You said – we did

The feedback we receive from patients, visitors, staff and members of the public is analysed to help us understand what we do well and where we can improve.

We are always keen to improve the care that we provide. We have given some examples below of the feedback we have received and how it has been used to make changes.

Here we talk about some of the lessons we have learned from complaints received from either patients or their relatives.

You can see the three steps we took to change things following complaints.

• You said
• Key points from investigation
• We did

You said…

Good communication with patients and carers is essential throughout a patient’s care. Personal and sensitive information and advice must be communicated in the right manner and tone to minimise stress. This helps to ensure patients and carers understand what is being said to them.

Privacy is very important. Our staff are reminded that dignity and respect is to be maintained for patients at all times, including during discussions.

The communication between staff, departments, GPs and other hospitals can also be an issue. It can cause delays in arranging transfers and appointments, omissions in care or medication, and distress or potential harm to the patients involved.

Good communication before, during and after a patient’s discharge from hospital is crucial. It can prevent readmissions and complaints when communication breaks down between hospitals, GPs, community staff or carers.

Key points from investigation

Common themes raised by patients and relatives around communications issues include:

• discussion of sensitive information on wards with little or no comfort or privacy
• a perceived lack of empathy and/or compassion when speaking to patients and relatives
• use of medical terminology or NHS jargon, and complex explanations about conditions and treatments
• issues arising from poor communication at handover between shifts or teams
• failure to fully explain complications at the time
• need for improved documentation of medication, observations and discussions to ensure smooth transition at handover
• clarity over who to contact if concerns arise once patients leave hospital
• failure to clearly document within medical and nursing records.

We did

We carried out a range of activities to improve communication in our hospitals, including:

• ensuring routine checks are made, helping to prevent any lapses in communication
• training and professional development of staff in the Trust’s values and core behaviours
• discussion and review of how a breakdown in communication arose with all the members of staff involved
• sharing best practice communication with other staff members on wards to avoid future communication breakdowns
• reinforcing the need for effective and professional communication with family members at all times
• improvement in handover communications (between healthcare professionals) to make key staff aware of concerns raised by patients or relatives
• need to manage patient and carer expectations through improved communication from an early stage
• test patients’ understanding of communication, and provide written information if appropriate.

You said…

Appointments for many patients can be a stressful experience, juggling home and work-life to attend. Consequently, any errors or changes to appointment times can be upsetting and difficult to deal with. Sometimes, this can trigger a complaint.

Some people can travel long distances, or attend appointments on a regular basis. This can mean large investments in patient time and money, often with special arrangements being made for them to attend. Because of this, we must ensure the accuracy of appointments we make, and that we effectively communicate when changes need to be made.

Patient expectations are raised when optimistic waiting times are given for treatments and procedures, and it is far better for staff to be realistic in these cases.

Key points from investigation

Common themes raised by patients/relatives around appointments, include:

• administrative errors including the address of patients, and the date, time and location of appointment
• verbal miscommunication of appointments with no written correspondence to confirm
• poor communication between hospitals caring for the same patient
• ineffective communication of changes made to the initial appointment notification
• optimistic waiting times given for treatments and procedures
• delays to appointments resulting in long waiting times
• missing case notes
• appointment slots moved and then later cancelled
• delays caused by staff illness or machinery maintenance, and no apparent contingency plan.

We did

In response to patient complaints around appointments, we carried out improvements including:

• updating medical staff more frequently about waiting times
• departments to monitor and audit the time it takes to allocate appointments from receiving the request, and to escalate to senior managers where problems occur
• all outpatient clinic staff to keep patients informed and provide explanations for delays
• sharing best-practice communication with other staff members on the ward to avoid problems occurring again
• review of the communication process for rescheduling patient appointments
• provide extra capacity to reduce waiting times
• manage patient and carer expectations by communicating accurate waiting times
• informing patients about hospital or clinic delays or problems, when patients arrive.

You said…

When communicating with patients, the attitude of some staff can sometimes be seen as dismissive or argumentative. This may be when trying to diagnose or explain complex and sensitive information about a patient’s care and treatment. This could also occur if staff are under strain due to workload, or they are having difficulties in explaining to the patient or relative, or due to an unintended misunderstanding.

A failure to communicate effectively and at the right time about care/discharge plans when asked to do so, or to keep patients and relatives informed during the patient’s stay in hospital, can cause distress to patients and is a prime reason for complaints.

Key points from investigation

Common themes raised by patients/relatives about the attitude of staff include:

• a lack of empathy and/or compassion when speaking to patients/relatives
• complex explanations and use of medical terminology or NHS jargon
• failure to seek advice from senior staff if difficulties arise
• issues arising from poor communication at handover between shifts or teams
• failure to explain complications at the time
• failure to provide early responses to requests for informal meetings or explanations from medical staff, from patients/carer when concerns first arise
• poor in-care bedside manner, and appearing brusque or lacking compassion.

We did

In response to patients comments around the attitude of staff, we carried out actions, including:

• staff training and professional development to be aligned to Newcastle Hospitals’ core values and behaviours
• discussion and review of cases with all members of staff involved to promote individual learning
• sharing best practice with other staff members on wards to avoid incidents reoccurring
• reinforce with all staff the need for effective and professional standards of communication with family members
• improvements in handover communications between healthcare staff, to make key staff aware of treatment considerations and concerns raised by patients/relatives
• the need for junior doctors and nursing staff to know when to seek assistance from senior staff
• the need to manage patient expectations through improved communications at an early stage in their care.