Best practice in health complaints

management: Review of the Health Services

(Conciliation and Review) Act 1987

Beth Wilson, Victorian Health Services Commissioner

Kathy Ettershank, Review Team, Department of Health, Victoria

3rd Annual Health Care Complaints Management Conference

24 September, 2012

Health Complaint Commissioners

in Australia and New Zealand

What we do

• The Health Services Commissioner (HSC) receives and

resolves complaints about health service providers with

a view to improving the quality of health services for

everybody.

Legislation

• Health Services (Conciliation and Review) Act 1987

• Health Records Act 2001

Background – the Act

Guiding Principles

• Quality healthcare, given as promptly as circumstances permit

• Considerate healthcare

• Respect for the privacy and dignity

• Adequate information on services and treatment available, in terms which are understandable

• Participation in decision making

• Environment of informed choice in accepting or refusing treatment or participation in education or research programs

What are the complaints about?

• Communication Issues

• Informed consent

• From blame to mediation and learning

HSC processes

Assessment, Mediation and Conciliation

– Impartial & confidential

• Formal Inquiries/Investigation

• Referrals

HSC vis a vis AHPRA

• HSC and Boards continue to inform each other of

relevant complaints received. Must also consult each

other on the handling of complaints

• Must reach agreement on whether a complaint should be

taken further by Board.

• If agreement cannot be reached the more serious view of

the matter will prevail and Board will carry complaint

forward on that basis.

Experiences of the HSC following

changes to the Wrongs Act in 2001

• Even where very serious mistakes leading to

ongoing symptoms and inability to rejoin

workforce - may still be insufficient level of

impairment to satisfy requirements of the

Wrongs Act.

Delays and Expenses for HSC

• Significant delays

• Assessments are expensive

• Implications of psychiatric assessments

Attitudes of Medical Insurers

Changes of attitude since Wrongs Act – “dramatic”.

• Causes frustrations to conciliators.

• Over the threshold still not compensated because

not permanent.

• Significant “stuff up” but no compensation.

• HSC has to refer people to lawyers.

• Extra work for the courts.

Claims and Settlements

There has been:

• decrease in the amounts paid and

• decrease in the number of middle-ranking

settlements, i.e. approximately $20,000 to

$50,000 where it is not realistic to litigate

without “topping up” the special damages with

general damages.

• Large claims and small out-of-pocket and refunds (ex gratia) etc are pretty much unaffected.

Success Stories

• Advising solicitors and the insurers sympathetic to

objects of act and HSC‟s processes - good results

• Cooperative attitudes from providers, can get good

outcome for injured individuals. E.g., local examination

sufficient. Processes rely enormously on goodwill.

• Some health services do not insist on technicalities

because clear from medical reports there is problem.

Expert Review Panel’s

Review of the Health Services (Conciliation and

Review) Act 1987

March – December 2012

Process

• External panel of experts to advise Minister

• Discussion Paper launched by Minister 20 June 2012

• 6000 complainants/respondents, 887 (others)

• Submissions in response to Discussion Paper

• 270 individuals (230 complainants), 82 organisations

• Preliminary consultations

• 33 individuals, organisations and consumer forums

• Complainants Study

• Roundtable consultation - October

• Options Paper to Minister this year

• New legislation 2013

Terms of reference

Examine whether changes are required to:

• reflect best practice in health complaints resolution for all health service users

• strengthen the role of the HSC in improving the health system and the patient experience

• respond to a changing health service environment and changes in legislation

• address any scope, policy or operational issuesin the current legislation

The context for reform

• New challenges in healthcare

• Changes in health system management

• National health practitioner regulation

• Related legislative changes

• A maturing health quality and safety framework

• Expansion and development of complaints

resolution schemes

The complaints process – 2010–11 statistics

(Total of 2,183 complaints closed)

Conciliation

Assessment

Enquiry

1,046 (48%) complaints closedComplaints declined, resolved, withdrawn or referred

899 (41%) complaints closed- Referral

- Advice resolves

- Local resolutions successful

238 (11%) complaints closedComplaints resolved, withdrawn, referred or deemed

non-conciliable

Investigation No investigations

conducted in 2010–11

HSCRA 1987 – functions of the Commissioner

Core function

• Resolution of complaints

Additional functions

• collection and use of complaints information to

improve the quality of healthcare

• broader inquiries and investigations

• education, training and guidance about the

prevention or resolution of complaints

Complaints

• Facilitate efficient local resolution

– Role in ensuring good practice through training and

education for providers

– empower consumers to resolve complaints

• Who should be able to lodge complaint

(e.g. third parties, class complaints)?

• Advocates/support, „self advocacy‟

Preliminary Assessment process

• Timeframe for assessment process

• Time limits for provider response

• Formal mechanisms in the legislation to

facilitate assisted early resolution – e.g.

mediation/ preliminary inquiry powers

• Mechanisms for working with referral bodies,

e.g. AHPRA and boards

Conciliation

• „Public interest‟ considerations

• Power to request information

• Options where non-compliance

• E.g. stronger naming powers

Investigation

• Commissioner initiated investigations

• Codes/ Standards

• Non-compliance with recommendations and follow-up

– Reporting and publication/ „Naming powers‟

– Referral, e.g. Department or board

• Sharing of information

Incompetent/ impaired or unethical

unregistered providers

• Extent of the problem

• Code of Conduct

• Naming powers

• Prohibition orders

• Inter-jurisdictional co-operation

HSC’s complainants study

The research specifically aims to identify:

• whether or not the complainants in the proposed

study experienced a gap between their expectations

and their experience of the Commissioner‟s

complaints process

• Whether, and to what extent, lack of understanding

of what can be achieved by lodging a complaint

with the Commissioner contributes to the gap

between expectations, outcome and experience.

• Representative sample of approximately 400 adult

complainants

• Only complainants with closed cases over the last

3 years will be approached to participate.

• Survey methodology using computer assisted

telephone interview (CATI) will be employed.

• A third party research company undertaking data

collection

HSC’s complainants study

www.health.vic.gov.au/hscrareview

Thank you