Complaints Management at DHBs

Helen DavidsonPrincipal Legal Advisor

&Jessica Mills

Senior Legal AdvisorActing Director of Advocacy

2015 HDC ConferenceImproving the Consumer Experience

9 March 2015

Overview

• Complaints resolution and the HDC Act

• DHBs and complaints management

• Good complaints management systems

• Case examples

Complaints resolution and the HDC Act

Health and Disability Commissioner Act

“An Act to promote and protect the rights of health consumers and disability services consumers, and, in particular, - (a) to secure the fair, simple, speedy, and efficient resolution of complaints relating to infringements of those rights …”

HDC Act: who resolves complaints

• The Health and Disability Commissioner• The Health and Disability Advocacy Service• Providers of health and disability services:

– Right 10 of the Code– Section 33 of the HDC Act

Why complain

• People complain to:– receive information– be taken seriously– improve care quality– receive an apology– ensure accountability

Consumers/complainants are most satisfied when these outcomes are met directly, at the point of service

DHBs and complaints management

DHB Complaints Number of complaints received about all DHBs over the last five years

2009/2010 2010/2011 2011/2012 2012/2013 2013/20140

100

200

300

400

500

600

700

DHB Complaints

2009/2010 2010/2011 2011/2012 2012/2013 2013/20140

10

20

30

40

50

60

70

80

Rate of complaints received about DHBs per 100,000 discharges

What the data tells us

Consumers raised concern about DHBs providing an inadequate response to their complaint in 20% of complaints to HDC about DHBs in 2013/14.

What consumers tell us

What consumers tell us

Concerns expressed about DHB responses (similar for most DHBs):• response not timely• unsatisfactory response

– did not address all concerns– did not listen (minimised or dismissed consumer)

What DHBs have told us

• Room for development in the following areas:– getting frontline staff to accept

complaints as a learning opportunity and responding to patient feedback

– improving communication to management about complaint outcomes

– informing complainants about the progress of their complaints

– recognising early signs of dissatisfaction and facilitating meetings early on to address emerging concerns

Good complaints management systems

• Complaints are inevitable• Allows complaints to be handled systematically

and fairly• Ensures there is a mechanism for consumer input

into quality improvement

Why a good complaints management system is

important

Why manage complaints well

“The consumer’s voice for bringing change is a powerful one” Anthony Hill, Commissioner

• Managed well, complaints can:– help us learn from mistakes– identify gaps in services– provide trend data that is useful for quality

improvement– restore trust and mend relationships

Case example 12HDC00932service improvement

• Obstetric registrar breached Code for proceeding to an instrumental delivery without recognising the complexity of a woman’s presentation during labour

• DHB in breach for systemic issues: – did not have a culture that sufficiently supported the

registrar – Placed onus on junior staff to identify limits of their

expertise

Case example 12HDC00932service improvement

• DHB implemented new policy for mandatory consultant involvement in all mid-cavity and rotational instrumental deliveries, except where registrar credentialed

• HDC recommended the DHB: – audit compliance with the new policy– provide HDC with a report on adverse outcomes– communicate with all DHBs to ensure that DHB policies

in relation to the supervision of obstetrics registrars are consistent

Features of a good complaints management

system

Be open to complaints

Be ready to respond

Put it into practice

Learn and prevent

Be open to complaints

• Have a clear, visible, and accessible complaints process– inform consumers that they can complain

to you and how• Encourage an organisational culture

that: – welcomes complaints (from staff and

consumers) – encourages staff to respond positively and

proactively – has a quality improvement focus

Be open to complaints

Be ready to respond

Put it into practice

Learn and prevent

Case example: accessible complaints process

• Consumer complained verbally to frontline staff • Told she could only make a complaint in writing• HDC referred complaint back to the DHB• DHB met with the consumer • ED staff, clerical and others, were reminded that

complaints can be made verbally• DHB reported that complaint was satisfactorily

resolved with the consumer

Be ready to respond

• Ensure DHB’s expectations for complaints handling is clear

• Train staff to recognise and respond to complaints

• Put in place a system for managing complaints– a central department for complaints co-

ordination– consistent and fair system for logging and

responding to complaints– electronic systems to gather complaints and

trends

Be open to complaints

Be ready to respond

Put it into practice

Learn and prevent

Put it into practice

• Recognise a consumer is dissatisfied• Identify their concerns and desired

outcomes• Record and acknowledge complaint• Notify appropriate senior staff and

staff concerned• Keep consumer updated on process

Be open to complaints

Be ready to respond

Put it into practice

Learn and prevent

Put it into practice

• Formulate a response– consider who should be involved in the response:

staff concerned, senior staff, interpreter– content of the response: does it address the

consumer’s concerns, offer an explanation, accept responsibility and apologise (where appropriate), point to change to avoid repetition

– how to best communicate the response: meeting, written response

• Involve the consumer/complainant in the resolution process

• Check in with complainant/consumer to see whether resolution is achieved

Be open to complaints

Be ready to respond

Put it into practice

Learn and prevent

Case example: poor communication of response• Woman concerned about the clinical care provided to

her husband before he died• DHB undertook a SER, met with the woman and

apologised• Woman felt isolated from the discussion as she did

not understand the content• HDC concerned man’s wife left with unanswered

questions• HDC asked DHB to arrange a further meeting with the

man’s wife

Case example 11HDC00877 adequacy of investigation

• 15-year-old boy with intellectual impairments and high needs in the care of a community home

• In 2009, two of the boys carers met with the DHB and raised concerns that the team leader was physically and verbally abusing the boy

• No evidence that the carers’ concerns were formally investigated and DHB did not inform the boy’s parents of the complaints and action taken

Case example 11HDC00877 adequacy of investigation

• Further concerns brought to attention of parents• In 2010 the boy’s parents complained to Police and

National Health Board• DHB conducted a paper-based investigation, did not

interview staff and did not involve the boy’s parents. DHB concluded complaints not substantiated.

• Further review in 2011 and 2012, which involved staff interviews, found a high probability that the team leader had physically and verbally abused the boy

Case example 11HDC00877 adequacy of investigation

• HDC concluded that:– the DHB’s response to the concerns raised about the

care provided to the boy fell well short of the expected standard and placed the boy’s safety at risk

– the DHB breached Rights 4(1) and 4(4) for failing to adequately respond to concerns about the boy’s care

– the DHB breached Rights 1 and 6 for failing to provide the boy’s legal guardians with adequate information

– The DHB was referred to the Director of Proceedings

Case example 11HDC00877 adequacy of investigation

“In my view, given the nature and seriousness of the allegations made, a paper-based review [in 2010] was wholly inadequate. It is difficult to justify a decision to conduct only a paper-based review in response to serious allegations of abuse of a vulnerable consumer. As is evidenced by Mr H’s review a year later in 2011, evidence supporting Mr and Mrs A’s concerns would have been available from staff if they had been interviewed in the course of the … investigation, and had been supported to raise their concerns.”

Case example 11HDC00877 adequacy of investigation

“Mr and Mrs A were not informed about what was happening with their son and, as his legal guardians, they should have been. Master A is a vulnerable consumer and his parents are his guardians and advocates. Not to involve Mr and Mrs A in that process was contrary to the principles of transparency and engagement.”

Case example 09HDC01040 delayed response

• Friend of a 79-year-old woman complained to a DHB about delays in arranging specialist urological services in a provincial hospital

• DHB took four and a half months to respond to the complaint – advised that the complaint had been mislaid

• The letter included an apology for the delay in responding, but no explanation as to why this occurred.

• Complaint to HDC – about care and DHB’s response to the complaint

• DHB breached Right 10(3) due to delay in responding to the complaint and the response did not reflect a fair investigation of the complainant’s concerns.

Case example 09HDC01040 delayed response

The Commissioner stated:“In my experience, most complaints are made because consumers and their representatives want to know that where a service has been deficient, improvements are made so that other patients do not experience the same problems. Handled with due care and consideration, complaints can provide opportunities for learning and improvement. Handled badly, they can inflame a situation and increase mistrust. Dealing with complaints effectively and meaningfully is an essential part of providing a quality health care service.”

Case example 09HDC01040 delayed response

Learn and prevent

• Use complaint trends to improve quality

• Share learnings from complaints – internally and across DHBs

• Keep senior management, Board and Chairs informed

• Capture positive feedback about quality improvements

• Be accountable

Be open to complaints

Be ready to respond

Put it into practice

Learn and prevent

Lessons

• Get the basics right:– have an open, fair and easily accessible complaints

process– be responsive to the consumer (acknowledge, involve

in the resolution process, and update)– culture and staff training– integrate complaints management across the

organisation– be thoughtful in how to best respond to the complaint– collect data and monitor complaints for quality

improvement purposes

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 Service

www.hdc.org.nz