Title: Using Natural Language Processing to improve the speed, responsiveness and learning from the management of healthcare complaints
Funder: Department of Health and Social Care

Abstract: Background The NHS receives over 175,000 complaints every year, with our trust (UHL) alone receiving over 4500 complaints or concerns. However, several major national reports have found major failings with the process by which NHS organisations handle complaints. Particular issues highlighted included the rigour and speed of investigations, the quality of explanation provided and especially the lack of learning and improvement derived from them. These issues stem from the sheer volume of complaints, the considerable manual workload and high staffing burden (and associated cost). The Aim of this project therefore is to develop an AI based automation system using Natural Language Processing which will: 1) Decrease staff workload, thereby speeding up complaints response 2) Objectively identify underlying themes and therefore increase the process’ rigour 3) Reliably categorise complaints to identify common themes, thereby improving learning and patient care. Methods This project builds upon work we have previously undertaken for the Care Quality Commission and Ministry of Defence. We will develop Natural Language Processing pipelines which will: 1) ingest the free text data 2) analyse the individual response and present the themes to the complaints personnel 3) Categorise the aggregated complaints to highlight particular themes and direct quality improvement efforts. To ensure transparency it will be “open book” AI with full explanation of the technique. Patient representatives (including those from BAME backgrounds) and AI ethicists will be fully involved in the project to ensure equity and respect for diversity are maximised. Outcomes The project is expected to take approximately nine months. The end-point of the project is a minimum viable product which will be immediately incorporated into routine use at University Hospitals of Leicester NHS Trust. As the issues faced by UHL are universal, we aim to rapidly disseminate it across the NHS and international markets thereafter.

Lay abstract: Complaints by Patients and Carers to hospitals and GPs are extremely common. There are over 4500 per year to our hospital Trust alone (and 175,000 across the NHS). As well as being deeply personal and important to the individual patient and family, they contain valuable lessons for the service and hospital. We know that patients are often not satisfied with the way that their complaint is answered &ndash; in particular, the time taken to respond. We also know that clinicians and managers are also not satisfied with the complaints system, as there is so much information available it can be difficult to see what improvements should be made. The underlying cause of this dissatisfaction from both patients and clinicians is that the current complaints system is manual - relying on people to read, classify, allocate for response, collate responses and to identify patterns of poor care. Our project aims automate key parts of the complaints system using a technique called &ldquo;Natural Language Processing&rdquo; to automatically identify the key issues in the complaint, allocate them to the appropriate person for a response, collate responses for human sign-off, and to alert the hospital staff when new patterns of poor care are identified (or known patterns re-emerge). We have used this technique very successfully previously in projects for the Ministry of Defence and Care Quality Commission. Work Plan The project will be run using an agile methodology (the collaborative effort of self-organising and cross-functional teams and their customer/end user). The sprints (events) will be aligned to a project timeline specified at project onset and shared with NIHR. The nominated DM will liaise with NIHR as required regarding progress. At University Hospitals of Leicester, we routinely work with patients as an integral part of complaints process. Two of our independent patient partners will be invited onto the Project Management Group to ensure that the project remains grounded and patient focused. If successful, the system will immediately be integrated into the Complaints process and Quality Improvement process at our partner hospital trust. The Head of Patient Safety is a co-applicant to the grant bid and other senior directors are named collaborators. This will ensure its rapid deployment within the hospital Trust as a model for wider introduction within the NHS. Future plans are to develop similar systems for GP surgeries, Mental Health and Ambulance Services, and to include other forms of patient feedback. Unsatisfactory complaints management is known to be a key factor behind most litigation against the NHS. Improving this is expected to reduce the cost of litigation against UHT. There is also the potential to significantly reduce the overall multi-billion-pound NHS cost, releasing this money for patient care.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE