Hospitals too defensive over complaints

  • Date: 16 August 2013

A CULTURE of defensiveness among NHS staff and a fear of speaking out among patients is hampering improvements in care at some NHS hospitals, according to new research by the Health Service Ombudsman in England.

Three separate pieces of research were carried out by the Ombudsman in support of a Government review into how NHS hospitals deal with complaints – this in response to the Frances Report on the failings at Mid Staffordshire NHS Foundation Trust which "demonstrated the appalling consequences when hospitals do not listen to and act on the concerns of patients".

In its research the Ombudsman’s office first analysed evidence from its own cases and explored the themes underlying patients’ experiences of complaint handling. It then gathered evidence of how NHS trust boards use information from complaints to put things right and to learn. A third piece of research brought together patients, complainants, carers and NHS staff to participate in a two-day workshop on the NHS hospital complaints system.

Complainants and patients highlighted poor communication as a key issue along with a defensive culture once a complaint was made. One participant described how her complaint went back and forth for two weeks – but as soon as she threatened to raise the bar by involving the CEO or the press it was dealt with within the hour.

Key issues raised by staff included a fear of being blamed rather than acknowledged for listening and putting things right, a confusing variation in complaints procedures between hospitals, too much deference to senior colleagues on wards, and a need for more training on responding to complaints.

Suggested improvements include moving towards an open culture of feedback and improvement, adopting a fresh focus on putting things right on the ward and replacing deference and hierarchy in hospitals with a new culture of collaboration between leaders and staff to listen to concerns and improve services.

The Health Service Ombudsman, Julie Mellor, said: "There has been much said about what is wrong since Mid Staffs. But, we have now identified what can be done to make things better. This research – the first of its kind – brings together patients, carers and frontline staff in designing a new model that works for everyone. The strong message was the need for a step change in the culture from defensiveness to welcoming and seeking feedback, including concerns and complaints, to deliver continuous improvement and the best possible patient care.

"The key themes that come up again and again - those of openness, leadership and culture change – all start with the board and end at the point of delivery on the ward. There is a toxic cocktail of reluctance by patients to complain and defensiveness by hospitals in handling complaints. This means concerns and complaints are going unheard or unaddressed. Only strong leadership from boards will deliver the culture change and improvement on wards that we all agree the NHS needs."

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