Most patients believe complaining about their care will not make a difference, but taking patient feedback seriously is essential in a post-Mid Staffordshire world, says Bernie Cuthel of Liverpool Community Health Trust
Transparency, honesty and courage are vital ingredients in creating a culture that listens and responds to patients’ views. Here at Liverpool Community Health NHS Trust, we are determined to deliver on our promise to put patients’ experiences at the heart of our progress and to learn from mistakes we make.
Earlier this year, the NHS Ombudsman claimed NHS leaders are failing to listen to and learn from patient complaints. It added that the Mid Staffordshire scandal was not an isolated case: over 64 per cent of patients did not believe complaining could make a difference.
This is clearly wrong, but “acceptance of the unacceptable” has become the norm among some NHS boards and it is behaviour we must challenge.
‘Engagement activities include monthly “Breakfast with Bernie” meetings, where frontline staff can discuss with me any issues they have’
For meaningful change to take place across any organisation, the lead has to come from the top, which is why two years ago we decided to improve our direct contact with the people we serve and we now invite patients to join our board meetings to share with us their personal stories.
Furthermore, as board papers are public documents, patient feedback is now readily available to everyone. This quite rightly places the onus on the board to ensure complaints are effectively tackled.
Leaving the comfort zone
The decision to put board members in contact with patients was at times uncomfortable and a challenge to the usual closed door scenario with which we are all more familiar. But we were prepared to accept this in order to truly understand our patients’ experiences and listen to their stories.
These experiences are often harrowing to hear, but this is the point: you have to listen to understand their experiences before you can act effectively, as a board, to improve outcomes for people in our care.
‘Measures include going back to the floor and speaking with staff and patients to see if progress reports presented at board meetings are being realised’
Effective processes and systems were put in place to ensure we meaningfully resolved these complaints by identifying to patients and staff the problem, solution and progress being made. This has involved a series of regular staff and patient engagement activities.
These include monthly ‘Breakfast with Bernie’ meetings, where frontline staff can discuss with me any issues they have and question how the board is meeting current and potential challenges.
Other measures include going back to the floor and speaking with staff and patients to see if progress reports presented at board meetings are being realised. It is also to check if there are any blocks in the system preventing tangible change from taking place.
We now also publish feedback from board member visits to services. This feedback includes details of any concerns and the views of staff and patients. It also provides the board with key information about improvements or actions required, as well as positive observations and insights.
Remarkable work to tackle pressure ulcers is one example of how improving board behaviour is leading to real results for patients, with the trust bucking the national trend in this area. In 2012-13, there were four recorded cases of grade 4 community acquired and avoidable pressure ulcers, which is a reduction of 64 per cent compared to the 11 cases recorded in 2011-12.
It takes a great deal of courage for patients to tell us about occasions when we might have failed them. Having an open and transparent relationship is key to tackling what the health ombudsman, Dame Julie Mellor, rightly refers to as a “defensive” response when many boards are confronted with service failure.
Bernie Cuthel is chief executive at Liverpool Community Health Trust