Complaint Management in Complaint Management in Victorian Acute Health Care Victorian Acute Health Care

Public Hospitals Public Hospitals & &

the key characteristics of Complaint the key characteristics of Complaint Liaison OfficersLiaison Officers

33rdrd National Health Care Complaints Conference National Health Care Complaints ConferenceThursday March 29, 2001Thursday March 29, 2001

Kay CurrieKay Currie

Background Background AimsAims ParticipantsParticipants MethodMethod ResultsResults Future directionsFuture directions

BackgroundBackground

LegislationLegislationCurrent situationCurrent situationRelationship to qualityRelationship to qualityAccreditationAccreditationNumber of complaints as an outcome Number of complaints as an outcome indicatorindicatorModelsModels

AimsAims

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

ParticipantsParticipants

Complaint liaison officers in acute health Complaint liaison officers in acute health care public hospitals in Victoriacare public hospitals in Victoria

Hospitals categorised as A 1, A2, BHospitals categorised as A 1, A2, B

Other staff who handle complaintsOther staff who handle complaints

CLOs (6)CLOs (6)

MethodMethod

Ethics approvalEthics approval Contact 37 hospitalsContact 37 hospitals Notify all CEOsNotify all CEOs Focus GroupFocus Group Statistical analysisStatistical analysis QuestionnaireQuestionnaire

QuestionnaireQuestionnaire

25 items25 items5 sub sections:5 sub sections:

1. Hospital, network, name1. Hospital, network, name2. Specialist role, key person2. Specialist role, key person3. Demographic profile3. Demographic profile4. Organisation & culture4. Organisation & culture5. Relationship to other internal & 5. Relationship to other internal & external programsexternal programs

Question 10Below 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.

ResultsResults

Response rate to questionnaireResponse rate to questionnaire

Response Rate for Metropolitan Response Rate for Metropolitan and Regional Hospitalsand Regional Hospitals

RegionalRegional MetropolitanMetropolitan TotalTotal

RespondedResponded 10 (63%) 14 (67%) 24 (65%)NS

Non responseNon response 6 (37%) 7 (33%) 13 (35%)

TotalTotal 16 (43%) 21 (57%) 37(100%)

ResultsResults

Response rate to questionnaireResponse rate to questionnaire CLO profileCLO profile

0123456

CLOs

<12months

12-24months

25-36months

37-48months

49-60months

>61months

Time

Length of time in the position

Distribution of age categories for complaint liaison officers in regional and metropolitan hospitals

01234567

30-39 40-49 50-59 60+ Other

RegionalMetropolitan

Complaint Liaison Officers:Highest education level achieved (%)

PrimarySecondaryTertiaryPost GraduateNot reported

0

5

10

15

20

25

Scores/frequencies

1 2 3 4 5 6 7 8

Data points

Training scores and frquencies for training type undertaken by CLOs

FrequenciesScores

ResultsResults

Response rateResponse rate CLO profileCLO profile Issues categoriesIssues categories

Differences on issues categories Differences on issues categories between specialist & non between specialist & non specialist CLO staffspecialist CLO staff

AccessAccess The average(mean) number of access issues was The average(mean) number of access issues was

significantly greater where there was a specialist CLO significantly greater where there was a specialist CLO staff.staff.

TreatmentTreatment Treatment issues were significantly lower where there Treatment issues were significantly lower where there

were specialist CLO staff.were specialist CLO staff.

0 5 10 15 20 25 30 35

Percentage

Access

Administration

Cost

Communication

Rights

Treatment

Issu

es c

ateg

ory

Comparison of proportion of complaint issues between sample and HCIP as reported in Health

Services Commissioner Annual General Report, 1999 HCIPSample

ResultsResults

Response rateResponse rate CLO profileCLO profile Issues categoriesIssues categories Total numbers of complaintsTotal numbers of complaints

Number of complaintsNumber of complaints22 of 24 (92%) hospitals reported 22 of 24 (92%) hospitals reported number of complaints for 1999number of complaints for 1999Regional hospitalsRegional hospitals

mean = 86, range 10-283mean = 86, range 10-283Metropolitan hospitalsMetropolitan hospitals

Mean = 205, range 32 – 420Mean = 205, range 32 – 420Significant relationship found between Significant relationship found between specialist complaints management staff specialist complaints management staff and increased number of complaints.and increased number of complaints.

0

1

2

3

4

5

Frequencies

Under 50 50-100 101-150 151-200 201-250 251-300 351-400 401-450

Categories

Number of complaints (1999) by regional and metropolitan hospitals

Regional Metropolitan

050

100150200250300350400450

Number of complaints

1 2 3 4 5 6 7 8 9 10 11

Number of complaints by hospital with and without a designated complaint liaison officer

DedicatedCLONo dedicatedCLO

ResultsResults

Response rateResponse rate CLO profileCLO profile Issues categoriesIssues categories Total numbers of complaintsTotal numbers of complaints Models of complaint managementModels of complaint management

Models of practiceModels of practiceNo significant differences found between No significant differences found between metropolitan & regional hospitals.metropolitan & regional hospitals.No model of practice was identified by No model of practice was identified by 54% of complaints management staff.54% of complaints management staff.

46% metropolitan46% metropolitan 54% regional54% regional

Where a model was nominated, 72% had Where a model was nominated, 72% had specialist CLOs specialist CLOs

ResultsResults

Response rateResponse rate CLO profileCLO profile Issues categoriesIssues categories Total numbers of complaintsTotal numbers of complaints Models of complaint managementModels of complaint management Attitudinal issuesAttitudinal issues

Attitudinal variablesAttitudinal variables

Regional staffRegional staff Did not think complaints were a good quality Did not think complaints were a good quality

indicatorindicator

Specialist staffSpecialist staff Saw complaints as reliable quality and Saw complaints as reliable quality and

patient satisfaction indicatorspatient satisfaction indicators Felt unsubstantiated complaints should not be Felt unsubstantiated complaints should not be

disregardeddisregarded Did not think most complainants usually Did not think most complainants usually

wanted compensationwanted compensation

ResultsResults

Response rateResponse rate CLO profileCLO profile Issues categoriesIssues categories Total numbers of complaintsTotal numbers of complaints Models of complaint managementModels of complaint management Attitudinal issuesAttitudinal issues Focus GroupFocus Group

Focus groupFocus group

UnsupportedUnsupportedIsolatedIsolatedData & reports often under-utilisedData & reports often under-utilisedThe need for more and better trainingThe need for more and better trainingLack of autonomyLack of autonomyOften felt powerless – staff, patientsOften felt powerless – staff, patients

CLOs indicated they often felt:CLOs indicated they often felt:

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

Future DirectionsFuture Directions

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