Guide to Complaint Handling in Health Care Services

Transcription

1 Guide to Complaint Handling in Health Care Services Health Services Review Council

2 Health Services Review Council 2005 Health Services Review Council Steering Committee: Michael Gorton (President 2004) David Brous Marcia Coleman Robyne Schwarz (President 2005) Project officers: Dianne Spartels (November 2002 December 2003) Lynn Buchanan (June November 2004) Acknowledgements The HSRC wishes to thank the following people from both the public and private sectors, without whose help this project would not have been done: the organisations and individuals who participated in the registered interest group, focus groups and key stakeholder group, those individuals who read drafts and gave their comments and suggestions, the Health Services Commissioner, Beth Wilson, and her staff, the hospitals who participated in piloting the guide and the training program Hepburn Health Services, East Grampians Health Service Ararat, and Western Health Service Footscray, Cath Harmer, Department of Human Services. Designed by: Leon Kustra, The X Factor Design & Editing Pty Ltd Illustrations: Matt Golding Printed by: William Troedel & Co Pty Ltd

3 Guide to Complaint Handling in Health Care Services Health Services Review Council

4 Foreword The Health Services Review Council ( HSRC ) is established under the Health Services (Conciliation and Review) Act The HSRC is an advisory body, assisting the Minister and the Health Services Commissioner with the health complaints system. The HSRC recognises that consumer complaints are an inevitable part of any health system. We believe that dealing promptly and effectively with complaints has considerable benefits for health organisations, including better quality health care, reduced likelihood of litigation, and substantial savings in the direct and indirect costs arising from adverse incidents, complaints and claims. This Guide is designed to assist health service providers to develop and implement effective complaint handling practices. An important aspect of this is supporting staff to deal with and learn from complaints. For this reason the HSRC has also developed and piloted a training kit to enhance the information contained in this Guide. We are grateful to the Victorian Department of Human Services, who funded the project. We also wish to thank the many health professionals who gave their time and expertise to participate in focus groups, to provide information, to comment on drafts, to attend meetings and to participate in pilot training programs. We congratulate health service providers on their good work and their willingness to make changes in order to improve the quality of the health care they provide. We commend this Guide to you as a useful tool in this endeavour. Health Services Review Council 2005

5 Contents ABOUT THE GUIDE 2 Why complaints are important 2 Successful complaint handling 2 How this Guide can help 2 How the Guide works 3 Other resources 4 1. GUIDING PRINCIPLES FOR AN EFFECTIVE COMPLAINT HANDLING SYSTEM 5 National trends 5 Key objectives 5 An integrated system 5 Guiding principles 6 Putting the principles into practice ORGANISATIONAL FOUNDATIONS 13 Policies 13 Promotion 13 Staff training and support 14 Complaints manager 15 Recording systems 15 Tracking 15 Data collection 15 Reporting COMPLAINT HANDLING SKILLS 25 Why people complain 25 Communication techniques 25 Skilful complaint handling 26 Dealing with difficult situations 27 Consumer-focused communication 28 Conducting meetings 29 Debriefing and improving skills SETTING UP YOUR SYSTEM/TOOLS 31 Audit tool 31 Sample complaint management procedure 38 Complaints register 39 Complaint/feedback form 40 Sample acknowledgement letter to consumer 44 Dealing with complaints checklist for staff USING THE SERIOUSNESS ASSESSMENT MATRIX (SAM) 47 Benefits of SAM 47 How the organisation uses SAM 47 Doing a SAM assessment 48 Sample scenarios COMPLAINT HANDLING PROCESS 17 What complaints are 17 Types of complaint 17 Point of service complaints/enquiries 18 Complaints needing investigation 19 Step 1: Assessment 19 Step 2: Information gathering 19 Step 3: Resolution/outcome 20 Step 4: Implementation 21 External complaints role of the Health Services Commissioner 22 Guide to Complaint Handling in Health Care Services 1

6 About the Guide A bungled investigation can quickly turn a reasonable complainant into a hurt, damaged and angry former consumer plaintiff. Why complaints are important Complaints are a vital form of consumer feedback that provides unique and valuable information to an organisation concerned with quality improvement and risk management. The challenge for health service providers is how to capture and use this information productively to improve the quality, safety and accessibility of the health care system for consumers. Complaints and other comments from consumers are a valuable learning tool. Successful complaint handling There are many benefits to be gained from an improved complaint handling system. Fundamentally, handling complaints well is consistent with the core values of a health provider in a complex, often fraught environment, it is in the interests of patients health and wellbeing. Dealing with complaints quickly and effectively also reduces stress on staff. It is clear from research, both in Australia and overseas, that better communication with consumers by health professionals and organisations significantly reduces the likelihood of litigation. A successful system results in: prompt and speedy resolution of complaints, reduced costs (direct and indirect) involved with complaint handling, better risk management, potentially limiting the number of complaints that may become formal legal claims, promotion of better health care outcomes, better quality assurance, by providing feedback on service delivery, more satisfied consumers. How this Guide can help Complaint handling systems vary from organisation to organisation because health service providers have different needs, depending on size and whether they are in a regional or metropolitan area. Although this Guide was designed for public hospitals, it is equally useful for other health providers. The principles and procedures described here can be used by all health providers, large or small they apply both to health services provided within an institution and to those provided in the community. The Guide builds on existing systems and processes. It assumes that organisations already have a clear set of quality goals, procedures and policies to achieve identified standards. The Guide can be used to evaluate an existing complaint handling system to see where improvements can be made and also can be used as an aid to setting up a new system. The emphasis is on practical tools to make complaint handling easier and more integrated across the whole organisation, and to ensure that organisations use information collected from consumers effectively. These tools are designed to be used by all staff within the organisation, not just a designated complaints officer. In this system staff are empowered to deal with complaints at the point where they arise. Staff training is a fundamental aspect of a successful system and the related training kit is designed to help all staff manage complaints better. 2 Guide to Complaint Handling in Health Care Services

7 How the Guide works The Guide is divided into discrete sections. It can be read as a whole, or individual sections can be used separately. The components are as follows: 1. Guiding principles This section explains the principles underlying the approach to complaint handling. It explains how the complaint handling system can be integrated into the work of the whole organisation. It also shows how the principles translate into practice and shows the desired practice indicators relevant to each principle. 2. Organisational foundations This section describes the crucial system requirements that are needed promotional strategy, recording systems, staff training and feedback systems (to ensure that complaints can be used to generate change where needed). 3. Complaint handling process This section sets out the steps involved in handling an individual complaint and provides a flow chart for easy reference. 4. Complaint handling skills This section is designed to be used as an aid to staff training and awareness. It includes tips on minimising conflict and how to deal with difficult situations, as well as some communication skills and strategies. 5. Setting up your system This section contains practical tools, including an audit tool to evaluate an existing system and a description of how to set up a system. It includes sample forms and a letter. There is also an example of a one-page checklist that can be used to promote complaint handling to staff. 6. Using the SAM Matrix This section explains the Seriousness Assessment Matrix (SAM), which has been developed as a complaint assessment tool. It is a way of determining the level of seriousness of a complaint and therefore who should be informed and be responsible. It includes a description of the matrix, a diagram of the matrix and sample scenarios showing how the matrix is applied. Guide to Complaint Handling in Health Care Services 3

8 Other resources The approach adopted in this Guide is in line with trends in other Australian states and nationally. There are other useful resources available to assist health organisations with complaint handling. It is recommended that they be referred to as well. Complaints Management Handbook for Health Care Services, NSW Health Care Complaints Commission (commissioned by the Australian Council for Safety and Quality in Health Care), part of the project Turning Wrongs into Rights: Learning from consumer reported incidents. Open Disclosure Standard: A national standard for open communication in public and private hospitals, following an adverse event in health care, Australian Council for Safety and Quality in Health Care, July Sentinel Event Program Annual Report , Department of Human Services, Victoria, contains useful case studies and examples of risk reduction strategies developed in response to a sentinel event. Health Complaints Toolkit: Guidelines for health services in the management of complaints, Health Services Liaison Association, Victoria, Every Complaint is an Opportunity: Guidelines for hospitals in the management of complaints, Health Services Liaison Association, Victoria, Making Feedback Work for You, Queensland Health, includes Complaint Co-ordinators Handbook, CD Rom Training Package and Guidance Document to the Queensland Health Complaints Management Policy. Listening and Learning: ACT Health consumer feedback standards, ACT Health, Better Practice Guidelines for Frontline Complaints Handling, NSW Health, Taylor, D, Wolfe, R and Cameron, P, Analysis of complaints lodged by patients attending Victorian hospitals, , emja ( Kingston, M, Evans, S, Smith, B and Berry, J, Attitudes of doctors and nurses towards incident reporting: A qualitative analysis, emja ( 4 Guide to Complaint Handling in Health Care Services

9 1. Guiding principles for an effective complaint handling system PRINCIPLES 1 National trends Key objectives An integrated system Guiding principles Putting the principles into practice

10 Guiding principles for an effective complaint handling system National trends Over the past ten years or so there has been an increasing recognition within Australia and internationally of the importance of open communication to improve patient safety and the quality of health care. There is an increasing emphasis on creating an environment where mistakes or adverse outcomes are used to improve systems and processes, rather than focussing on individual behaviour and looking for someone to blame. National standards have been developed, and many states are developing their own frameworks for reporting on complaints and adverse events. Key objectives All health service providers should have a comprehensive complaint management process that includes the following objectives: to provide an efficient, fair and accessible mechanism for handling consumer complaints, to recognise, promote and protect consumer rights, to collect data and monitor complaints for the purpose of improving the quality of health service delivery. An integrated system The complaints system should be integrated into the work of the whole organisation. This means that: complaints are used to identify gaps in the quality of the service, investigation of complaints is collaborative, and information is shared among management teams (including clinicians and quality improvement teams), administrators and consumers. A complaint handling system is similar to an incident reporting system. Both provide critical information that can be used to promote positive change in the organisation. In a fully integrated system, complaints can highlight adverse events that may otherwise have been overlooked. Furthermore, complaints data can be aggregated with incidents data to provide more complete information. Creating a system where feedback is encouraged allows for consumers to make positive comments as well as complaints. This goes hand in hand with an organisational culture where staff are encouraged and supported to report near misses and adverse events without fear of reprisal or blame. Guiding principles for an effective complaint handling system 5

11 Guiding principles The complaints management system outlined in this Guide is underpinned by seven guiding principles. The way in which complaints are handled may vary from organisation to organisation, but the underlying principles remain the same. These principles can be incorporated as a core component of service delivery and understood by staff at all levels. At the end of this section there is a table showing how each principle works in practice. This is supplemented by an audit tool in the section on Setting up your system, which allows each organisation to assess their own performance. Seven guiding principles 1. Quality improvement Complaints management is an integral part of the quality improvement approach that has been adopted by the health service. 2. Open disclosure The health service has a policy of open disclosure in relation to adverse events and complaints. 3. Commitment The health service and its senior management are fully committed to an integrated complaints management system and will provide the necessary support for it to operate effectively. 4. Accessibility The health service encourages consumers and staff to give feedback about the service and makes it easy for them to do so. 5. Responsiveness The health service has a consumer-focused approach, being receptive to complaints and treating complaints seriously. 6. Transparency and accountability The complaints process is clearly articulated, open and accountable to both staff and consumers. 7. Privacy and confidentiality The health service respects the privacy and confidentiality of consumers and the information received during the complaints process, while at the same time making its decisions open and accountable. 1. Quality improvement Complaints management is an integral part of the quality improvement approach that has been adopted by the health service. Quality improvement in health care is a systematic process by which the quality of patient care is continually evaluated and improved. An effective complaints management system makes a vital contribution to this process. The link between complaints and quality improvement is a form of risk management quality and risk are intrinsically related. Lessons learnt from complaints are used to identify any changes needed and to avoid the same problems occurring again. A quality improvement approach focuses on system improvements rather than individual blame. In practice, there may be implications for a particular staff member or group of staff a complaint or incident may highlight the need for staff to receive extra support, more supervision or further training in an aspect of their work. For example, an increase in infection outbreaks on a particular ward may be addressed by a variety of measures, including clearer protocols for staff in relation to hand 6 Guiding principles for an effective complaint handling system

12 washing and training for staff in infection control. Collection of good data is essential for quality improvement to work. Complaints, feedback from consumers, staff observations and adverse events all provide useful information. All staff should be supported to participate in this including medical (both employees and visiting doctors), nursing, allied health, cleaning, catering and administrative staff. Quality improvement is a continuous and dynamic process. All health service providers need quality assurance committees who meet on a regular basis to monitor patient care and implement improvements. 2. Open disclosure The health service has a policy of open disclosure in relation to adverse events and complaints. The Open Disclosure Standard published by the Australian Council for Safety and Quality in Health Care in July 2003 says that: The elements of open disclosure are an expression of regret, a factual explanation of what happened, the potential consequences and the steps being taken to manage the event and prevent recurrence. The principles of open disclosure are equally relevant to complaints as well as to adverse events. The Standard emphasises the importance of communication with patients in a way that is respectful of their individual needs (see Appendix C of the Standard). This is discussed further in the section on Complaint handling skills. The Victorian Department of Human Services has supported the implementation of the Open Disclosure Standard through selected pilot sites and eventually through all health services. When using the Open Disclosure Standard, it is important to be aware of the following issues: It is critical to ensure that appropriate staff are involved in communication with the patient. Those involved in providing information to patients should have adequate training and be fully informed about the issues involved in open disclosure. Open disclosure, of necessity, involves medico-legal issues. It is about providing appropriate information to consumers, without necessarily an admission of liability. In Victoria, under the Wrongs Act 1958, an apology or an expression of sorrow or regret is not to be taken as an admission of liability unless the expression of regret provides a clear acknowledgement of fault. Similarly, following an adverse outcome, a reduction or waiver of fees does not constitute an admission of liability at law. However, if in the course of open disclosure, facts or objective information are provided, that information could later be used in litigation. It is only the expression of regret or sorrow or the waiver or reduction of fees that are protected by the Victorian legislation. If there are likely to be medico-legal implications arising from the adverse event, the health service provider needs to obtain appropriate advice before acting. Summary of open disclosure principles 1. Openness and timeliness of communication information should be provided in an open and honest manner. 2. Acknowledgement adverse events should be acknowledged to the patient and their support person as soon as practicable. 3. Expression of regret the patient and their support person should receive an expression of regret for any harm from an adverse event as early as possible. 4. Recognition of the reasonable expectations of the patient and their support person they can expect to be fully informed, to be treated with empathy and respect, and to be given support. 5. Staff support staff should be encouraged to recognise and report adverse events and supported through the open disclosure process. 6. Integrated risk management and systems improvement investigations should focus on the management of risk and on improving systems of care. 7. Good governance adverse events should be analysed and there should be a system of accountability so that changes to prevent recurrence are implemented and their effectiveness reviewed. 8. Confidentiality the privacy and confidentiality of patients, carers and staff should be protected, in accordance with state and federal law. For the full principles, refer to the Standard (see Other resources, p. 4). Guiding principles for an effective complaint handling system 7

13 3. Commitment The health service and its senior management are fully committed to an integrated complaints management system and will provide the necessary support for it to operate effectively. One of the most significant factors in the success of a complaints management system is leadership and commitment from senior staff. The governing body of the organisation must provide policy leadership and organisational structures to support that policy. Management plays a critical role in the creation of an environment that views complaints positively and encourages learning. The senior levels of the organisation need to be open to the outcomes of investigation of complaints, and be prepared to respond constructively. All health organisations should have a clear complaints process, which is co-ordinated by a senior staff member to ensure that complaints are dealt with effectively and promptly. Management commitment to structural support in the form of systems, tools and resources is also essential. Commitment is also required from all stakeholders across the organisation, including doctors, nurses, allied health and administration staff. All staff need to be willing to participate actively in resolution of complaints as part of their everyday work and to implement change as a result if necessary. Staff should be given the necessary training and support to do so. 4. Accessibility The health service encourages consumers and staff to give feedback about the service and makes it easy for them to do so. The complaints management system should be accessible and promoted throughout the organisation to both consumers and staff. It should be clear to patients, their families and staff how to make a complaint or offer feedback. The promotional material should make it clear that comments are welcome. Complaints processes should be user-friendly, making it easy for consumers to make a verbal or written complaint. Consumers can talk to any staff member about their concerns. If the staff member cannot help, they can call in a more senior person to assist, or direct the consumer to the appropriate person such as the unit manager or complaints manager. Accessibility of a complaints system involves practical considerations. For example, staff need to be aware of the existence of the complaints manager and know how the complaints process works in the organisation. Consider also the need for the complaints process to function 24 hours a day, seven days a week. It is important that the complaints process is accessible for people who speak languages other than English and for people with physical or intellectual impairments (see the section on Complaint handling skills for further discussion of communication issues). Promotional material can be made available in other languages. 5. Responsiveness The health service has a consumer-focused approach, being receptive to complaints and treating complaints seriously. Health organisations should be receptive to complaints rather than viewing them as a nuisance or a waste of time. Complaints should be seen as an important source of constructive feedback and treated as a matter of priority. Health care is a partnership. Consumers must not be victimised or discriminated against if they complain, nor should they be treated as a nuisance. This may take the form of negative attitudes comments from staff such as If you come into our hospital you have to be prepared to follow our rules should be discouraged. Patients and their families and friends have a right to complain about the provision or standard of any service at any time, using their preferred communication method. This is set out in the Victorian Public 8 Guiding principles for an effective complaint handling system

14 Hospitals Patient Charter. All complaints should be treated seriously, even if at first some seem unreasonable or trivial. The organisation should help consumers to detail their complaints fully and to participate effectively in the handling of their complaint. This requires flexibility with regard to communication methods. It is unreasonable to expect all complaints to be in writing if necessary, a written record can be made by a staff member. The aim of the system should be to make it easy for consumers to give their feedback or ask questions. 6. Transparency and accountability The complaints process is clearly articulated, open and accountable to both staff and consumers. The complaint system should be consistently applied, open and fair. The organisation should clearly articulate the steps involved in the process and the options available for resolution. The consumer should also be informed about their right to complain to the Health Services Commissioner if they are not satisfied with the organisation s process. The person complaining should be kept informed about the status of the complaint throughout the process. If possible, they can be involved in discussion about outcomes. They should also be given information at the end about what steps the organisation has taken as a result of their complaint. Health providers also have a responsibility to the wider community to be transparent about the safety of their health care. Information about complaint trends and steps the organisation has taken to address problems should be publicly available, e.g. through the organisation s Quality of Care Report or annual report. 7. Privacy and confidentiality The health service respects the privacy and confidentiality of consumers and the information received during the complaints process, while at the same time making its decisions open and accountable. All complaints will be treated confidentially, with information used only for the primary purpose for which it was obtained. Information about complaints should be stored separately from the medical record and should not form part of the medical record. The privacy of those involved should be protected, as much as possible, during the complaints process. Investigations should be conducted discretely and staff should be alerted to the importance of not gossiping about what has happened. This applies, not only to the privacy and confidentiality of consumers, but equally importantly to the privacy and confidentiality of staff. All health organisations need to be mindful of their responsibilities under state and federal privacy, health records and freedom of information laws. Nevertheless, it is important that relevant facts are communicated to the people involved and that there is open communication about the investigation process and outcomes. Guiding principles for an effective complaint handling system 9

15 Putting the principles into practice Using the guiding principles, the table below demonstrates the components of an integrated system. An audit tool has been included in the Section on Setting up your system to enable health service providers to assess whether their current practice accords with the desired practice indicators outlined in the table below. Key principle Quality improvement Desired practice Quality and risk management teams are in place to analyse data and inform organisational changes. Information about complaints and other feedback from consumers is regularly reported to senior management and quality and risk management teams. Lessons learnt from complaints are used for system improvements. Complaint trends are reviewed regularly by quality and risk management teams. Findings from complaints are regularly communicated to staff. Open disclosure The organisation has adopted the national standard on open disclosure. Staff involved in giving information to patients are fully informed about the issues relevant to open disclosure. Staff are encouraged and supported to report adverse events. Information from open discussion of adverse events is shared throughout the organisation and used to inform clinical practice and organisational processes. Commitment Accessibility Adequate resources are provided to support an effective complaints management system. There are clear policies in place for adverse events, incident reporting and complaint handling. All health providers have a complaints process overseen by a designated complaints manager who has the support of senior management. Staff across all levels of the organisation are trained in complaint handling and able to deal with first point of contact. Staff responsible for investigating and resolving complaints are trained in complaint handling and have a systems focus. Staff are encouraged to make suggestions and identify problems even if a complaint is not made there is a system in place for staff to report concerns. The organisation has an easy-to-use recording system to track complaints. Complaints data is collated to identify patterns and trends and to report to senior management and quality and risk management committees. Information is widely available to consumers on how to make a complaint, including: a general information package, brochures, posters and signage that explain how consumers can lodge complaints or provide general feedback and where they may do so. These should be available throughout the organisation. There are multiple access and referral points within the organisation and these are actively promoted to consumers. The access and referral points and related information are user-friendly for the most disadvantaged members of the community. Information and signage are available in relevant community languages. The complaint process is easy for all consumers to use. Complaints can be made 24 hours a day, seven days a week. 10 Guiding principles for an effective complaint handling system