Implementing a Statewide Patient Complaint System.
Implementing a Statewide Patient Complaint SystemGOALThe improvement of the quality and performance of health services through the development and implementation of a State-wide approach to managing and utilising patient survey and complaints data.ObjectivesA coordinated and strategic approach to the collection, utilisation & comparison of consumer feedbackConsumer feedback framework with links to core quality indicatorsComplaints Management System aligned with National and HRC requirements and directionCorporate Policy and guidelinesTraining and support for key stakeholders and system usersWhy do this?Better Health for all Queenslanders+ve-veQuality Improvement InitiativesPolitical DriveCouldnt get statisticsDidnt know what the issues whereDidnt want to knowDidnt provide trainingHRC receives many complaints that they need notGrowth industry - Catch the train now.How do you sell the beauty of consumer feedback? Particularly the negative.Live itBreath itBelieve itDream itWhy is Queensland Different?Is Queensland different?DemographicsCulturallyBottom up buy inNational recognitionLessons learnedProcessDevelopmentWorkshopsWide consultation and feedback on draft documentsPilotIt must work before rolloutRolloutFingers crossed and here we goComplaint handling is the responsibility of everyone in the organisation.Complaint Coordinatorauthoritycooperation and support from all levelsreports directly to the District Managerreadily accessible referral authorityComplaint Coordinator cont.dealing directly with consumersensure timeliness and consistency in management and correspondenceassist staff to draft correspondence, manage complaints and achieve resolutionensure that complaint data is used to improve health service deliverySay Sorry, and mean it.Complaint data for qualityNumber of complaintsResolution timeframesComplaint severityExternal ReferralsIssuesStaff CategoryResolution Mechanisms/Outcomes.Organisational ActionsSeriousness123451LLMHH2LLMHE3LMHEE4MMHEERisk5HHEEESo, how are we surviving?NetworkingBuilding on current structuresEncouraging and building on enthusiasm and good will.Support from both the bottom up and top down levels.Heres to a prosperous future and Better Health for all AustraliansWhen I first took on this project a lot of people asked me if I really wanted to do this. Naively I said, yes, why wouldnt I, it has all the things I love: Challenge, Adventure, Travel, and I get to work with people to improve health service delivery or as Queensland Health puts it Better Health for all Queenslanders. An issue that I am quite passionate about. I am also passionate about complaints. I suppose you could say that Im positive about the negative. So why would Queensland Health even try to approach this from a state-wide level? Taking this approach is far from easy and I must say a bit like taking a heap of people shopping and asking them to buy all the same clothes. You cant make everyone happy. In place of this approach we could just teach people how to communicate better with consumers who want to complain, and that would get us a long way considering that approximately 80% of complaints result from poor communication or mishandling. But what happens then, we may reduce the number of complaints (particularly the complaints about the complaints process and those referred to the Health Rights Commissions) and increase complainants satisfaction but how much would we lose. Lots.Integral in complaint management is the identification of issues that can be considered and analysed systematically for systemic problems. The amount of quality information that could be gained is immeasurable. So that is why we should collect and analyse the data, but why should we do this on a state-wide level. Considering the size of the task would the benefits be outweighed by the problems? I must say No.One of the wonderful things about collecting the data on a state-wide level is that we can benchmark with others and learn better ways of doing things. This does rely on a few important things though, Primarily:.Consistent data collection; and.Consistent categorisation of complaints data.Without this, we cant really benchmark because we are comparing the unlike and if the whole purpose is to improve quality we need to compare ourselves with others. So, other than youve now met the insanity that has been given the opportunity to guide the process, what is on the horizon. My best advice on this score is:Sell, Sell, Sell.Consult, Consult, Consult.Do I sound like a real estate agent, in some way I am.To achieve the selling and buying you have to live it, breath it, believe it and dream it.I cant under emphasise this. If you dont you have no way of convincing others that this is a good thing.One thing I noticed in getting feedback from people is that they often start with I dont mean this in a personal way, or, please dont get offended in what I have to say. I must say that I get a great feeling when I can say I wont, if I didnt really want your feedback I wouldnt have asked for it.On the other hand I can tell from experience why they ask this and I can also assimilate this to the complaints process. This is why a large number of people dont complain. After the first consultation round the willingness of people to participate increased and I now wonder if the reason for this is that everyone who provided feedback the first time, got a thank you. This is one of the philosophies that is been intricately linked with Queensland Healths complaint process. Say thank you.Maintaining quality on such a broad scope.Demographically Qld is probably more like the Western States than the Eastern. We have large spances of wide open space with great distances from one town to another.Culturally, we have significant issues with Aboriginal and Torres Strait Islander peoples and are very similar to the Northern Territory in that respect.Acceptance. One of the first things that struck me when I started this project was the want or need from the Districts. One of the first things we undertook as part of the process was to consult, consult, consult. Nationally, a need for the collection and utilisation of complaints data has been recognised and a need for this data to be enterprise wide is growing. So I dont really believe we are any different. Maybe just the first to undertake it on such a large scale.The workshops to say the least were a resounding success. This is partly due to having an environment who had already determined that they wanted the project. The buy in was there before I came along and was mostly generated by word of mouth.Early in the piece while we were preparing the workshops a strange e-mail arrived on my desk from the top with a nice request to curve the attendance at the workshops. I must admit that Ive never received an e-mail that discourages active participation before, and I really say that that was the initial intent, but I must say it sent me into quite a quandary. How do I tell people who are enthusiastic about partaking in the development of a project that there attendance is not wanted, without derailing the whole show. I still dont know the answer to that one and basically we just became inventive in how we addressed the issue.The second part in the Development phase was the consultation and feedback on the draft policy and resource kit. You might all think I am mad, but the draft documents were sent to over 300 people for comment. Why? My golden rule. Consult, Consult, Consult. We got some great feedback, the effort was worth it and has resulted in a much more user friendly and applyable policy that maintained the quality principles.Before people complain they will often make some off the cuff remark. This will fall well short of a complaint but it is essential that this comment be noticed and accted upon by front line staff.Ownership by everyone is 100% the right way to go. People should not be encouraged to pass the buck. If we have a mentality that all complaints are referred to a specific person for management, ownership will not occur and a change in complaint culture will never eventuate.Experience from succussful complaint handling organisations suggest that a tiered or stage approach that incorporates all employees in compalint handling is the most effective way to manage complaints in an organisational context. Im here to say, that the theory should be no different in the health care context. So why should this be any different for health care?Over worked, Under resourced. If we make it easy then more people will complain and well have more work to do.Why is it that people never have the time to address the issues but always have the time to do it again. An the second timeit will take at least twice as long. This lead to the following model, which aims to resolve the majority of compalints at the front line and with the compiments of the NSW Ombudsman, looks like this: As you will note Tier 1 in the main fits with our ownership policy.Tier 2 introduces what we have titled the complaints coordinator. This position is designed to give some stability to the process, and quality in the handling and data.There is no more being shuffled from one point to another. If the first person cant manage it, for whatever reason, they get referred. The referral is very integral because people should never feel as if they are being shunted from pillar to post. Referral statements should be positive direction to the appropriate person. Staff are encouraged to explain that they are unable to help with this specific issue but there is a specific person who can assist them. This person has some very important role components of which executive support is at the top of the list. The third tier is seen as equally important. It must be acknowledged that there will always be complaints because we are not trying to get rid of them, we are trying to get them, and there will always be complaints that are too big for us to handle. Effective working relationships with external organisations is important to both the consumer and health care organisations and this is the third Tier of the process. Effective working relationships with these organisations can not only be beneficial for the public but the organisation. Why is it so hard to say sorry. Not long after I started in this position I received an e-mail from up above saying How do you propose to teach people to say sorry. Im still pondering that issue and John Howard certainly isnt helping my cause. Firstly, part of the problem is that People just dont like complaints. They are personally affronted by the feedback, even if it was outside their role or ability to do anything differently. This leads to what I believe is a bigger driving force. Saying sorry admits culpability and this one is bigger than me. One of the driving forces of this belief is the defence associations. They wont allow you to say sorry. Its such a shame because evidence indicates that the payouts might be less and the process shorter if they just said sorry.Generally though, it is plainly obvious that complainants generally seek little more than an apology accompanied by an accurate sensitive explanation and guarantee that the same problems wont be experienced by others. With that information in hand I am just learning the million and one ways of saying sorry without ever saying sorry. We seem to be relatively good at not outwardly apologising. Im guessing that I havent said anything that any of your dont know so far. So lets move away from the obvious.Number of complaints received annually in respect of activity data.Number of complaints resolved in the particular reporting period and within 4 weeks, 3 months, 12 months and longer than 12 months.Number of complaints according to complaint severity.Number of complaints referred to health service by an external agency (E.g. Health Rights Commission, Professional Registration Bodies, Minister for Health)Number of complaints according to issues complaints contained: Communication, Corporate Services, Privacy/Discrimination (Rights), Treatment, Consent, Costs, Professional Conduct, Grievances. Staff Category and number for each category where the subject of the complaint was identified as an individual employee (E.g nurse, medical practitioner, allied health professional, volunteer)Number of complaints according to resolution Mechanisms/Outcomes.Organisational Actions taken as a result of complaints.Seriousness1Trivial, Vexatious, misconceived2Complaint could be easily resolved at the front-line3Legitimate consumer concern, especially about communication or practice management, but not causing lasting detriment4Significant issues of standards, quality of care, or denial of rights; complaints with clear quality assurance or risk management implications5Long-term or severe damage, including death, serious adverse outcome, grossly substantiated care, professional misconduct.RiskPriorityImpact on service provision;Low Possible obvious PR impact; ModeratePossible financial impact,HighLikelihood of recurrenceExtremeRecurring costNon, Minor, Moderate, Major, Extreme