The power of explanation in

healthcare mediation

Presentation by

Dr Grant Davies

Acting Health Services Commissioner

Date: 9 September 2014

Office of the Health Services Commissioner

Level 26

570 Bourke Street

MELBOURNE VIC 3000

Telephone1300 582 113

Fax: (03) 9032 3111

Email: hsc@health.vic.gov.au

Website: www.health.vic.gov.au/hsc

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 (Vic)

– Health Records Act 2001 (Vic)

How we do it – Assessment, mediation and conciliation

Impartial and confidential

General information about the

OHSC

Approximately 8,500 enquiries per year

Approximately 3,000 complaints per year

Staff of 25, 16 of whom are direct complaint

handlers

How we do it

Assessment

– 84 days

Conciliation

– Privileged and confidential

Investigation

Issues for consumers of health care HSCR Act Issue Categories (1606 complaints)

Treatment (54%)

Access (15%)

Communication (10%)

Cost (9%)

Rights (7%)

Administration (5%)

Context

Covenantal relationship.

Patient experience a significant focus in

healthcare.

Health literacy improving and being given a

greater focus.

Resulting in partnership rather than passive

receipt of health care.

Background

Uni of Melb Law Intern – Dr Christian Behrenbruch.

Is it feasible to introduce a formalised mediation process in the Assessment phase of OHSC process?

Objectives of the study:

– Statutory compatibility

– Procedural compatibility

– Risk mitigation

Data Analysis

2000-2010 conciliated cases (a little over

3000)

Data integrity better in later years 2009-

2010

Stratified for apology, explanation or both

Compensation has low prevalence (general

damages)

At a High Level : A Good Idea?

Compensation

Alone

2%

Apology Alone

3%Apology +

Compensation

2%

Explanation

Alone

46%

Apology +

Explanation +

Compensation

2%

Other

28%

Apology +

Explanation

Alone

16%

Explanation +

Compenstion

1%

Vitally important for characterising whether the types of complaints the

OHSC might be intrinsically suitable for mediation.

Complainant Objectives?

Outcomes: Controlled for

Explanation Pure Explanation

64%

Explanation + Apology

22%Other

11%

Explanation + Apology +

Compensation

2%

Explanation +

Compensation

1%

• In 2010, 64% of cases closed on the basis of pure explanation (no compensation element, no apology).

•This grows to 86% when apology and explanation (but still no compensation) is combined.

•Not only is explanation important with apology, but appears to be critically important stand-alone.

Objectives v Outcomes (10 Years) Role of

explanation a

dominant cluster

Consistent across

entire 10 years of

Ciril database

So why is explanation in our complaints

process so effective?

Discussion

Changing type of mediation/conciliation

Values based healthcare

Discussion

(What is the broader context?)

Discussion

Expectation management

Work with health services.

Communication underpins

everything

Misunderstanding or lack of understanding

of values between the parties

Communication/explanation critical in all

aspects of health care continuum (From

initial presentation to complaints resolution).