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1 SOURCE: Ministry of Health DATE APPROVED: January 28, 2009 DATE EFFECTIVE: January 28, 2009 REPLACES POLICY DATED: - POLICY TITLE: Complaint Policy REFERENCE NO. PAGE: 1 of 4 REVISION DATE(s): Title: Complaint Policy Purpose and Applicability: 1. To improve the delivery of quality healthcare services and protect patient s health, rights and safety by ensuring complains are reviewed/investigated, tracked, trended and resolved to the best extent possible. 2. To provide a mechanism which identifies, addresses and manages user complaints in a timely and efficient manner. 3. To improve user satisfaction. Definition: Complaint any formal, written or verbal grievance (telephone, media, rumour) that is filed by a patient, or on behalf of a patient who is incapable of doing so themselves, when a patient issue cannot be resolved promptly. Policy: All complaints, written, verbal including telephone, media complaints and rumours regardless of point of origin shall be acted upon by the Office of the Director of Health Services, Technical Advisors and Regional Health Managers. Complaints Handling Process A. At the Service Delivery Level It has generally been recognized that the most effective and efficient way to handle complaints is to resolve them at the service delivery level. Therefore, all public hospitals are required to have in place a mechanism to handle complaints. 1. All Regional Health Managers are required to designate an officer who will receive, investigate and resolve complaints received by each individual hospital. 2. Regional Health Managers, on the advice of the Director of Health Services, shall display in prominent places, notices regarding the complaint mechanisms. 3. Regional Health Managers are required to submit on a monthly basis, a complaint digest, which provides a summary on the nature of complaints and the outcome of investigations by the hospitals to enable Director of Health Services to have an understanding of the level of performance of the hospitals in handling complaints. Where appropriate, the office of the DHS may provide advice to hospitals on how to avoid further complaints. 1

2 A.1 Record Keeping The Regional Health Manager will ensure that a complaint file along with the outcome of the investigation, and any other appropriate documents is maintained. Investigation records will not be maintained in personnel files or student files unless they are part of a formal corrective action. B. At the Regulatory level The office of Director of Health Services also undertakes investigation into complaints received from clients of private hospitals. Regional Health Managers will be asked to provide a written report on the allegations of the complaints and their actions in handling the complaints. In the course of investigation, the office of Director of Health Services or persons duly authorized by the Director, are empowered to enter and inspect the premises and any records. After investigation, Office of Director of Health Services will furnish a reply to the complainant on the findings of the investigation. Where there are complaints involving system errors in hospital management, the office of the Director of Health Services will direct the hospitals to take appropriate measures to rectify such errors. However, on issues relating to professional misconduct, the complainant would be advised to refer his case to the respective professional regulatory body (councils). C. Procedures for processing Complaints Complaints received at the Ministry of Health will be logged on the approved Complaint Form. Once logged, the Office of the Director of Health Services shall review each complaint and route to the appropriate Regional Health Manager/Clinical Director/Manager (as in the case of the private sector). Within two days of receipt of the complaint, the relevant Regional Health Manager/Department Head/Clinical Director shall provide feedback to the Office of the Director of Health Services acknowledging receipt of complaint. Preliminary investigations are to be organized by the Regional Health Manager and a summary report submitted to the Office of the Director of Health Services within two weeks of receipt of complaint. If a complaint is of a nature that there were no written submissions forthcoming and the complaint is such that it requires further clarification, the Office of the Director of Health Services shall: 1. inform the relevant Regional Health Manager of the complaint; or 2. organize an investigation team and simultaneously inform the relevant Regional Health Manager of the complaint; 3. inform the Regional Health Manager of the findings of the investigations; 4. forward findings of the investigation to the appropriate professional councils for review and necessary action. In cases where there is alleged adverse patient outcome, the Director of Health Services shall, at his discretion, refer the findings of the investigation for Peer Review in addition to resolution through the patient complaint mechanism. 2

3 If the complaint presents apparent issues of legal liability or media involvement, the complaint shall be immediately referred to the Chief Executive Officer, Ministry of Health for appropriate course of action. In routine cases once a complaint is logged, assigned a complaint number by the Office of the Director of Health Services, it will be routed to the: Relevant Regional Health Manager Deputy Director of Health Services responsible for the respective region Technical Advisor Relevant accountable head in the private sector/ non-governmental association or service provider The Complaints Committee shall generate a monthly report detailing each complaint that remains unresolved without disclosing the patient s identity. In situations where investigations remain unresolved, the respective Regional Health Manager will be requested to submit progress reports on investigations. The Ministry of Health s Complaints Committee shall review complaints, appropriateness of action taken and delinquent responses and submit a monthly report to the Chief Executive Officer through the Director of Health Services. Upon notification of a request for grievance hearing, the Director of Health Services shall coordinate the hearing. Forms: 1. Ministry of Health Complaint Form shall be used when logging a complaint. 2. Ministry of Health s Monthly Complaint Report Form. 3

4 Responsibilities: 1. The office of the Director of Health Services, Ministry of Health will be responsible to receive and log complaints on the approved complaint form. 2. Regional Health Managers shall provide timely feedback to the Office of Director of Health Services regarding preliminary investigations. 3. The office of the Director of Health Services shall review complaint and disseminate it to the relevant Regional Health Manager/Clinical Director. 4. Director of Health Services shall liaise with Chief Executive Officer when complaint involves liability or media involvement. 5. Complaints Committee, Ministry of Health shall submit monthly written reports of active complaints and quarterly reports of trends to the Director of Health Services and Regional Health Manager using the t Monthly Complaint Report Form. 6. Complaints Committee, Ministry of Health shall review complaints, appropriateness of action taken and delinquent responses and submit quarterly reports to the Director of Health Services, who shall be responsible to submit progress reports to the Chief Executive Officer. 7. The Regional Health Manager shall ensure that a complaint mechanism be put in place to facilitate user complaint. Effective date: This policy will be effective on the day of issuance. Signatures: Approved by: Date: Dr. Michael Pitts Director of Health Services 4

5 MINISTRY OF HEALTH COMPLAINT FORM Name of Complainant: Name of Service Accessor/Aggressor:. Contact Number Date of complaint / / Time: a.m./p.m. Origin of Complaint.. Complaint (please write clearly and concisely) Referrals: Yes No Name of Facility: Service used: (please tick) In-patient facility Emergency Room Pharmacy Radiology Out-patient Clinic Psychiatric Clinic Physiotherapy Clinic Laboratory Signature: Officer Receiving Complaint Signature: Complainant Date: / / Date: / / Referral of Complaint: Regional Health Manager: North/Central/Western/South Private sector Action Taken: (To be completed by appropriate Regional Health Manager and resubmitted to the Office of Director of Health Services) Recommendation (s)/preventive Action Signature: Regional Health Manager Date: / / 5

6 COMPLAINT NO. DATE RECEIVED MINISTRY OF HEALTH MONTHLY COMPLAINT REPORT FORM PENDING ACTION ACTION TAKEN RESULTS CLOSED DEMAND FEEDBACK TO COMPLAINT 6

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