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Improvements to services following a complaint to an advocate

The advocacy service promotes complaints as being important consumer feedback that provides an opportunity for learning and quality improvement.

The following changes have been made by providers as a result of a complaint being made to an advocate about their service:

DHBs

Dental

Disability

Maternity

Mental health and addictions

Private health services

Residential

DHBs

• A DHB has undertaken to improve communication between surgical and medical teams when a surgical patient becomes medically unwell. In addition, a review of the communication pathway for house officers seeking support and advice from others is being undertaken. House officers will also receive improved training as part of their orientation about the pathway.
• A hospital emergency department has acknowledged a need to have an on call social worker available during weekends and is implementing this as a result of a complaint
• A public hospital is developing an information leaflet for parents/ caregivers with advice about hip spica removal and encouragement of mobility.
• Following an investigation of a complaint about a lost test result, a DHB department identified a process error which has been removed. The booking and scheduling section also reviewed how information is currently distributed within and between internal and external services. They are also looking for an electronic solution to replace the current manual process so all patient test results are sent directly to their general practitioners. 
• A different DHB developed new protocols for the public and private referral process. One of the consumers (there were two complaints) has been invited to be on a new DHB Consumer Advisory Group. 
• A complaint about consumers in a hospital missing out on meals unless there were family members or friends visiting those who could not feed themselves, resulted in a formal check that every one has been fed and organising help for those who require feeding.  
• The Client Engagement Facilitator of one service has undertaken to meet with the clinical team monthly for ongoing education on the five themes outlined in a consumer's complaint. 
• A public hospital has implemented a bedside handover pilot in two wards that includes input from consumers and increases the transparency of their service.
• A DHB has improved signage about the after hour services. They have also started to advertise how to access after hours services on a regular basis.
• A DHB has changed its forms in ED to show the time a consumer presents rather than the time at which they were triaged.
• A throw away comment made by a surgeon about not knowing what an instrument in a surgical pack was for was overheard by a consumer. As a result of the consumer expressing concern, a review of the packs was carried. The review revealed the particular instrument is rarely used so it has been removed from all standard packs.
• Another DHB surgeon has implemented a system where post surgery instructions are printed and available immediately after the surgery instead of handwritten notes. A sticker is also placed on the consumer's file. The DHB is currently investigating how to implement this system across all the DHB's surgical departments. 
• A DHB has changed the procedure for consumers requiring level 3 plus steroid injection procedures which are now to be performed in the surgical unit.
• A hospital agreed to use a complainant's experience as part of the communication quality improvement training programme
• Changes were made to anaesthetic processes following a consumer complaint about the equipment not functioning properly.
• The importance of acknowledging any pain and/or discomfort during a procedure, so the consumer feels listened to and knows that the provider is aware of their situation, was discussed at a staff meeting following a complaint.
• A consumer complained about having her bladder nicked during surgery. It was discovered that the pre-op checklist did not have a box to tick that a consumer's bladder had been emptied. The form was revised following the complaint. 
• A consumer's complaint resulted in a number of changes at a District Health Board Hospital: A "stroke information pack" has been developed with a strong focus on information for Maori patients who have suffered from a stroke or TIA. This includes information about local support services as well as where to locate relevant brochures and information for families on after care and management. The hospital chaplain has changed his practices to ensure he checks with all room occupants present, prior to performing any spiritual activities.
• Staff from a DHB gynaecology service attending a resolution meeting acknowledged the importance of providing sufficient information for women to make an informed decision regarding treatment options. As an outcome of the meeting, they are developing a more comprehensive information pack for women to refer to following a gynaecology consultation.
• As a result of a complaint where a patient was left off a booking list a DHB Transport Service has advised that changes have been made to their manual booking system. As an extra safeguard, the Duty Managers now have access to the travel bookings database
• Following a complaint from a consumer, a nurse team leader reminded staff and included a notation in the ward communication book that all requirements from multidisciplinary teams are to be adhered to prior to discharge. 
• Accident & Emergency Staff were reminded to keep consumers informed of delays at all times.
• As a result of a complaint a DHB assured the consumer they would instruct staff to complete a new pre-assessment form for each surgical admission. The complaint revealed staff had used a form completed for a previous admission which contained out-of-date information.
• A complaint about a significant communication issue was resolved at a meeting with DHB staff.  The DHB agreed to provide communication training and support to a physiotherapist. In addition,  the senior specialist involved has put new systems in place to prevent any future misunderstandings between himself and the rostered house surgeon.

Dental

• One dentist has changed his practice to prescribe antiseptic mouthwashes and/or antibiotics for consumers who show signs of infection prior to surgery.

Disability

• A disability provider undertook to make regular checks of hours not provided to clients by coordinators checking the payroll reporting system. They will then seek an explanation about why these hours have not been provided so they can follow up appropriately with the client and the NASC. In addition, they will train their monitors to ensure a client fully understands the hours they are entitled to. They will also work with the client and family (where indicated) to determine the best way to deliver these hours on the support plan.
• The manager of a taxi company who specialize in transporting people in wheelchairs, took a staff member to the consumer's home after a complaint about the staff member refusing to transport the consumer in the manner the consumer needed.  This proved to be an effective way to help the staff member understand the need to listen to what consumers say works best for them.
• A service provider reviewed and changed their van runs following a complaint from a resident that she was driven around for an hour before going to her day centre - to fit in with the night staff going off duty.  The van runs now fit with consumers' requirements.
• As a result of a complaint, a home support agency made changes to their communication processes.
• General Practice + community-based services
• A complaint about a general practitioner has resulted in discussions with the general practitioner, the PHO, a DHB and Language Line to highlight situations where a face-to-face interpreter is most important for a consumer. 
• A prompt card with relevant questions is being developed for people who take children to see a GP.
• Another provider is reviewing the written information they supply to consumers about fee structures so it is clear and not ambiguous.
• A provider agreed to remind the clinical staff about the appropriate paediatric specialty referral pathway and timeframe standards. 
• Changes were made to a health centre policy so consumers referred to palliative care will be seen either by a palliative care doctor or the district nursing team.
• A complaint about the difficulty of using the Language Line phone service with a non English-speaking consumer and a doctor with English as a second language resulted in the doctor successfully negotiating with the PHO for funding to be available for the medical centre to bring in an interpreter when necessary. 
• Another complaint about a general practitioner resulted in discussions between the general practitioner, PHO, DHB and Language Line to ensure interpreters can be easily accessed when required by a consumer.
• Lab Tests agreed to update the specimen collection guide to avoid confusion between the test form and the specimen collection guide.
• A medical centre amended practice guidelines for repeat prescriptions.
• A medical practice developed a guideline requiring a locum doctor to seek advice and support from colleagues when unsure about treatment for a consumer.
• A pharmacy has set aside a room well away from the reception area so staff can speak in private with consumers who need an explanation about the medicines they have been prescribed. The room will also be used when it is necessary to have private discussions with consumers.
• A community laboratory reminded the staff to be courteous and to listen to patient's views rather than overruling patient knowledge. They also carried out a review of the tidiness and cleanliness of their local branches.
• A health centre has introduced a new position of Clinical Supervisor to improve the standard and quality of patient care
• A medical centre adopted a peer review structure for pain relief management of their patients. One of the centre doctors has also written a paper on the risk of pain relief leading to dependency and addiction, which he is submitting to a couple of medical journals to raise awareness of this situation.

Maternity

• A maternity service took steps to ensure that before students accompany their midwives on home visits they must phone and ask permission from the pregnant woman beforehand.  If the contact by phone is unsuccessful the student must remain in the car until permission is granted by the woman.
• A maternity service has made a number of changes following several complaints. The changes include ongoing discussions with medical staff to remind them that when a woman has a miscarriage, both parents need to be included in discussions about what happens to the baby.  Stronger analgesia (than codeine) will be charted by the obstetric team on admission or as soon as it becomes apparent that a woman is going to miscarry.  In addition, an individual nurse or midwife will be allocated to stay during the time a woman is in labour (when she is miscarrying)
• During a meeting with maternity staff it was identified there were no clear guidelines on treatment and care around wound sites following an episiotomy. As a result a pamphlet is to be produced that will be included with every information pack given out to expectant mothers.
• Parents who complained about a traumatic birth experience 5 years ago were pleased to hear that changes have already been made. To help with closure of their ongoing grieving they were delighted to be given the opportunity to write up their story for the Obstetrics Journal. 

Mental Health and Addictions

• Staff have invited consumers using planned and crisis respite services to provide feedback to inform service improvement. Since receiving a complaint, regular reflection has become a part of all supervision sessions on what can be done better.
• As a result of a complaint that involved cultural sensitivity, a mental health manager underwent cultural training and has also engaged with a cultural advisor on an ongoing basis.
• An  inpatient mental health unit has implemented an online case file so information about consumers is readily available to all unit staff.
• A DHB response to a complaint about their mental health services- included the DHB arranging for DAO staff to attend regional training to update them on their requirements and obligations as Duly Authorized Officers
• A mental health advisor at a DHB has set up a consumer group to advise on staff training
• A CADs consumer complained about the lack of any form of email communication even for non-clinical purposes such as organising appointments or confirming and cancelling them. The consumer does not have a postal address and can't afford a mobile phone. He wanted the DHB to inform him about his appointments by email. The CADs keyworker supports this approach as regular contact by email will help his recovery and help to establish a therapeutic relationship. The DHB agreed to implement an email communication system between patients and staff in the near future.

Private Health Services

• As a result of a resolution meeting to discuss a complaint, a private consultant agreed to instigate a research project within the next six months. The research is to identify adverse affects following a particular procedure that has occurred with patients attending the clinic over the last three years.

Residential

• A rest home provider is writing up a list of dairy free food for the kitchen staff to ensure that those who need dairy free meals receive them.
• A rest home group's national manager reminded all staff & GPs (nationally) of the importance of open and honest communication with families.
• One rest home agreed to make a number of changes including having one GP responsible for all care to improve continuity and responsiveness. They will also be reviewing all resident files to ensure resuscitation information is accurate, and that a certified first aider is rostered on all shifts. They will also have advocacy training on the Code as well as Effective Communication and Open Disclosure. Residents and their families are to be updated at least annually on contact details for management (more often if there are changes).
• One provider requested local hospice staff provide training for their staff to ensure terminally ill consumers receive care that is consistent with their needs. 
• After a complaint from a consumer had been resolved, the staff spoke to all residents of a rest home about their choice to have meals  either in their own room or in the dining room
• A rest home is creating a "Welcome Letter" with information about staffing and medical care so short term residents are better informed about what they can expect.
• A complaint from a mother frustrated with the care a residential service was providing to her intellectually disabled son prompted a joint training session for the residential staff on strategies and coping mechanisms when working with her son. The staff will also receive ongoing refresher training on the needs of people with Autism. 
• A DHB made a written recommendation to a rest home regarding their policy on when a referral to a dietitian should occur. This followed a complaint about an inadequate response by the rest home to a resident losing a considerable amount of weight.