Dorothy Armstrong's thoughts on apology generated a real buzz at our recent Glasgow event.  We're delighted that she's agreed to write this blog.

‘We are all human – we can all make mistakes.’

This quote is from a man whose son died. He brought his complaint to the Ombudsman, he said, to ensure that he was listened to, lessons were learned and to receive an apology.

In my role as Professional Adviser to the Scottish Public Services Ombudsman (SPSO), I hear first hand from patients, relatives and carers about negative experiences of healthcare. The most common emotion expressed is of vulnerability, helplessness and humiliation.

When I read the stories shared on Patient Opinion, the themes are very similar to our experience at the SPSO. We see poor communication, behaviour and attitude as the most significant factors in the complaints we receive. In many cases, people feel that they have not been listened to. They feel patronised and powerless. If only staff involved in a mistake or wrong doing, had been honest and open and provided an apology at the time, they would not have continued to complain.

‘An apology is the superglue of life. It can repair just about anything.’ 

New South Wales Ombudsman, (2009).

As children, we are programmed to say sorry for our mistakes, but, in our working lives as adults, saying sorry is a real challenge. When used well in the NHS setting, an apology can be both very powerful for the patient and empowering for staff.

Sorry made easy - The 3 R’s

You can use this tool at work and at home. I’ve found it particularly effective with my teenage children – take a deep breath and try it too!

Regret

It is important to recognise that something has gone wrong by acknowledging the wrong doing, even if you are not at fault. Saying sorry, in a meaningful and sincere manner, is crucial. Often this first step is enough to de-escalate the situation.

Reason

Even if you feel criticised and hurt, it’s really important to provide a reason (if there is one) for the mistake, but to avoid being defensive. Make sure you are clear that the wrong doing was not intentional or personal, so try to keep to the facts. It can help to put yourself in the complainant’s shoes and step back from the situation. Stay objective.

Remedy

Try to resolve the mistake there and then, if you can. Ask the complainant what they would like to happen and take responsibility to investigate, if required, and to provide feedback to them as soon as is practicable. Encourage colleagues to be proactive too.

Dr Dorothy Armstrong is Professional Adviser to the Scottish Public Services Ombudsman.

The SPSO’s Guidance on Apology sets out what an apology is and what you can do to make it meaningful.

I recently had the privilege of being in a teleconference with Mike Alverson, the CEO of Kaiser Permenante, one of the biggest integrated providers of health care in the States.

One of the interesting things he said was that Kaiser now divided health care into 4 settings:

• - Staffed beds. This includes hospitals and residential settings
• - Ambulatory care by which they mean clinics, out patients, pharmacies etc
• - Domiciliary settings where the patient is looked after in their own beds
• - The web – email and skype consultations, telemedicine, appointment booking, shared decision making and other information aids and your own personal EPR

This made me stop for lots of reasons. Of course! The web *is* a major setting for health care. And one that is rapidly evolving and effecting the other three. And - just like PO - the web is an intrinsically egalitarian place to do health business.

All this is not just happening in California where Kaiser is based. Whether it is giving feedback about what happened to you via Patient Opinion, booking your own appointment on Choose and Book, using your own EPR via Patients Know Best, or exploring patient-founded sites like MoodScope, the web is already becoming a major place for patients across the UK.

For many people the NHS is like marmite, but whether we love it or hate it, we all end up using it one day, one way or another.

Students are one of the most outspoken, actionable social groups around, so when asking a number of them for their opinions on health services – an outspoken answer was what I got.

It has been an interesting few days hearing student’s thoughts on their health services. Below is a film the students I met, sharing their views – but not everyone was happy to be filmed, and as you’ll read below, there were quite a range of views!

International students, on the whole told me that they thought the NHS was great. When asked why, they mostly replied, ‘because it is free and available to all’. Interesting, a majority of the international students I spoke to also felt open minded to the idea of reforms and privatisation of the NHS.

In comparison, British students were a little more sceptical. But, overall they also agreed that the NHS was a great thing, although they did say that there are improvements to be made – all of which can be done with the help of patient feedback.

Elizabeth Etheridge who is studying French at the University of Sheffield, told me how her Nan had recently been in hospital but she felt the only reason ‘things were being done quickly’ was because her mum ‘knew the right people and could pull a few strings’. However, when speaking of the University health service, she could not speak highly enough, ‘fantastically well run, great service and really pleasant doctors.’

Interestingly, when I asked her about her thoughts on Patient Opinion, she said, ‘I’ve never heard of it but I think it’s a great idea. Change always starts from the bottom.’

One group of students I have been eager to speak to are medical students. Fortunately, I did manage to speak to a few outside the University Information Commons on Wednesday.

Although they didn’t wish to be filmed or be directly quoted, they did speak to me and pass on some really intriguing information. One male student who was in his fourth year of medicine told me of how he was intending to leave the field before he had even started because of ‘all of the bureaucracy’. His course mate told me she would be sticking with it but was sceptical of her future as she said, ‘the NHS isn’t what it used to be’. She also told me how all the medical students she knew were in uproar over the current proposed changes.

Speaking with students about their experiences of health services and their thoughts on the NHS, has made me see that students do care about their services and would like to see change. What is more important I think now, is that a site such as Patient Opinion try and expand its reach to students. Students are the next generation and with their strong political ideologies and desire for change, their work and interaction with PO could be surprisingly influential.

 

Undeterred by hailstones, a bitter wind and a few technical difficulties, I spoke to a range of students outside the University Information Commons in Sheffield today regarding their experiences of health services and their thoughts on the NHS.

For all students, going to university can be a scary and stressful time, moving cities, homes, and for some getting used to a new doctor’s surgery. For international students it can be terrifying, moving countries, adapting to a new culture and then to adapt and learn about a new health system too – it’s a lot to take on.

I was fortunate enough to be able to speak to a number of international students who gave a really interesting perspective on the NHS. The general consensus revealed a very positive attitude towards UK health services, with the greatest appeal being that it is available to all.

However, jumping into the unknown and a new health system for some international students, is pretty scary and one student remains sceptical.

Ravleen Khaira, a first year law student from the University of Sheffield, moved to the steel city a year ago from Singapore. Fortunately, since arriving she hasn’t needed to use any British health service, but speaking to her British friends has made her reluctant to try.

She said: “My friends have spoken of the long waiting times and unreliable nature of the service. They’ve told me it’s not very good. My friend’s have said they would rather go back to Singapore to be treated than be care for here.”

Hopefully, Rayleen will regain a little confidence in the British health service if the time comes that she needs to use it.

Third year bio-medical science student, Ming-te Lee, currently volunteers at Northern General Hospital and had an interesting take on the controversial reforms:

“The NHS is generally a good organisation but the future of it might be changing and I think with privatisation, it could be a good or bad thing. I think the purpose of healthcare could become more like a business rather than focusing on the quality of healthcare.”

When asked about their University health service, they all agreed it was very efficient and they were well guided into how to register.

Overall, although some may be sceptical, it appears international students admire our National Health Service and its unique ability to cater for and support one and all.

British perspectives differ though as I continue to explore tomorrow.

In my final week with PO I will be looking at student health services and our experiences of them. As a student, going to university can be a stressful time and thinking about registering and dealing with a new health centre is just another issue to add to the pile. From registering, to getting used to a new GP, it can all be a bit of a whirlwind. I want students to share their stories and experiences of their health services.

Over the week, I will be looking at a variety of issues, from how international students see the NHS and their experiences, to speaking with medical students about why they choose what has become such a controversial career path and asking how they feel about being publicly rated just as a hotel is on Trip Advisor. I will be speaking to the students of Sheffield and asking for their opinion on health services, ‘warts ‘n’ all’.

Equipped with a camera, charm and insightful questions I will pool together student’s experiences of the NHS and health services.

Follow my daily updates and look out for my overall findings on Monday.