Complaints Management at DHBs

Helen Davidson

Principal Legal Advisor

& Jessica Mills

Senior Legal Advisor Acting Director of Advocacy 2015 HDC Conference

Improving 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

300 200 100 0 600 500 400 700

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

2009/2010 2010/2011 2011/2012 2012/2013 2013/2014

DHB Complaints

80 70 20 10 0 40 30 60 50

Rate of complaints received about DHBs per 100,000 discharges

2009/2010 2010/2011 2011/2012 2012/2013 2013/2014

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

Why a good complaints management system is important

• • • Complaints are inevitable Allows complaints to be handled systematically and fairly Ensures there is a mechanism for consumer input into quality improvement

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 12HDC00932 service 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 12HDC00932 service 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

Learn and prevent Be open to complaints Put it into practice Be ready to respond

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 Learn and prevent Be open to complaints Put it into practice Be ready to respond

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 Learn and prevent Be open to complaints Put it into practice Be ready to respond

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 Learn and prevent Be open to complaints Put it into practice Be ready to respond

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 Learn and prevent Be open to complaints Put it into practice Be ready to respond

• • • • •

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.

Case example 09HDC01040 delayed response

• • 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.”

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 Learn and prevent Be open to complaints Put it into practice Be ready to respond

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