‘Who Ya Gonna Call?’ – Feedback & Complaints | New Aged Care Standard #6

If there's somethin' strange in the neighbourhood
Who ya gonna call? (ghostbusters)
There's somethin' weird and it don't look good
Who ya gonna call? (ghostbusters)

Okay, okay – there may be no ghosts around here, but sometimes things don’t look so good for some of our clients.

‘I feel safe and am encouraged and supported to give feedback and make complaints. I am engaged in processes to address my feedback and complaints, and appropriate action is taken.'

Complaints and feedback are the cornerstone of Continuous Quality Improvement. I mean, how do we know what and where we can improve if we don’t know what to address?

We also don’t want the clients of our services to just wait until things get totally out of hand. We really want to hear from them well before that so we can address the issue in a constructive manner, rather than being reactionary.

We want those who use our services to feel comfortable in raising issues with us – whether that be writing to us, completing surveys, or telling us face-to-face when they’re not happy about something, as well as letting us know when things go well or what they like about us, our staff or the services we provide.

But sometimes, it’s not that easy.

I know from experience as a manager, that even when I have suspected things are not as good as they could be and have encouraged clients to give feedback, people don’t always give you an honest answer. This can be due to a number of reasons.

• They don't want to be seen as a bother, or a complainer (“I should be grateful for the help I get.”)
• They don't want to get a staff member in trouble (“She has such a hard job and needs the work, maybe I’m expecting too much.”)
• They don’t want their complaint to negatively impact on necessary support (“If I complain I might not get any help at all or the support I get will be worse.”)
  

When people won’t or don’t feel they can complain, we face a real dilemma. Clients who don’t complain not only experience a less-than-satisfactory service themselves, their silence means we don’t know what to improve.

Dissatisfied, silent clients can also cause the service provider to be reflected in a poor light. These are the clients who change service providers without saying why and are the people talking to their friends and family about the ‘bad experience’ they had with the service, which is why they needed to change their provider.

So short of employing someone like Kevin (Chris Hemsworth – Ghostbusters II) to encourage people to pick up the phone and call us, how do we get people to feel comfortable about telling us when they’re not happy about things?

We ‘ain’t afraid’ of feedback.

Firstly, I think it comes down to awareness and education for everyone involved. We need to make sure that our clients and their carers and family understand that they’re part of the process of making our aged care services better. They need to see that they’re advocates of quality care and when they speak up, they make it better for all consumers.

How are you going to do this?

Educating Clients

Have you thought about about running feedback and complaints sessions as part of an activities day?

A relaxed morning tea or BBQ setting can promote open dialogue between clients, their family and service providers. You have the opportunity to help people identify what, when and how feedback and complaints can be made. This is also a good time to introduce the Aged Care Advocacy service in your area. The Advocate may even be able to attend and respond to questions from clients and their carers directly.

What information is in your client resources?

Do you outline to people their rights, including the right to complain about something that they’re not happy about or that they feel could be done better when receiving care and support, and is this information provided to them in a way they can understand?

Do you use your client handbook as a place to start the conversion around complaints and feedback when accepting a new person into your service?

Rather than just handing over the handbook or information pack and expecting people to read it at their leisure, take the opportunity to run through key sections or documents including the complaints section, highlighting advocacy services and other key phone contacts. It’s helpful to reinforce that their ‘feedback’ at any time is integral in supporting them appropriately, and understanding when things aren’t right and need to change.

How do you support people from different cultural or language groups to understand their right to provide feedback, including complaints?

Do you need to bring in cultural advisors who can help people understand better and encourage ongoing dialogue? Do you ensure that people know they are able to contact the interpreter service, or other communication support services, where they need assistance in explaining their point clearly when lodging a complaint?

And what about those people who – in the words of the Ghostbusters song – are all alone?

Sometimes, people who are socially isolated, or are living apart from regular family contact, can feel less empowered to speak up. Do you seek to connect these people to peers or other support services who can act as a sounding board when they are unsure of their rights or whether they have genuine grounds for making a complaint.

Do people understand that they can remain anonymous when making a complaint?

Of course, to do this you have to have processes in place to be able to allow people to make an anonymous complaint or suggestion for improvement. Think feedback boxes in common areas or iPad surveys in the centre. Where you have people who are unable to write down their issues, but still want to remain anonymous, ensure there is a process in place such as having access to the Aged Care Advocate or a person who operates separate to the direct supports of Aged Care such as the Community Manager in remote Indigenous communities.

Educating Staff

Of course, our staff also need to be trained in how to accept and encourage feedback from clients.

Now, I know that some staff members don’t like passing on bad news or complaints to management, perhaps thinking it reflects badly on them, but we all have a responsibility to protect people who are vulnerable. They also need to understand the idea of Continuous Quality Improvement and that a complaint is not ‘the end of the world’ but ‘the start of making something better’.

Staff also need to understand what a complaint is.

I have read a number of complaint forms and registers over the years where the staff member has noted a situation where one family member is complaining about another family member, where the issue at stake has nothing to do with the organisation, the services being delivered or the care of the client. Staff need to recognise that the complaint needs to be about the supports that are delivered by the service or an agency subcontracted to deliver identified services.

Staff also need to understand when and how to escalate different types of complaints and when this tips over to be an ‘incident’. It’s helpful to describe to staff what this is.

You might find the following points useful in deciding appropriate responses and timing for different complaints, however always follow your organisation’s policies in this area:

Simple – inconvenience or annoyance has been caused, e.g. someone was overlooked when picking up clients to go on an outing.

• Investigate what and why this happened, apologise and put in measures to minimise the risk of this re-occurring.
• Document in the client’s progress notes and in the complaints register, if a change in process arose out of this incident ensure all relevant staff are notified and document in Quality Improvement register.
• Timing – respond to client within 7 days.

Regular – this is something that has been happening frequently and/or has a greater impact on the client, e.g. meals are consistently not suitable for the client’s condition, such as renal disease or diabetes.

• Investigate what and why this happened. Meetings with external stakeholders may need to be held to develop strategies to minimise this issue from re-occurring. Apologise to client and appraise them of what is being done to address the issue.
• Document in the client’s progress notes and in the complaints register, where a change in process arose out of this incident ensure all relevant staff and stakeholders are notified and document in Quality Improvement register.
• Timing – respond to client within 3 days.

Urgent – these are serious complaints that relate to allegations of theft, physical or emotional harm, sexual abuse or other crimes, or any situation that causes significant distress or harm to the client.

• Any allegations must be reported to the authorities and the Department must be advised as soon as management becomes aware of the allegation. Management and staff will assist the authorities with any investigation.
• Document in the client’s progress notes and in the complaints register, where a change in process arose out of this incident ensure all relevant staff and stakeholders are notified and document in Quality Improvement register.
• Timing – respond immediately on becoming aware of the complaint.

Educating other Stakeholders

Just like the Ghostbusters didn’t work alone in getting the job done, neither do we. Good aged care support often includes working with other stakeholders. This means we need to develop good working relationships with other stakeholders, both with those who provide services and supports to clients and those who interact with them outside of formal care provision.

If you take the time to seek regular feedback from other stakeholders and encourage them to let you know of any concerns raised by the client or their family, you can often address issues before they move from ‘mole hill to mountain’.

Organisational Culture

Of course, we also encounter people who don’t complain because in the past they’ve found it makes no difference. However, unlike the politicians in the Ghostbusters movie, we don’t want to pretend that everything is alright and deliberately ignore what is happening.

This is the second key aspect of ensuring complaints are raised and dealt with effectively. Having systems and processes in place that support the Feedback loop and Quality Improvement.

When things go wrong we need to be responsive and there needs to be Open Disclosure.

What is Open Disclosure?

“Principles of open disclosure – If things go wrong, the patient, their family and carers should be provided with information about what happened in a timely, open and honest manner. The open disclosure process is fluid and will often involve the provision of ongoing information.” – Australian Commission on Safety and Quality in Health Care.

This definition also reflects what we should be doing in the Aged Care sector. We need to recognise the problem, not try to brush it under the carpet – I think there’s been enough of that in the industry in the past and we’re now seeing that carpet being lifted through the Aged Care Royal Commission. When we address issues head on we are less likely to have ‘ghosts of the past come back to haunt us’.

If our corporate culture however focuses on Continuous Quality Improvement;

If we are seeking to truly identify what the consumer wants and how we should be meeting their needs;

If we look at ways that support consumers to provide feedback such as the use of focus groups where we encourage participants to discuss the good and the bad;

If we conduct surveys on a regular basis, where the results are actually reviewed and acted upon;

If we capture information about the client during the assessment phase that allows us to identify whether they need support to raise a complaint and what that looks like;

If we include clients and their carer/s in developing appropriate responses to identified issues;

If we respond to complaints effectively and in a timely manner and we learn from the experience;

If we have clearly documented processes for responding to complaints and feedback and everyone knows and upholds these within the organisation;

Then I think that we will be well on our way to meeting this Standard!

We hope you enjoyed this article on the sixth Standard. This blog post is part of a series on the New Aged Care Standards, where we investigate how and why they were developed and take an in depth look at each of the Standards to give you ideas for implementing these effectively within your organisation. If this is of relevance to you and you’re not signed up for our short email alerts, fill in the quick form at the bottom of the page and we will let you know when the next post is released. We also send a monthly round up of blog posts and videos.

Other posts in this series

Why Do We Need New Aged Care Standards?

What Difference will the New Aged Care Standards make to Consumers?

What Impact Will The New Aged Care Standards Have On Your Organisation?

‘What About Me?' – Consumer Dignity & Choice | New Aged Care Standard #1

‘We're All In This Together' – Ongoing Assessment & Planning | New Aged Care Standard #2

‘Stand By You' – Personal Care & Clinical Care | New Aged Care Standard #3

‘Help me get my feet back on the ground' – Services & Supports for Daily Living | New Aged Care Standard #4

‘Wouldn't It Be Loverly?' – Organisation's Service Environment | New Aged Care Standard #5

‘Lean On Me' – Human Resources | New Aged Care Standard #7

‘The Greatest Show' – Organisational Governance | New Aged Care Standard #8

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