‘No’ , 88.89% ‘Don’t
know’.
There are no comments to support this percentage and it is uncertain
whether it indicates that the carer has not been talked to yet or if the
carer has selected this response to represent not applicable.
13
Same-sex accommodation
(123 ratings)
Quarter 4: Patient and Carer Experience Report – NHS Choices and Patient Opinion Websites
NHS Choices website reviews from patients and their carers (Patient Opinion covers the same reviews as posted on NHS Choices)
During quarter 4, 14 patients provided feedback about RUH services, received during January, February and March 2016, through NHS
Choices reviews and ratings:
Ten of the 12, who rated the hospital using the star system, rated it as the top five stars – of these five were in reference to the Emergency
Department – and one each regarding Oncology, ENT, SAU, Maternity and Pulteney Ward.
Of the ten five star rated comments eight were regarding staff attitude and behaviour and two about the care and treatment provided:
The patient and staff interface was really exceptional and I would say way above expectations in such a busy environment, and it
was busy. Thank you. (ED Patient)
Although working under immense pressure, they (both doctors and support staff) remained positive, cheerful, calm and caring and
a credit to their profession. (ED Patient)
Every single person who looked after me were totally profession, caring, explained what was happening and were reassuring. I
cannot thank everyone enough for their support. (RUH Patient)
Of the four ratings below five stars: two had not rated as the comments had been pulled through from Patient Opinion Website and two
reviewers had rated the Trust with one star. Of these two: on reading one comment it was an extremely positive review and it is possible this
was rated incorrectly, the other comment referred to a patient’s observations of the Emergency Department, although there was no negative
comment about their own treatment, which they referred to as adequate.
Based on 156 ratings for this hospital (snapshot as of 25/04/2016)
Cleanliness
(150 ratings)
Staff co-operation
(153 ratings)
Dignity and respect
(155 ratings)
Involvement in decisions
(152 ratings)
14
Quarter 4: Patient and Carer Experience activities across the Trust
T)F
Friends and Family Test (FF Friends and Family Test (FFT) T)
National Spotlight on Friends and Family Test week at the RUH
During 14th – 18th March the Trust took part in the National Friends and
Family Test (FFT) spotlight week. The Patient Experience Team hosted
an information stand outside the Lansdown restaurant to raise
awareness of FFT with patients, visitors and staff and to collect
comments about their experiences of the RUH:
I was looked after so well in the Gynaecology Department. I would
recommend this department to everyone.
Staff are helpful and kind. Thank you for looking after me.
Urology Outpatients rock! Very good team.
Lansdown restaurant first class.
Excellent staff.
Fabulous staff doing
fabulous work. Thank you.
The staff always make me
feel special.
X-ray porters are excellent.
Celebrating what patients tell us about our staff through the
Friends and Family Test (FFT)
Posters were developed for the National FFT spotlight week to
identify the overwhelmingly positive words that patients are using to
describe RUH staff when providing feedback through FFT.
These words were used to design positive presentation posters for
wards, outpatient departments (Specialty), maternity services and
the emergency department. Matrons presented the posters to staff to
celebrate the work that staff do and the benefits it has on a positive
patient experience.
15
Quarter 4: Patient and Carer Experience activities across the Trust
T)F
Friends and Family Test (FF Friends and Family Test (FFT) T)
Patient Experience Matters
The Patient Experience Team have produced posters for inpatient wards, outpatient departments, the emergency department and maternity
services; these are displayed in appropriate areas for patients and staff to access them. They communicate what patients are telling the Trust
about what is positive about their experiences, what they suggest the Trust could improve and what the Trust has done to improve services in
response to patient experience feedback. This will be repeated every quarter.
16
Quarter 4 Complaints Report – numbers received
17
Formal complaints received in Q4, 2015/16
In Q4 the Trust received 66 formal complaints:
30 (45%) Medical Division
25 (38%) Surgical Division
11 (17%) Women and Children’s Division
Number of complaints by Quarter/Year
The average per month for the rolling year is 25.
There was an increase in the number of complaints in January.
2 relate to care given in 2012 and 15 to care given between
October and December 2015. The rest relate to care given in
January 2016.
Year Q1 Q2 Q3 Q4 Total
2012/13 87 74 91 120 372
2013/14 110 117 97 61 385
2014/15 86 81 75 68 310
2015/16 100 82 55 66 303
10
20
30
40
Nu
mb
er
of
com
pla
ints
Total number of complaints received
Number of complaints received Trendline
Of the 29 complaints received in January, 14 relate to care
given in December and January 2016. 13 of these relate to
events on days when the hospital was in black escalation.
The table above shows there is no significant change in the number
of formal complaints received in Q4 compared to the same quarter in
2014/15. Although there is a 20% increase between Q3 and Q4 in
2015/16, the overall number of complaints for the year has remained
stable.
Complaint by subject
18
Complaints by subject
The table below details the subject of formal complaints in Q4.
The following tables provide a further breakdown of the above
complaint subjects.
Complaints- Subjects Number
All aspects of clinical treatment 39
Communication/information to patients
(written and oral) 10
Attitude of staff 7
Admissions, discharge and transfer arrangements 5
Appointments, delay/cancellation (out-patient) 3
Personal records 2
Total 66
All aspects of clinical treatment Q4 Number
Inappropriate care and treatment 20
General enquiry - clinical care 12
Co-ordination of medical treatment 2
End of life care concerns 2
Competence/knowledge of staff 1
Error in performing a procedure on patient 1
Invasive procedure carried out 1
Total 39
Communication /Information to patients Number
Lack of a clear explanation 3
Inappropriate/inaccurate/incomplete correspondence 2
Inappropriate/Insensitive communication/attitude 2
General Enquiry - Communication 2
Safeguarding procedure/concerns 1
Total 10
Admissions, discharge and transfer arrangements Number
Cancellation of admission 1
Delay in discharge 1
Inappropriate/Insensitive communication/attitude 1
Inappropriate/unsafe Discharge 1
Misunderstanding 1
Total 5
Personal records Number
Data protection breach/confidentiality breach 1
Inappropriate/inaccurate/incomplete correspondence 1
Total 2
Complaints Report – Complaint by subject and response rate
19
Division Number
Medical 5
Surgical 22
Women & children 10
Total closed eligible for 25 day target 37
It is disappointing that of the 37 complaints detailed above, 5 (13%) of
the 37 were responded to within the timeframe. 13 (35%) were
responded to between 0-30 days and 24 (65%) between 0-40 days.
The remainder exceeded 40 days.
Work is continuing with the Divisions to identify the causes of delays
and to improve performance against the target using tracking and
weekly Datix reports.
Attitude of Staff Number
Staff attitude 5
Disinterested/uncaring 1
Inappropriate/unsafe Discharge 1
Total 7
Appointments, delay / cancellation Number
Appointment information, date, time, location 1
Length of time for new appointment 1
Misunderstanding 1
Total 3
Complaint by subject continued
Where patients/carers have made a formal complaint, if the response
is delayed, contact is made by the Division and a later date for the
response is agreed. The tables opposite show the response both
within a 25 and 40 day timescale.
Responses within agreed deadlines Q4
50 complaints were closed in Q4.
39 were considered as Grade 2.
Grade 2 complaints are subject to a local target response of 25
working days. Complaints where the response is delayed due to
waiting for information from other organisations and resolution via
meetings are excluded (2). Therefore, 37 complaints were subject
to the 25 working day target this quarter. This is shown in the table
below.
Complaints Report – Complaint by subject and Response rate
0
1
2
3
4
5
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
De
c-1
5
Jan
-16
Feb
-16
Mar
-16
Re-opened complaints for the past twelve months
Total number of re-opened complaints
Number of re-opened formedicine
Number of re-opened forsurgery
Number of re-opened forWomen & Children
Reopened complaints in Q4 2015/16
Ten complaints were reopened in Q4 2015/16; 4 for the Medical
Division, 2 for the Surgical Division and 4 for the Women and
Children’s Division. Q3 and Q4 saw an increase in the number of
reopened complaints compared to Q1 and Q2. The cases have been
reviewed. On initial review, patients/carers presented further
questions linked to their original concern or they disagreed with the
response and accepted the offer to meet.
0
5
10
15
20
25
30
35
40
45
Surgery Medicine Women & children
Per
cen
tage
wit
hin
25
day
s
Division
Within 25 working days grade 2 complaints %
Within 25working daysgrade 2complaints %
Total: Surgery: 0 Medicine: 2 Women & Children: 3
54565860626466687072
Surgery Medicine Women &childrenP
erce
nta
ge w
ith
in 4
0 d
ays
Division
Within 40 working days grade 2 complaints %
Within 40 working daysgrade 2 complaints %
Total: Surgery: 14 Medicine: 3 Women & Children: 7
20 20
Quarter 4: Learning and service improvement from complaints/PALS/FFT feedback
21
Issue Division Lessons learned
Patient anxious and requested an elective caesarean
section however this was declined. Patient felt that
the doctor lacked compassion and emotional
empathy.
Women
and
Children
Concerns were discussed as part of teaching and appraisal process to
ensure similar situations do not occur in the future for other expectant
mothers.
Unacceptable wait for operation which was then
cancelled and a further long wait for rebook.
Women
and
Children
Initial communication was identified as causing the issues raised.
Apology given and appointment expedited. Explanation given to the
patient who was satisfied with the outcome.
Maternity patient went home with catheter and no
advice on its management/care was given and the
patient experienced problems.
Women
and
Children
Equipment starter packs now available so that all women going home
with a catheter will have the correct equipment and advice.
Delays reported by parents in the Paediatric
Assessment Unit waiting for their children to be seen.
Women
and
Children
Measures to improve patient flow include – review working patterns
and availability of medical and nursing staff to improve communication
between staff. The team have developed a nurse-led discharge
proforma and an information leaflet for parents.
A parent raised a concern that breast-feeding mums
were missing meals on the Neonatal Intensive Care
Unit (NICU)
Women
and
Children
Staff now offer meals to mums with babies on NICU
Quarter 4: Learning and service improvement (continued)
22
Issue Division Lessons learned
Patient had suffered a fracture. Family concerned
that discharge occurred without rehabilitation and
there was no attention made to the patients ongoing
medical needs. Patient subsequently fell at home.
Medical
Division
Appropriate assessments had been carried out. It was identified
that the communication with the family regarding discharge
expectations and ongoing management could have been more
comprehensive. This was discussed with the ward team.
Relative was unhappy that they had not been
informed of the patient’s arrival and subsequent
transfer from the Emergency Department to a ward.
Medical
Division
A project is being undertaken by a senior nurse to ensure that
current procedures are strengthened and nursing/medical staff
are asked the question on Millennium ‘whether relatives have
been informed’.
Patients not always aware whether our menu
options contain gluten.
Corporate Updated food labels to include the nationally recognised gluten-
free sign to help people recognise gluten free food.
Parent unhappy about the dental treatment her son
received.
Surgical
Division
Head of service has ensured that all staff are made aware of the
importance of providing realistic timescales regarding the length
of anaesthetic and return to ward, and that all the relevant
information is given to the patient or their relative at the point of
discharge.
Complaints Report Q4 – Complaint subject
23
Quarter 4 Complaints by ward/area
The table opposite shows the ward areas for the complaints
received in Q4. It should be noted that the complaint is
allocated to the location of the patient at the time of the
incident and may not be specifically about the care given in
that area.
Outpatient service complaints
27% (18) of the complaints received in Q4 relate to
outpatient services. The number of complaints has
remained stable throughout 2015/16.
17% (3) related to the Medical Division, 55% (10) related to
the Surgical Division and 28% (5) related to Women and
children’s Division.
Top Subjects of Outpatient complaints
The top three subjects (15 complaints in total) for outpatient
complaints across all Divisions remains the same as quarter
2 and 3 - clinical care and concerns, communication and
information and appointments.
Ward Area Subject Number
ACE OPU Clinical Care and Concerns 2
Discrimination and Safeguarding 1
Acute Stroke Unit Clinical Care and Concerns 2
Charlotte Ward Communication and Information 1
Critical Care Services (ITU) Clinical Care and Concerns 1
Emergency Clinical Care and Concerns 1
Forrester Brown Ward Clinical Care and Concerns 2
Communication and Information 1
Haygarth Clinical Care and Concerns 2
Mary Ward Clinical Care and Concerns 2
Communication and Information 1
Medical Short Stay Communication and Information 1
Parry Ward Communication and Information 1
Philip Yeoman Ward Clinical Care and Concerns 1
Pulteney Clinical Care and Concerns 1
Communication and Information 1
Respiratory Ward Clinical Care and Concerns 1
Robin Smith Communication and Information 1
Surgical Admissions Unit Clinical Care and Concerns 1
Staff Attitude and Behaviour 1
Surgical Short Stay
Admissions/transfers/discharge procedure
(Inpatients/ED) 1
Clinical Care and Concerns 1
William Budd Ward
Admissions/transfers/discharge procedure
(Inpatients/ED) 1
Total 28
Complaints Report Q3 – Complaints in relation to activity
24
These charts show the numbers of complaints in relation to activity
per 10,000 contacts.
The complaint trend for the Surgical and the Medical Division has
decreased against activity in quarter 4.
The complaint rate in the Women and Children’s Division also
shows a decrease in the complaint rate at the end of quarter 4
compared to quarter 2.
The complaint rate in March is the lowest rate seen through 2015/16
at 2.5 per 10,000 contacts with the yearly rate high seen in April
2015 at 6.8 per 10,000 contacts.
0
5
10
15
20
25
30
22000
23000
24000
25000
26000
27000
28000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2015/2016
Medical Division - Complaints in relation to Activity (rate per 10,000 Contacts)
Medicine Complaints Medicine Activity Medicine Complaints Rate
0
5000
10000
15000
20000
25000
02468
101214
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2015/2016
Surgical Division - Complaints in relation to Activity (rate per 10,000 Contacts)
Surgical Complaints Surgery Complaints Rate Surgery Activity
9500100001050011000115001200012500
0
2
4
6
8
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2015/2016
Women's and Children's Division- Complaints in relation to Activity (rate per 10,000 Contacts)
Women & Children Complaints Women & Children Complaints Rate
Women & Children Activity
Complaints Report Q4: Parliamentary Health Service Ombudsman and Patient Survey
25
National PHSO Complaints about Acute Trusts Q3 2015/16
In Q3 the PHSO received 2621 new complaints about NHS acute Trusts in England. This compares to 2658 received by the PHSO in Q2.
In Q3 804 of the complaints received were assessed and 331 of these were passed to stage 3 for formal investigation,
48% of the complaints investigated were upheld in Q3. Comparison of complaint numbers between Trusts should be treated with caution as the
activity levels of Trusts have not been taken into account.
The table below shows PHSO investigations for Q3 2015/16 for the RUH and other local Trusts. The PHSO have
confirmed that there were 2 complaints fully or partially upheld in 2015/16. They are to amend their records.
Acute Trust Complaints received by PHSO
Complaints PHSO accepted for investigation
Investigations fully or partially upheld
Investigations not upheld
Q3
20
14-1
5
Q4 2
014-1
5
Q1
20
15-1
6
Q2
20
15-1
6
Q3
20
15-1
6
Q3
20
14-1
5
Q4
20
14-1
5
Q1
20
15-1
6
Q2
20
15-1
6
Q3
20
15-1
6
Q3
20
14-1
5
Q4
20
14-1
5
Q1
20
15-1
6
Q2
20
15-1
6
Q3
20
15-1
6
Q3
20
14-1
5
Q4
20
14-1
5
Q1
20
15-1
6
Q2
20
15-1
6
Q3
20
15-1
6
Royal United Hospitals Bath NHS Foundation Trust 9 4 7 7 6 3 2 2 0 2 0 1 0 1 3 2 0 1 2 0
Salisbury NHS Foundation Trust 6 5 4 3 3 3 1 1 1 0 1 1 1 0 0 1 1 1 1 0
Taunton and Somerset NHS Foundation Trust 3 9 6 2 9 0 2 1 0 2 1 0 0 0 1 1 0 0 1 1
Weston Area Health NHS Trust 10 4 4 4 8 3 2 1 2 0 0 0 1 0 1 0 1 1 0 1
Yeovil District Hospital NHS Foundation Trust 2 3 2 0 4 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0
Complaints Report Q4: Parliamentary Health Service Ombudsman and Patient Survey
Investigations by the Parliamentary and Health Service
Ombudsman (PHSO) in Q4, 2015/16 for RUH
The Trust has 10 cases open with the PHSO at present.
2 cases remain open from Q3 2015/16.
8 new cases were opened in Q4 2015/16.
Of the 8 new cases, 1 relates to several episodes of care the
patient received between 2011 and 2014; 1 to care given in 2012;
1 to care given in 2013 and 5 to care given in 2015. 4 of the new
cases have been brought by relatives of patients regarding care
and treatment options that they feel had a negative impact on the
patient’s outcome. These 4 cases have been passed to the
relevant team for review.
Quarter Complaints
received
Accepted for
Investigation
Partially or
fully upheld
Not
upheld
Q3 2014-15 9 3 0 2
Q4 2014-15 4 2 1 0
Q1 2015-16 7 2 0 1
Q2 2015-16 7 0 1 2
Q3 2015-16 6 2 3 0
PHSO Q3 Summary for RUH
The table opposite shows the number of complaints received by the
PHSO, numbers investigated and the conclusions reached.
It should be noted that three phases reported (received, investigated
and concluded) may not relate to the same quarter, due to the length of
time taken to investigate each complaint.
Complaint Survey of patients and families who have had
cause to complain
Thirty complaint surveys were sent out in quarter 4 to
patients/carers who made a complaint and had received as
response within this period. 6 responses have been received to
date.
4 (66%) were either satisfied or very satisfied with how their
complaint was handled. 1 did not provide a response and 1 was
very dissatisfied at the delay in receiving their response, although
they acknowledged being kept informed of the delay. Timeliness
of responses is being addressed with the Divisions.
26