Your Service Your Say

1. Your Service Your Say The Management of Service User Feedbackfor Comments, Compliments and Complaints-HSE Policy 2017 Awareness Session Presented by: Date:

2. Background to YSYS Revision Your Service Your Say is the HSE national standard procedure for managing service user feedback Ombudsman’s Report: The main barriers to giving feedback or making a complaint were identified by participants as: • A fear of repercussions for their own or their relatives’ treatment • A lack of confidence that anything would change as a result of complaining 2

3. Main changes Governance changes (Complaints Managers, CHO and HG responsibilities) Emphasis on Learning Casebooks No Wrong Door Emphasis on resolution at first point of contact Development of Complaints Management System Development of eLearning Training Tools Revised Standardised Letters and Report Template Complaints Officers must make Recommendations

4. Guiding Principles of the revised Policy

5. ‘No Wrong Door’ Approach All staff are encouraged to accept feedbackand make an attempt to assist the service user. Having a ‘No Wrong Door’ approach ensures that wherever a complaint is raised, it is the relevant staff and not the service user that is responsible for routing it to the appropriate place for response.

6. Tell a staff member. All staff are encouraged to accept feedback – no wrong door approach. • Ask a member of staff for details of where to send a letter which sets out your experience of our services. • Emailyour feedback to yoursay@hse.ie • Complete a Feedback Form and leave it in the identified areas provided by the local service you are using or visiting. You may also give it to a member of staff or ask a staff member for an address. • You can use the website feedback facility at the following address: www.hse.ie/feedback • Telephone us on: • YOURSAY Team: 1890 424 555 (Monday to Friday: 9am – 5pm). If telephoning from a mobile please contact: 045 880400, to avoid additional charges. • HSE Live Team: 1850 241 850 (Monday to Friday: 8am to 8pm, Saturday :10am – 5pm) How to provide Feedback?

7. Compliments Comments and Compliments Comments • A comment is a verbal or written remark expressing an opinion or reaction. • A compliment is an expression of praise, commendation or admiration. Learning from Positive Experiences It is recommended that good patient experience and compliments received should be promoted and reported across all services within the HSE.

8. YSYS - Support A comprehensive Guidance Manual on the revised Your Service Your Say Policy and other supporting documentation including letter and report templates is available online from www.hse.ie/yoursay Local Consumer Affairs Office can offer advice and assistance. Each CHO and Hospital Group has a Complaint Manager in place to be a champion for the feedback process though an active and visible leadership role with key involvement in education, training and reporting arrangements. Online E-Learning HSEland Modules Complaints Manager Forum

9. Other documents include

11. NEW YSYS –Learning Dual Purpose - Point of Contact Complaints Resolution & Escalation Form Point of Contact Complaints Resolution Form • To be completed by: Any staff member who has resolved a service user’s complaint at point of contact. Send to Line Manager. Point of Contact Complaint Escalation Form • To be completed by: Line Managers who are unable to resolve a complaint at the point of contact.

12. NEW YSYS - Learning, Improving and Accountability Complaints Officers Complete an anonymised learning notification form following a complaint investigation onlyin cases where learning has been identified. Send to Complaints Manager for circulation. Generate a quarterly anonymised learning summary (casebook) on the complaints investigated highlighting learning that have relevance for the wider organisation. Send to Complaints Manager for appropriate circulation and also share at the Complaints Officer Forum Review Officers Complete an anonymised learning notification form following a complaint review only in cases where learning has been identified. Send to Complaints Manager for circulation.

13. Your Service Your Say Complaints Management

14. Definition of a Complaint(Health Act 2004) “A complaint means a complaint made about any action of the Executive, or a Service Provider that, it is claimed does not accord with fair or sound administration practice, and adversely affects the person by whom, or on whose behalf, the complaint is made”. An action does not represent fair or sound administrative practice if it is: • taken without proper permission or authority, • taken for unnecessary reasons, • the result of negligence or carelessness, • based on incorrect or incomplete information, • discriminatory, • based on bad administrative practice. A complaint is an expression of dissatisfaction which needs a response

15. Who can complain? Any person who has received or sought health or personal social services from the Executive or Service Provider. If a person is entitled to make a complaint but isunable to do so because of age, illness or disability, the complaintmay be made on that person’s behalf by: • a close relative or carer of the person (parent, guardian, son, daughter or spouse or is cohabiting with the person); • any person who legally has the care of the affairs of that person; • any legal representative of the person; • any other person with the consent of the person; and • if a person who would otherwise have been entitled to make a complaint is deceased, a complaint may be made by a close relative or carer of that person.

16. How can a complaint be made? The HSE and Service Providers must be flexible in receiving feedback and allow feedback to be received in a way that suits the service user e.g. by letter, e-mail or verbally Service Users must be allowed the flexibility to lodge a complaint with any staff member…remember the ‘no wrong door’ approach.

17. Updated What is Advocacy? All complainants have a right to appoint an advocate to assist them in making their complaint and to support them in any subsequent processes in the management of that complaint. Advocates help, facilitate, negotiate, defend… Citizens Information Board defines advocacy as “a means of empowering people by supporting them to assert their views and claim their entitlements and where necessary, representing and negotiating on their behalf

18. Matters that are excluded from investigation under Part 9 of the Health Act 2004 In line with best practice, the HSE will investigate every complaint using the complaints procedure, an alternative process or refer it to the appropriate personnel. • a matter that is or has been the subject of legal proceedings before a court or tribunal • a matter relating solely to the exercise of clinical judgment • an action taken by the Executive or a service provider solely on the advice of a person exercising clinical judgment • a matter relating to recruitment or appointments • a matter relating to or affecting the terms or conditions of a contract of employment • a matter relating to the Social Welfare Act • a matter that could be the subject of an appeal under Section 60 of the Civil Registration Act 2004 • a matter that could prejudice an investigation being undertaken by An Garda Síochana • a matter that has been brought before any other complaints procedure established by law e.g. Complaints Process under Part 2 of the Disability Act 2005 However, where a matter is excluded from investigation under Part 9 of the Health Act 2004, using their knowledge Complaints Officers will identify if the complaint should be dealt with by: • using the complaints procedure, • using an alternative process; or • referring it to the appropriate personnel.

19. Time Limits for making a Complaint

20. Stage 2: General Timeframes

21. Your Service Your Say Stages of Complaints Management

22. Overview of the Four Stages of Complaints Management 22

23. Your Service Your Say Stage 1: HSE Point of Contact Resolution Stage 1 HSE Point of Contact Resolution Complaint resolution at First Point of Contact

24. Point of Contact • All HSE staff must aim to resolve complaints they receive at first point of contact, if possible. • Feedback (Comments, Compliments & Complaints) may be given to any member of staff. • If local staff are unable to deal with this feedback personally they should provide reassurance that it has been listened to, understood and then outline how this feedback will be handled beyond this point. Note: It is important to ensure that Service Users’ immediate healthcare needs are being met, as appropriate, before dealing with the issue.

25. Point of Contact HSE staff should always respond appropriately – LISTEN* approach They should acknowledge the feedback in an open and honest way demonstrating empathy and understanding. Establish what the service user expects from providing their feedback. Provide an apology/explanation where possible and avoid apportioning blame, being argumentative or defensive. Some complaints may not be appropriate, due to their nature, to handle at point of contact and may need to be referred on to a line manager, if appropriate.

26. Why Point of Contact Resolution? • Complaints are dealt with directly and quickly where the issues arise. • Little formality as possible. • Prevents issues escalating due to delays or unwillingness to address issues. • Demonstrates proactive response from the service. • Staff empowered to deal with complaints. • Saves time and resources than formal approach.

27. Remember! Don’t Forget Where a staff member has successfully resolved a complaint, at that first point of contact, they must complete a Point of Contact Complaint Resolution Form and send it to their Line Manager!

28. NEWHSELanD Module 1Effective Complaints Handling (1CEU Point)

29. Effective Communication • Listening • Empathy • Questioning • Body Language • Tone of Voice

30. Active Listening involves: Suspending your own thoughts and judgments, and giving your undivided attention to the speaker • Being motivated • Empathising with our service users • Interrupting only when appropriate • Paraphrasing and Summarising • Taking in the whole picture • Asking questions – note taking if appropriate • Using positive body language We hear with our ears but listen with our brain.

31. Empathy Put yourself in the other person’s shoes

32. Effective Questioning • Ask questions to clarify the complaint: • Ask one question at a time (avoid bombardment) • Use open questions to gather information (Tell me about…what happened, where did it happen, when did it happen…) • Use closed questions to clarify detail (so you’re saying….) • Do not be afraid to ask the same question twice • Do not use leading questions • Do not express opinions in words or attitudes • Try to separate hearsay from fact by asking interviewees how they know a particular fact

33. Body Language and Tone of Voice

34. LISTEN Approach Listen to the complainant Identifythe issues (be aware of multiple issues) and what outcome the complainant would wish to result from their complaint Summarise the issues Thank the complainant Empathise and Explain what the next step is going to be. Now Act - determine the appropriate action.

35. Listening The word LISTEN contains the same letters as the word SILENT - Alfred Brendal

36. Audio option Option here to play the audio from Module 2. The audio is available on the trainers link as a separate file This shows how a Complaints Officer manages to resolve a couple of issues informally over the phone with a complainant.

37. Making an Apology It is the policy of the HSE that where failures in the delivery of care to a Service User have been identified, these failures must be acknowledged to the Complainant/Service User and a meaningful apology provided. An apology can be made by any member of staff at any stage of the complaints management process. Written apologies are recorded on the Complaints Management System.

38. Dealing with Unreasonable Behaviour “Unreasonable complainant conduct is any behaviour by a current or former complainant which, because of its nature or frequency raises substantial health, safety, resource or equity issues for our organisation, our staff, other service users and complainants or the complainant himself/herself.” (New South Wales Ombudsman)

39. Dealing with Unreasonable Behaviour • Unreasonable Behaviours - includes extreme anger, aggression, threats or other threatening or violent conduct or calling repeatedly. • Unreasonable Persistence - persisting with their issues even though they have been dealt with to finality. Persistent ringing (e.g. numerous calls throughout the day without offering any new relevant information, calling repeatedly when already advised the person they are seeking is absent etc.). • Unreasonable Demands - insisting on outcomes that are unattainable. • Unreasonable Arguments - holding conspiracy theories unsupported by evidence, and irrationally interpreting facts or laws and refusing to accept other more reasonable interpretations.

40. Dealing with Unreasonable Behaviours Remember that while you may have been the focus of a person’s anger you are not responsible for it. Try not to take criticism/anger/aggression personally. • Listen carefully, try not to argue • Avoid laying blame or being defensive • Never reply in kind to abuse, rudeness or threats • Be respectful and helpful • Express concern • Ask the person to speak more slowly so that you can take the full details • Request the behaviour to stop • Acknowledge you have received the message. • Sit down and encourage the complainant to sit at all times while speaking with you

41. Complaints that cannot be resolved at Point of Contact

42. Complaints that cannot be resolved at Point of Contact • If it is not possible to resolve the complaint to the satisfaction of the complainant at the first point of contact, the person receiving the complaint must advise the complainant: • The reasons why the complaint cannot be resolved at the point of contact. • That they (the staff member) should escalate the complaint to their line manager, who will endeavour to resolve within (< 48 hours) 2 working days.

43. Complaints that cannot be resolved at Point of Contact If the line manager cannot resolve the complaint, they should complete a [Point of Contact Complaint Escalation Form] with the service user and escalate the matter to the relevant Complaints Officer. If requested by the Complainant, the staff member/Complaints Officer may provide assistance to the Complainant to complete a written complaint.

44. Your Service Your SayStage 2: HSE Formal Investigation Process Stage 2 HSE Formal Investigation Process Complaint Investigation by Complaints Officer

45. Stage 2 Process The Complaints Officer will: • Consider if the complaint can be resolved informally by making contact with the complainant . • Acknowledge the complaint within 5 working days of receiving the complaint. • carry out a formal investigation • may request such documents and communicate with any persons he/she reasonably believes can assist with the investigation of the complaint. • complete a report and make findings and recommendations • may not make a finding or a criticism adverse to a person without affording them the opportunity to make representations.

46. YSYS Guidance for Clinical Staff https://www.hse.ie/eng/about/qavd/complaints/ysysguidance/appendices/ysys-guidance-for-clinical-staff.html Developed in conjunction with the Office of the Ombudsman For any staff member who requires guidance around the clinical aspects of complaints under the YSYS process. Revised YSYS policy – the Clinician now signs their own Clinical Judgment report.

47. The Steps - Investigation

48. Recommendations A Complaints Officer will decide on any recommendations to be made as a result of the findings of the investigation. These recommendations to include: • Action to be taken to remove the causes of the complaint or its likelihood for re-occurrence as far as is reasonably possible where deemed necessary by the investigation. • Redress for the Complainant where deemed appropriate by the investigation.

49. The Report • Within the report the Complaints Officer should answer any questions the complainant wanted answered. There is a report template which helps the Complaint Officer to complete this report along with various template letters. • The report should detail the investigation process itself and explain how findings were made. • Send the final report to: • the complainant • the accountable officer (e.g. Head of Service) • other relevant staff/managers Within 30 working days of receiving the report the accountable officer Accountable Officer must write to the Complainant and Complaints Officer detailing their Recommendation Action Plan, and advising them of any recommendation(s) are rejected, amended or if alternative measures are being taken and set out the reasons for the decision.

50. Post Investigation • Send the final report to: • the complainant • the accountable officer (e.g. Head of Service) • other relevant staff/managers • Invite all to contact the Complaints Officer for clarification of any issues • Inform the complainant that they have a right to seek a review of the outcome of the investigation and inform them of the relevant review process. • Within 30 working days of receiving the report the accountable officer (e.g. Head of Service)must put an action plan in place for the implementation of the recommendations of the investigation. The action plan, persons responsible and timeframes are to be identified and recorded.