HDC and Complaints Management

Transcription

1 HDC and Complaints Management Rose Wall Deputy Commissioner, Disability Practice Managers & Administrators Association Conference 10 September 2016

2 HDC Overview Vision The Act and Code HDC s complaint resolution role Complaints management in primary care The value of complaints Responding to complaints Learning from complaints

3 Health and Disability Commissioner

4 HDC Vision Engagement Transparency Consumer Centred System Seamless Service Culture

5 The Act and Code

6 The Health and Disability Commissioner Act 1994 Establishes the Office of the Health and Disability Commissioner, and the Commissioner s roles and functions Provides for a national Health and Disability Services Consumer Advocacy Service Provides for the appointment of an independent Director of Proceedings

7 Purpose of HDC To promote and protect the rights of consumers and, to that end, to facilitate the fair, simple, speedy, and efficient resolution of complaints HDC Act 1994

8 HDC Mission Independently upholding consumer rights by: promotion and protection; resolving complaints; service monitoring and advocacy; and education.

9 Jurisdiction Health or Disability Service Health or Disability Service provider Health or Disability Service consumer

10 Code of Rights Consumers have rights and providers have duties (clause 1) Every provider must take action to inform consumers of their rights and enable consumers to exercise their rights (clause 1) Sets out 10 rights (clause 2) Provider compliance (clause 3)

11 Code of Rights Consumers have rights and providers have duties respect, dignity, fairness (Rights 1-3) appropriate standards (Right 4) communication, informed choice, consent (Rights 5 7) support, complaints (Rights 8 and 10) research and teaching (Right 9)

12 HDC s Complaints Resolution Role

13 Complaints per year Complaints received Complaints closed / / / / /2016

14 Individual providers complained about in 2015/16 General practitioner (31%) Midwife (7%) Nurse (7%) Dentist (5%) Psychologist (5%) Orthopaedic surgeon (5%) Psychiatrist (4%) Internal medicine specialist (4%) Obstetrician & gynaecologist (4%) General surgeon (4%) Other (24%)

15 Number of complaints received about general practices and general practitioners each year General practices General practitoners / / / / /2016

16 Complaints in context 15 million GP consultations 564,000 acute hospital discharges 3,331 complaints to advocacy 1,958 complaints to HDC

17 Top issues complained about in relation to GPs 1. Missed/delayed/incorrect diagnosis 2. Inadequate/inappropriate clinical treatment 3. Inadequate/inappropriate examination/assessment 4. Disrespectful manner/attitude 5. Delayed/inadequate/inappropriate referral

18 The Complaint Process Complaint Received Unless outside jurisdiction Seek further information (if necessary) Provider response Obtain clinical advice (where required) Complaint resolution method Referral Advocacy Mediation Investigation No further action Complaints Assessment Triage

19 Complaint resolution options Broad options for complaints resolution: Referral to another agency (e.g. Medical Council) Referral to provider Referral to advocacy Mediation conference Formal investigation Take no action / no further action Focus is on local and early complaints resolution

20 Individual sanctions Review of practice Individual apology Competence review DP referral

21 Organisational sanctions Review of policies and procedures Organisational apology Staff education Audit

22 Recurring themes Have a learning system Get the basics right Read the notes Ask the questions Talk with the patient Listen to the patient and the patient s family Ensure continuity of care Take responsibility

23 Complaints Management in Primary Care

24 The Value of Complaints

25 Why complain? People complain to: - receive information/explanation - receive an apology - be taken seriously - improve care quality - ensure accountability

26 The value of complaints The consumer s voice for bringing change is a powerful one Managed well complaints can: - help us learn from mistakes - identify gaps in services - provide trend data - restore trust and mend relationships

27 Why a good complaints management system is important Complaints are inevitable Allows complaints to be handled systematically and fairly Ensures consumer input into quality improvement

28 Responding to Complaints

29 Barriers to complaint management: What consumers tell us Response not timely Response did not address all concerns Did not feel heard An apology was not offered Lack of preventative action

30 Case study: Inadequate response to complaint Mrs A complained to a medical centre regarding the treatment of her daughter s migraines Mrs A complained to HDC when she did not hear back from the medical centre in regards to her complaint The medical centre responded directly to Mrs A s complaint 14 working days after receiving it The medical centre acknowledged that the timeliness of this response was not in line with policy

31 Case study: Inadequate response to complaint The Commissioner considered that the delay in acknowledging and responding to Mrs A s complaint was unacceptable In response to this complaint, the medical centre reviewed and revised its complaint handling process The Commissioner asked the medical centre to apologise to Mrs A and her daughter

32 Your obligations under Right 10

33 Complaints management: Professional and contractual requirements PHO Services Agreement requires the PHO to work to implement a consumer complaints process RNZCGP Foundation Standard and Aiming for Excellence require the practice to uphold the patient's right to complain in accordance with Right 10 of the Code

34 Complaints management Recognising signs of dissatisfaction Identifying any misunderstandings Diffusing through open and honest communication Personally interacting with complainant Apologising Seeing complaints as a learning opportunity

35 When receiving a complaint DO: Listen carefully to what the consumer is saying Try to see things from their perspective Remain polite and respectful Express regret or provide information if appropriate Clarify anything you are not sure about Thank the person for their feedback Tell them what will happen next DON T: Be defensive or take it personally Blame others Make assumptions without checking the facts Argue with the consumer Be dismissive it takes courage to complain

36 Apologies A good apology: acknowledges the impact of the incident on the consumer/complainant expresses responsibility conveys regret explains how the incident has resulted in changes in practice

37 Activity: Evaluating apology letters

38 Apologies Things to avoid: Not signed From the lawyer Organisational apologies that ignore individual responsibility Impersonal language/formulaic Blaming the consumer/consumer s family I m sorry you feel that way Stressing the impact of the complaint on the provider Making excuses

39 Learning from Complaints

40 Case study: Changes to practice (C13HDC00031) GP ordered ultrasound of lump in man s groin Man previously had a mole excised, histology report indicated it was melanoma in situ Ultrasound report stated that the lump was probably a reactive lymph note, recommended FNA or followup ultrasound GP told man that lump was benign Five months later lump had grown and become painful Man presented to another GP and was diagnosed with metastatic melanoma

41 Case study: Changes to practice (C13HDC00031) GP was found in breach of the Code for: failing to tell the man about the equivocal nature of the ultrasound report failing to adequately consider differential diagnoses failing to organise structured follow-up of the man Adverse comment was made about the standard of the GP s documentation

42 Case study: Changes to practice (C13HDC00031) The GP advised HDC that following this complaint he had: discussed his treatment of the man in a peer review meeting and with senior staff reviewed literature and attended a seminar on the diagnosis and management of melanoma reflected on his use of automatic keys started a log book for minor procedures attended a workshop on risk management, shared decisionmaking and managing adverse outcomes HDC recommended that the GP audit his clinical records to identify any patients that may require follow-up and have not received it. HDC also recommended that the Medical Council consider a review of the GP s practice

43 Wider learnings: Delayed diagnosis of Cancer Analysis of complaints in which expert clinical advisor considered that primary care management had contributed to delayed diagnosis The factors leading to a delayed diagnosis most commonly identified by our expert were: the cancer presenting with non-specific or atypical symptoms; poor communication with secondary care; appropriate referrals not being made; inappropriate reliance on negative test results; and the GP failing to adequately take, review or consider relevant patient history. Brought together the clinical recommendations made in the cases

44 Summary

45 Lessons Get the basics right Have an open, fair complaints process and easily accessible Be responsive to the consumer Consider culture and staff training Integrate complaints management across the organisation Be thoughtful in how you respond to the complaint Collect data and monitor complaints quality improvement processes for

46 Resources HQSC Root Cause Analysis for Clinical Incidents: A Practical Guide HDC complaints management checklist HDC Fact Sheet Right 10 Standards NZ Guidelines for complaint handling in organisations Health and Disability Advocacy Services

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