HDC and Complaints Management Rose Wall Deputy Commissioner, Disability Practice Managers & Administrators Association Conference 10 September 2016
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
Health and Disability Commissioner
HDC Vision Engagement Transparency Consumer Centred System Seamless Service Culture
The Act and Code
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
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
HDC Mission Independently upholding consumer rights by: promotion and protection; resolving complaints; service monitoring and advocacy; and education.
Jurisdiction Health or Disability Service Health or Disability Service provider Health or Disability Service consumer
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)
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)
HDC s Complaints Resolution Role
Complaints per year 2500 2000 1500 1000 Complaints received Complaints closed 500 0 2011/2012 2012/2013 2013/2014 2014/2015 2015/2016
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%)
Number of complaints received about general practices and general practitioners each year 500 450 400 350 300 250 200 General practices General practitoners 150 100 50 0 2011/2012 2012/2013 2013/2014 2014/2015 2015/2016
Complaints in context 15 million GP consultations 564,000 acute hospital discharges 3,331 complaints to advocacy 1,958 complaints to HDC
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
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
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
Individual sanctions Review of practice Individual apology Competence review DP referral
Organisational sanctions Review of policies and procedures Organisational apology Staff education Audit
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
Complaints Management in Primary Care
The Value of Complaints
Why complain? People complain to: - receive information/explanation - receive an apology - be taken seriously - improve care quality - ensure accountability
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
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
Responding to Complaints
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
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
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
Your obligations under Right 10
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
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
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
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
Activity: Evaluating apology letters
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
Learning from Complaints
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
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
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
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
Summary
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
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
www.hdc.org.nz