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ANNUAL REPORT 2013 Adjudicating Complaints for the Independent Healthcare Sector

Learning from Complaints During 2012-2013 Sally Williams, Adjudicator

An important and valued outcome of the complaints handling process is taking action to improve services and prevent the same problems happening again. Whenever an independent adjudicator reaches a decision on a complaint, they send a decision letter to the complainant and copy this to the ISCAS member the complaint was about.

The letter to the ISCAS member usually contains advice on how the organisation could improve its complaints handling. Often ISCAS members are asked to report back to ISCAS about actions they are taking as a consequence of this advice. In this way, independent adjudication seeks to be part of a circle of learning from complaints.

Where themes arise in the advice given to ISCAS members about specific complaints, these are shared with all ISCAS members through the Adjudicator’s Monthly Message (this can be found at in the news section). Over the last year the monthly message has touched upon a broad range of issues. These include the thorny issue of complaints and clinical negligence. It is not uncommon for complaints to reach the adjudicator that stray into the field of clinical negligence, however ISCAS members often express uncertainty over whether the complaints procedures can continue where a complaint appears to have arisen as a result of possible clinical negligence and compensation is sought. The new ISCAS Code, published in June 2013, seeks to be clearer on this point and reflects practice in NHS complaints handling. It states: ‘Even if independent advice is being sought about possible clinical negligence the ISCAS Code recommends that the complaints procedure and ultimately stage 3 adjudication is continued.’

Other themes from the year include the following:

1. Handling complaints received by email, including establishing a clear process for managing email interactions with complainants. This includes introducing timeframes that remove the pressure to give an immediate and, sometimes less considered, response and implementing a single database to log emails from the complainant and any organisational responses.

2. Demonstrating caution about what is contained in emails about complaints, which comprise an increasing proportion of complaints files and are potentially disclosable under the Data Protection Act. The informality of email can lure users into disregarding rules about confidentiality and the transfer of sensitive information. In reality, the risk of confidentiality breaches of personal information is much greater.

3. Ensuring that protocols governing the storage of patient records are adhered to by consultants with practising privileges and that information sharing happens to support complaints handling. Missing records make it much harder to establish the facts of a case and can create suspicion of a cover-up. Gaps often occur around consultant’s clinical notes or photographs and imaging taken by consultants.

4. The use of experts to advise on the clinical aspects of complaints, including the importance of independence and the absence of any conflict of interest, having a clear documentation trail, and transparency over the identity of the expert and the opinion they provide.

5. Managing complaints that involve third parties, such as clinical negligence lawyers or a professional regulatory body, including whether there are elements of the complaint that the organisation should answer regardless of whether other parties are involved, what purpose will be served by halting a complaints process while third party investigations take place, and how the interests of the complainant and those complained about are best served.

6. The potential to resolve complaints more swiftly by offering to meet with complainants early on. This can be helpful in resolving complaints in a collaborative way.

7. Greater use of templates to ensure that responses to complaints routinely contain the right information.


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