Best Practice in Health Complaints Management: Review of the Health Services (Conciliation and Review) 1987


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by Beth Wilson, Health Services Commissioner and Kathy Ettershank, Principal Policy Officer, Policy Coordination and Projects Branch, Strategy and Policy Division, Department of Health, Victoria delivered this presentation at IIR’s 2012 Healthcare Complaints Management conference. For more information about our wide range of medical and health events covering a broad range of industry issues, please visit

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Best Practice in Health Complaints Management: Review of the Health Services (Conciliation and Review) 1987

  1. 1. Best practice in health complaints management: Review of the Health Services (Conciliation and Review) Act 1987 Beth Wilson, Victorian Health Services Commissioner Kathy Ettershank, Review Team, Department of Health, Victoria 3rd Annual Health Care Complaints Management Conference 24 September, 2012
  2. 2. Health Complaint Commissioners in Australia and New Zealand What we do • The Health Services Commissioner (HSC) receives and resolves complaints about health service providers with a view to improving the quality of health services for everybody. Legislation • Health Services (Conciliation and Review) Act 1987 • Health Records Act 2001
  3. 3. Background – the Act Guiding Principles • Quality healthcare, given as promptly as circumstances permit • Considerate healthcare • Respect for the privacy and dignity • Adequate information on services and treatment available, in terms which are understandable • Participation in decision making • Environment of informed choice in accepting or refusing treatment or participation in education or research programs
  4. 4. What are the complaints about? • Communication Issues • Informed consent • From blame to mediation and learning
  5. 5. HSC processes Assessment, Mediation and Conciliation – Impartial & confidential • Formal Inquiries/Investigation • Referrals
  6. 6. HSC vis a vis AHPRA • HSC and Boards continue to inform each other of relevant complaints received. Must also consult each other on the handling of complaints • Must reach agreement on whether a complaint should be taken further by Board. • If agreement cannot be reached the more serious view of the matter will prevail and Board will carry complaint forward on that basis.
  7. 7. Experiences of the HSC following changes to the Wrongs Act in 2001 • Even where very serious mistakes leading to ongoing symptoms and inability to rejoin workforce - may still be insufficient level of impairment to satisfy requirements of the Wrongs Act.
  8. 8. Delays and Expenses for HSC • Significant delays • Assessments are expensive • Implications of psychiatric assessments
  9. 9. Attitudes of Medical Insurers Changes of attitude since Wrongs Act – “dramatic”. • Causes frustrations to conciliators. • Over the threshold still not compensated because not permanent. • Significant “stuff up” but no compensation. • HSC has to refer people to lawyers. • Extra work for the courts.
  10. 10. Claims and Settlements There has been: • decrease in the amounts paid and • decrease in the number of middle-ranking settlements, i.e. approximately $20,000 to $50,000 where it is not realistic to litigate without “topping up” the special damages with general damages. • Large claims and small out-of-pocket and refunds (ex gratia) etc are pretty much unaffected.
  11. 11. Success Stories • Advising solicitors and the insurers sympathetic to objects of act and HSC‟s processes - good results • Cooperative attitudes from providers, can get good outcome for injured individuals. E.g., local examination sufficient. Processes rely enormously on goodwill. • Some health services do not insist on technicalities because clear from medical reports there is problem.
  12. 12. Expert Review Panel’s Review of the Health Services (Conciliation and Review) Act 1987 March – December 2012
  13. 13. Process • External panel of experts to advise Minister • Discussion Paper launched by Minister 20 June 2012 • 6000 complainants/respondents, 887 (others) • Submissions in response to Discussion Paper • 270 individuals (230 complainants), 82 organisations • Preliminary consultations • 33 individuals, organisations and consumer forums • Complainants Study • Roundtable consultation - October • Options Paper to Minister this year • New legislation 2013
  14. 14. Terms of reference Examine whether changes are required to: • reflect best practice in health complaints resolution for all health service users • strengthen the role of the HSC in improving the health system and the patient experience • respond to a changing health service environment and changes in legislation • address any scope, policy or operational issues in the current legislation
  15. 15. The context for reform • New challenges in healthcare • Changes in health system management • National health practitioner regulation • Related legislative changes • A maturing health quality and safety framework • Expansion and development of complaints resolution schemes
  16. 16. The complaints process – 2010–11 statistics (Total of 2,183 complaints closed) Conciliation Assessment Enquiry 1,046 (48%) complaints closed Complaints declined, resolved, withdrawn or referred 899 (41%) complaints closed - Referral - Advice resolves - Local resolutions successful 238 (11%) complaints closed Complaints resolved, withdrawn, referred or deemed non-conciliable Investigation No investigations conducted in 2010–11
  17. 17. HSCRA 1987 – functions of the Commissioner Core function • Resolution of complaints Additional functions • collection and use of complaints information to improve the quality of healthcare • broader inquiries and investigations • education, training and guidance about the prevention or resolution of complaints
  18. 18. Complaints • Facilitate efficient local resolution – Role in ensuring good practice through training and education for providers – empower consumers to resolve complaints • Who should be able to lodge complaint (e.g. third parties, class complaints)? • Advocates/support, „self advocacy‟
  19. 19. Preliminary Assessment process • Timeframe for assessment process • Time limits for provider response • Formal mechanisms in the legislation to facilitate assisted early resolution – e.g. mediation/ preliminary inquiry powers • Mechanisms for working with referral bodies, e.g. AHPRA and boards
  20. 20. Conciliation • „Public interest‟ considerations • Power to request information • Options where non-compliance • E.g. stronger naming powers
  21. 21. Investigation • Commissioner initiated investigations • Codes/ Standards • Non-compliance with recommendations and follow-up – Reporting and publication/ „Naming powers‟ – Referral, e.g. Department or board • Sharing of information
  22. 22. Incompetent/ impaired or unethical unregistered providers • Extent of the problem • Code of Conduct • Naming powers • Prohibition orders • Inter-jurisdictional co-operation
  23. 23. HSC’s complainants study The research specifically aims to identify: • whether or not the complainants in the proposed study experienced a gap between their expectations and their experience of the Commissioner‟s complaints process • Whether, and to what extent, lack of understanding of what can be achieved by lodging a complaint with the Commissioner contributes to the gap between expectations, outcome and experience.
  24. 24. • Representative sample of approximately 400 adult complainants • Only complainants with closed cases over the last 3 years will be approached to participate. • Survey methodology using computer assisted telephone interview (CATI) will be employed. • A third party research company undertaking data collection HSC’s complainants study
  25. 25. Thank you