3 rd National Health Care Complaints Conference Thursday March 29, 2001 Kay Currie

1. Complaint Management in Victorian Acute Health Care Public Hospitals & the key characteristics of Complaint Liaison Officers 3rd National Health Care Complaints Conference Thursday March 29, 2001 Kay Currie

2. Background • Aims • Participants • Method • Results • Future directions

3. Background • Legislation • Current situation • Relationship to quality • Accreditation • Number of complaints as an outcome indicator • Models

4. Aims • To identify models of complaint management in acute metropolitan and regional public hospitals in Victoria. • To profile complaint liaison officers • To determine the relationship if any, between models of complaint management & the number of complaints received.

5. Participants • Complaint liaison officers in acute health care public hospitals in Victoria • Hospitals categorised as A 1, A2, B • Other staff who handle complaints • CLOs (6)

6. Method • Ethics approval • Contact 37 hospitals • Notify all CEOs • Focus Group • Statistical analysis • Questionnaire

7. Questionnaire 25 items 5 sub sections: 1. Hospital, network, name 2. Specialist role, key person 3. Demographic profile 4. Organisation & culture 5. Relationship to other internal & external programs

8. Question 10 • Below are a number of statements that may reflect the complaints management practices in your hospital. Please tick ONE response for each statement that reflects what YOU BELIEVE to be the current practice in your organisation. • 1 = Yes, 2 = Sometimes, 3 = Not sure 4 = Rarely, 5 = No • Signage about how and where to complain is prominently displayed throughout the hospital. • Pamphlets on complaint processes are distributed to patients. • A patient Charter of Rights is widely displayed throughout the hospital. • The organisation has a formal written complaint management policy. • Patient complaints and the outcomes are recorded in the patient's medical history. • Staff share a common understanding of the definition of a complaint.   • Clinicians value patient complaint data.  • Information on the services of the Health Services Commissioner is readily available to patients, their families and friends.  • Hospital staff have regular education and training in managing patient complaints.  • Staff respond defensively to patient complaints.  • Complaints received by staff are recorded.

9. Results • Response rate to questionnaire

10. Response Rate for Metropolitan and Regional Hospitals

11. Results • Response rate to questionnaire • CLO profile

16. Results • Response rate • CLO profile • Issues categories

17. Differences on issues categories between specialist & non specialist CLO staff • Access • The average(mean) number of access issues was significantly greater where there was a specialist CLO staff. • Treatment • Treatment issues were significantly lower where there were specialist CLO staff.

19. Results • Response rate • CLO profile • Issues categories • Total numbers of complaints

20. Number of complaints • 22 of 24 (92%) hospitals reported number of complaints for 1999 • Regional hospitals • mean = 86, range 10-283 • Metropolitan hospitals • Mean = 205, range 32 – 420 • Significant relationship found between specialist complaints management staff and increased number of complaints.

23. Results • Response rate • CLO profile • Issues categories • Total numbers of complaints • Models of complaint management

24. Models of practice • No significant differences found between metropolitan & regional hospitals. • No model of practice was identified by 54% of complaints management staff. • 46% metropolitan • 54% regional • Where a model was nominated, 72% had specialist CLOs

25. Results • Response rate • CLO profile • Issues categories • Total numbers of complaints • Models of complaint management • Attitudinal issues

26. Attitudinal variables • Regional staff • Did not think complaints were a good quality indicator • Specialist staff • Saw complaints as reliable quality and patient satisfaction indicators • Felt unsubstantiated complaints should not be disregarded • Did not think most complainants usually wanted compensation

27. Results • Response rate • CLO profile • Issues categories • Total numbers of complaints • Models of complaint management • Attitudinal issues • Focus Group

28. Focus group • Unsupported • Isolated • Data & reports often under-utilised • The need for more and better training • Lack of autonomy • Often felt powerless – staff, patients CLOs indicated they often felt:

29. ‘It is perceived (by the hospital) as administrative … [but] it is definitely not an administrative role.‘ • ‘There is an incorrect perception I’m trained in mediation processes and basic clinical work.’ • ‘People need to know… when they came to see you that you’ve actually got the responsibility and have power to act.’ • ‘No one actually looks at trends or actually reoccurring problems.’ • ‘If this is a serious role in the hospital, why am I not there to present my report and answer…’ • ‘once I’m dealing with personalities in the medical area I start to get problems because each of them has their own idiosyncrasies. One in particular hampers complaints …… they get lost” • you are often dealing with conflicts between what the doctor told the patient and what a nurse told the patient and you find the two don’t mix that well’ • ‘Oh god—not you again.’

30. Future Directions • Need for more research especially into the relationship between adverse events, quality & complaints. • Lack of evidence about the efficacy of the different models. • Need to better define job specifications that reflect the complexity, seniority & scope necessary for the position. • Need to establish specific training & qualifications.