complaint management in victorian acute health care public hospitals & the key characteristics...
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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
LegislationLegislation
Current situationCurrent situation
Relationship to qualityRelationship to quality
AccreditationAccreditation
Number of complaints as an outcome Number of complaints as an outcome indicatorindicator
ModelsModels
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 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.
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%)
0
1
2
3
4
5
6
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
0
1
2
3
4
5
6
7
30-39 40-49 50-59 60+ Other
Regional
Metropolitan
Complaint Liaison Officers:Highest education level achieved (%)
Primary
Secondary
Tertiary
Post Graduate
Not 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
Frequencies
Scores
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
HCIP
Sample
ResultsResults
Response rateResponse rate
CLO profileCLO profile
Issues categoriesIssues categories
Total numbers of complaintsTotal numbers of complaints
Number of complaintsNumber of complaints
22 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 10-283
Metropolitan hospitalsMetropolitan hospitals Mean = 205, range 32 – 420Mean = 205, range 32 – 420
Significant 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
0
50100
150
200250
300
350400
450
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 practice
No 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
UnsupportedUnsupported
IsolatedIsolated
Data & reports often under-utilisedData & reports often under-utilised
The need for more and better trainingThe need for more and better training
Lack of autonomyLack of autonomy
Often 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.