Risk and reputation intelligence supports NHS trusts in meeting Duty of Candour requirements

The reputational damage that can be caused by issues such as poor care is incalculable and it is clear that the NHS cannot rely on traditional channels to monitor such dissatisfaction.

However, sophisticated online monitoring tools are now available that can automatically detect these posts, enabling rapid response before they escalate, through means of a traffic light warning system.

The valuable asset of manual analysis of the commentary by experts is revealing how informative this can be.

From April 2015, the implementation of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 will be extended to all CQC-registered providers, although the statutory duty of candour was introduced for NHS bodies on 27 November 2014.

From years of experience working within and with healthcare providers, it became apparent that a solution was really needed to enable trusts to identify and engage with patient commentary

As a result, a breach of the duty of candour will be a criminal offence. So how can trusts be confident that they are prepared to act in a timely and appropriate manner?

“Patient feedback which is not in the form of a complaint, but which suggests cause for concern, should be the subject of investigation and response of the same quality as a formal complaint, whether or not the informant has indicated a desire to have the matter dealt with as such”, stated Recommendation 112 of The Francis Report .

Patient feedback and complaint platforms are constantly evolving, and hundreds of conversations relating to real issues and patients’ unmet needs within the NHS are happening on a daily basis on social media and open access sites online. Listening to these conversations and responding in a timely, sensitive manner can often empower trusts to identify issues before they escalate into more-serious situations and deal with them accordingly, enhancing patient safety and mitigating against potentially costly and time-consuming litigious situations.

It can be the case that these commentaries fall between the gap. Should the board be leaving the responsibility of monitoring for this kind of commentary to their communications team, or the PALS team? Or does it fall to the chief executive and the trust’s senior management team? The real challenge is how to identify the commentary in the first place and have it notified in real time.

Janet Gunner, managing director of Risk & Reputation Intelligence, part of MMR International, said, “From years of experience working within and with healthcare providers, it became apparent that a solution was really needed to enable trusts to identify and engage with patient commentary.

"Having developed a technology that, partnered with expertise in the field, can readily do this, we are now seeing this become a key requirement as highlighted in the recently published updated regulations and are already supporting trusts as they look to implement systems and processes to remain compliant and promote patient safety.”

Patient feedback which is not in the form of a complaint, but which suggests cause for concern, should be the subject of investigation and response of the same quality as a formal complaint, whether or not the informant has indicated a desire to have the matter dealt with as such

Forward-thinking trusts are now working with Risk & Reputation Intelligence as a solution-focused service provider to access this wealth of data and identify early warning signs. As a result they are immediately gaining actionable insights.

One Trust which is currently using this service was notified immediately of a post in mid December by a gentleman stating he had 'received a weird phone call from my [local hospital’s] 'Ebola' department (not infectious disease dept) and said I had had an association with someone who had come into contact with Ebola….’.

The caller knew the gentleman’s private details, including his road and mobile phone number and when he tried to end the conversation the caller contacted him again and was verbally abusive.

Subsequent to the post appearing on social media, followers responded and within just one hour and 10 minutes it had achieved a reach of over 700, with the potential for that to escalate into the thousands.

The telephone call had not originated from the trust named in the post and, as a result of being made aware of the post, it was able to privately message the individual concerned to reassure him and subsequently involve the police.

Other examples cover an abundance of topics at varying degrees of levity for the patients and trusts involved, ranging from patients commenting about waiting times, to a tweet about a patient with high blood pressure being unattended for three hours and suffering a major stroke.

So why is it so important that trusts are aware of these posts?

The NHS Litigation Authority guidance document Saying Sorry cites timeliness as being key to effective engagement with patients, adding: "The initial discussion with the patient and their family should occur as soon as possible after recognition that something has gone wrong.”

In summary, trusts should be 'achieving timely and fair resolution, enhancing learning and improving safety'.

initial discussion with the patient and their family should occur as soon as possible after recognition that something has gone wrong

CQC Guidelines for Essential standards of quality and safety further state that trusts should: “Use information about the quality of experiences of people who use services, or others acting on their behalf, the views of staff and the risks they are exposed to, including the outcomes of comments, complaints and investigations, to understand where improvements are needed.”

Monitoring and responding to online commentary enables trusts to engage with diverse audiences and pro-actively look to resolve issues and concerns before they evolve into more-serious breaches of patient safety or lead to reputational risk. In addition, this kind of approach creates opportunities for trusts to integrate online and offline engagement and build community engagement.