Learn And Share Lessons From Complaints Says Medical Defence Union

Main Category: Litigation / Medical Malpractice
Also Included In: Public Health
Article Date: 10 Oct 2008 - 3:00 PDT

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As the National Audit Office publishes its report on complaints handling1 today, highlighting a lack of learning from complaints, the Medical Defence Union, the UK's largest provider of insurance indemnity to doctors, stresses the importance of setting up a system to learn from significant events, including complaints, and sharing this knowledge with others.

Dr Michael Devlin, an MDU medico-legal adviser said: "In 2007, the MDU was asked to help with over 3,300 patient complaints by our medical and dental members. Some complaints were unjustified, others were the result of human error which led to an adverse outcome, but the majority were made as a consequence of a system failure such as the inadvertent filing of blood results that had not been acted upon. We entirely agree with the NAO's recommendation, and usually advise our members, to use complaints as an opportunity to identify underlying system problems and seek to resolve them.

"Patients and their representatives often say that their motivation in making a complaint is to find out what went wrong and they would like an apology. Equally important, they seek assurances that steps have been put in place to stop the same thing happening again. We recommend to all members that they log all significant events, including complaints, and have a system in place to ensure they are thoroughly investigated and that lessons are learnt and, if appropriate, systems or practice are altered accordingly. This will also include follow up to ensure that any changes put in place have had the desired effect. furthering addition, if practices are willing to share what they have learned with their colleagues in neighbouring practices, they may also be able to adapt their own procedures and to avoid similar problems arising themselves.

"The new NHS complaints procedure planned for April 2009, will place greater emphasis on local resolution. It is already clear that those involved in responding to complaints will be expected to involve the complainant throughout the process, work within existing clinical governance procedures and demonstrate any improvements which have resulted. Such an approach is not new: the MDU has for many years advised members to consider patient complaints as significant events that need to be investigated and acted upon. "

Among the key points of this advice are:

- Where a complaint has been received this should be recorded in writing and acknowledged by the designated complaints manager within three working days in primary care (two days in NHS bodies outside primary care). It can also be useful to offer the complainant a meeting to discuss the concerns raised. Such meetings can occasionally benefit from the presence of a conciliator.

- One person should be given responsibility for clinical governance and initiating action following any adverse incident. Their duties could include checking adverse incident reports are complete, documenting the action to be taken and providing feedback to staff and implementing training where necessary.

- Investigations should look beyond human error in order to identify and eliminate risks that could lead to a recurrence. For more serious incidents, you may decide to hold a meeting to discuss the issues in greater detail where all staff can contribute. Ensure a record is kept of the meeting and agree a date to follow up any action points.

- Provide a full, detailed and positive response to a complainant within ten working days of receipt in primary care (25 days in outside primary care and usually by the chief executive or complaints manager). This should ideally include an account of what happened, and apology where appropriate and an explanation of any steps which have been put in place to prevent a repeat of the problem.

- Report adverse incidents to the National Patient Safety Agency's (NPSA) National Reporting and Learning System (NRLS) which aims to collate reports nationally and introduce guidance and preventative measures so that others can benefit.

1 Feeding Back? Learning from complaints handling in Health and Social Care, National Audit Office, 10 October 2008

The MDU is a mutual, not for profit, organisation owned by our members who include over 50 per cent of the UK's hospital doctors and GPs. Established in 1885, we were the world's first medical defence organisation. We defend the professional reputations of our members when their clinical performance is called into question. Our benefits of membership include insurance for claims of clinical negligence and a wide range of medico-legal advisory services.

The MDU