Handling prfessinal cnduct cmplaints against dctrs
Handling prfessinal cnduct cmplaints against dctrs Handling prfessinal cnduct cmplaints against dctrs Avant supprts: à a natinally cnsistent apprach t cmplaints handling, nt nly in terms f prcess but als in terms f utcmes à a respnsive, risk-based apprach t managing cmplaints against medical practitiners à effective, fair and transparent management f cmplaints including: apprpriate triaging f cmplaints, especially thse that are minr r vexatius use f transparent perfrmance indicatrs relating t timeliness in the management f cmplaints parity in timeframes s that practitiners are able t have sufficient and equivalent time t respnd t regulatrs requests the prvisin f relevant infrmatin thrughut the life cycle f a cmplaint, t allw the practitiner t respnd and stay infrmed access t apprpriate clinical input and peer review f cmplaints t prvide prfessinal and clinical guidance t infrm regulatry decisin-making the ability t enter int alternative dispute reslutin, where apprpriate. Intrductin Avant is Australia s leading medical defence rganisatin, representing mre than 64,000 health practitiners and students. Avant assists dctrs in respnding t patient cmplaints thrughut Australia. Dctrs can receive cmplaints abut their prfessinal cnduct frm many surces. As well as receiving cmplaints frm prfessinal regulating bdies, practitiners can receive cmplaints frm ther regulatrs, such as the Department f Human Services abut billing practices and frm privacy regulatrs abut privacy breaches. Althugh this paper fcusses primarily n cmplaints t medical regulatrs abut dctrs prfessinal cnduct, many f the principles utlined belw apply equally t cmplaints handled by ther regulatry authrities. With changing patient expectatins and the increasing recgnitin f the imprtant interests f the cnsumer in the regulatry prcess, there is a risk f the practitiner s vice being lst. It is imprtant t make sure that thse being regulated are nt frgtten in the prcess f ensuring patient and cnsumer expectatins are met. Fr a regulatry system t be effective it must have the cnfidence f the prfessin being regulated. If the prfessin des nt have cnfidence in the regulatr, it will struggle t accept the cnsequences f regulatin. This will encurage an adversarial apprach t regulatin, leading t increased csts and reduced regulatry efficiency. Avant believes that an effective regulatry scheme fr dctrs shuld be based n the fllwing principles: à there shuld be a transparent prcess fr patients t make cmplaints r raise cncerns. à the regulatr s pwers t prtect the public shuld nt be exercised at the expense f the rights f practitiners t a fair prcess. June 2015 02
Handling prfessinal cnduct cmplaints against dctrs à allegatins shuld be investigated by a bdy with sufficient investigatry pwers, an understanding f the practice f medicine, and an understanding f the rle f a regulatr in prtecting the public. à the prcess shuld supprt the rights f dctrs t natural justice and prcedural fairness, including: t be given all relevant material under cnsideratin in a timely manner t have decisins made independently and bjectively, n the basis f relevant and cgent material The data n cmplaints The 2013/14 Australian Health Practitiner Regulatin Agency (AHPRA) annual reprt nted there was a 19% increase in cmplaints fr medical practitiners frm the previus year. It further reprted that: à 56% f all cmplaints received were fr dctrs, wh represent 16% f registered health practitiners à 4.9% f medical practitiners were subject t a cmplaint, which is the highest rate amngst registered health practitiners. t be given a sufficient pprtunity t be heard n matters affecting their ability t practise. Under the Health Practitiner Regulatin Natinal Law (Natinal Law), cmplaints abut the health, perfrmance r cnduct f a medical practitiner are called ntificatins. In this paper, cmplaint is used t refer t ntificatins under the Natinal Law as well as cmplaints t the Health Care Cmplaints Cmmissin (HCCC) in NSW and the Office f the Health Ombudsman in Queensland. Cmplaints received per year 6000 5000 4000 3000 2000 1000 0 2012 2013 2014 Calendar year Figure 1: Number f cmplaints fr registered medical practitiners 1 2012-2014 June 2015 03
Handling prfessinal cnduct cmplaints against dctrs Hw are cmplaints against dctrs handled in Australia? The Medical Bard f Australia (MBA) and AHPRA manage prfessinal cnduct cmplaints fr dctrs in Australia. Hwever, Queensland and NSW have their wn separate and different cmplaints handling prcesses fr practitiners based in these jurisdictins. In these states health cmplaints are managed by the NSW HCCC 2 and the Queensland Office f the Health Ombudsman 3 respectively. When a cmplaint is received by a cmplaints handling bdy it can prgress thrugh a number f stages. These include: à assessment à investigatin à use f the immediate actin pwer à health assessments à perfrmance assessments à actin after the cmpletin f assessments, investigatins, health r perfrmance assessments. There are key features that Avant believes a regulatry cmplaints system shuld have t further engender the cnfidence f medical practitiners and cnsumers alike. A cmplaints handling bdy shuld: à effectively triage cmplaints especially thse that are minr r vexatius à adhere t transparent perfrmance indicatrs relating t timeliness in the management f cmplaints à ensure that practitiners have sufficient and equivalent time t respnd t regulatrs requests à prvide relevant infrmatin thrughut the life cycle f a cmplaint, t allw the practitiner t respnd and stay infrmed à ensure that cmplaints are handled fairly, bjectively and efficiently, and in a transparent manner à access apprpriate clinical input and peer review f cmplaints t prvide prfessinal and clinical guidance t infrm regulatry decisin-making à enter int alternative dispute reslutin, where apprpriate. June 2015 04
Handling prfessinal cnduct cmplaints against dctrs Hw can cmplaint prcesses be imprved? Avant supprts a respnsive, risk-based apprach t managing cmplaints. This requires regulatrs t take the least intrusive curse f actin that will prtect the public frm the risk f harm, and nly escalate t mre frmal enfrcement when minimallyinvasive strategies d nt (r will nt) wrk. Avant further believes that there shuld be a natinally cnsistent apprach t cmplaints handling, nt nly in terms f prcess but als utcmes. An absence f cnsistency has led t cnfusin and delays regarding the rle f AHPRA, the MBA and statebased health cmplaints entities. Avant has further fund that management f cmplaints can at times be characterised by a lack f cmmunicatin, transparency and an inefficient use f investigative resurces. 4 Avant believes that there shuld be a statutry requirement that all relevant infrmatin cncerning a cmplaint be prvided t practitiners. Prvisin f all relevant infrmatin t dctrs at an early stage will greatly assist in speeding up the reslutin f matters and avid regulatrs and practitiners entering int prtracted debates abut prcedural fairness. Current regulatry prcesses have the ptential t adversely affect the mental, physical and financial health f medical practitiners. Avant believes that there shuld be greater acknwledgment by regulatrs f the impact f regulatry prcesses n dctrs health and wellbeing. Fr mre infrmatin, see Avant s psitin paper The impact f claims and cmplaints n dctrs health and wellbeing. [www.avant.rg.au/impact-f-cmplaints] The decisin t restrict practice The state and territry bards have the respnsibility f identifying matters where the evidence supprts the use f the immediate actin pwer. This pwer allws regulatrs t suspend the registratin f a practitiner if there is a serius risk t public safety. Avant cnsiders that use f emergency pwers ( immediate actin ) t restrict a practitiner s ability t practise shuld be prprtinate with the risk t be averted. T ensure this pwer is used fairly, legislative prvisins shuld be in place t allw a right f review fr any decisin t restrict a practitiner s practice withut the need t ldge an appeal in a tribunal. In Queensland, the Health Ombudsman can take immediate actin and restrict a practitiner s ability t practise withut reference f a cmplaint t a suitably qualified and experienced practitiner 5. The Health Ombudsman can use this pwer withut giving a practitiner the right t make a submissin abut whether the prpsed actin shuld be taken, r whether sme ther actin can be taken which prvides an apprpriate level f prtectin fr the public. In Avant s view, use f immediate actin pwer in this manner diminishes a practitiner s right t natural justice and cnfidence in the regulatry system. June 2015 05
Handling prfessinal cnduct cmplaints against dctrs Avant s psitin Avant supprts: à a natinally cnsistent apprach t cmplaints handling, nt nly in terms f prcess but als in terms f utcmes à a respnsive, risk-based apprach t managing cmplaints against medical practitiners à effective, fair and transparent management f cmplaints including: A apprpriate triaging f cmplaints, especially thse that are minr r vexatius use f transparent perfrmance indicatrs relating t timeliness in the management f cmplaints parity in timeframes s that practitiners are able t have sufficient and equivalent time t respnd t regulatrs requests the prvisin f relevant infrmatin thrughut the life cycle f a cmplaint, t allw the practitiner t respnd and stay infrmed access t apprpriate clinical input and peer review f cmplaints t prvide prfessinal and clinical guidance t infrm regulatry decisin-making the ability t enter int alternative dispute reslutin where apprpriate. Key submissins à Avant s submissin t the Review f the Natinal Registratin and Accreditatin Scheme [http://www.avant.rg.au/news/news-resurces/nrassubmissin/] à Avant s submissins t the Queensland Health and Cmmunity Services with respect t the Health Ombudsman Bill 2013 [http://www.avant.rg.au/wrkarea/dwnladasset.aspx?id=17179869954] à Avant s submissins t the Queensland Minister fr Health with respect t the review int the Perfrmance f the QBMBA, MBA and AHPRA [http://www.avant.rg.au/wrkarea/dwnladasset.aspx?id=17179869769] à Avant s submissins t the Victrian Legal and Scial Issues Cmmittee Inquiry int the Perfrmance f AHPRA. [http://www.avant.rg.au/wrkarea/dwnladasset.aspx?id=17179869559] 1 AHPRA Annual reprt 2013-14, Australian Health Practitiner Regulatin Agency, Melburne 2 Health Care Cmplaints Act 1993 (NSW). 3 Health Ombudsman Act 2013 (QLD). 4 Avant s submissin t the Review f the Natinal Registratin and Accreditatin Scheme fr Health Practitiners. 5 Health Ombudsman Act 2013 (QLD) s58. June 2015 06