Handling complaints: Handling complaints: research and developmentsresearch and developments

Professor Johan LegemaateProfessor Johan LegemaateVrije Universiteit AmsterdamVrije Universiteit Amsterdam

EPSO, Tallinn, 21 May 2010EPSO, Tallinn, 21 May 2010

A complaintA complaint

Expression of Expression of dissatisfaction with dissatisfaction with the healthcare the healthcare delivered to the delivered to the patientpatient

A complaint has to be A complaint has to be distinguished from: distinguished from: signal, report, signal, report, incident, adverse incident, adverse event etcevent etc

The right to complainThe right to complain

Is a key feature Is a key feature of the patients’ of the patients’ bill of rightsbill of rights

To enforce your To enforce your substantive substantive rights or to clarify rights or to clarify issues that are issues that are not yet regulatednot yet regulated

Health professionals: strong Health professionals: strong feelingsfeelings

They fear ‘a culture of They fear ‘a culture of complaints and claims’complaints and claims’

““A complaint is a free A complaint is a free advice”advice”

Handling complaints: the Handling complaints: the ‘aftersales’ of healthcare ‘aftersales’ of healthcare deliverydelivery

Council of Europe, 2006 Council of Europe, 2006

Council of Europe recommendation Council of Europe recommendation (2006)7 on the management of patient (2006)7 on the management of patient safety and prevention of adverse events in safety and prevention of adverse events in health care.health care.

““a fair and open complaints system, a just a fair and open complaints system, a just and adequate compensation system and and adequate compensation system and an efficient and reliable supervisory an efficient and reliable supervisory system.”system.”

Handling complaints: aimsHandling complaints: aims

To justify the (legal) needs of individual patients To justify the (legal) needs of individual patients To improve the quality of care on the basis of To improve the quality of care on the basis of

individual complaintsindividual complaints To detect structural quality problems in health To detect structural quality problems in health

care (complaint used as a signal)care (complaint used as a signal)

Related but yet different perspectives > different Related but yet different perspectives > different solutions, safeguards and requirementssolutions, safeguards and requirements

Handling complaints as a right of Handling complaints as a right of patients (individual dimension) (1)patients (individual dimension) (1)

WhatWhat does the patient want to achieve: does the patient want to achieve:

* * explanation, explanation, recognitionrecognition, , being taken seriousbeing taken serious, , aapologypology

* feeling that ‘justice is done’* feeling that ‘justice is done’

* to prevent the situation from happening again* to prevent the situation from happening again

* the compensation of damages* the compensation of damages

* ‘punishment’ * ‘punishment’

Handling complaints as a right of Handling complaints as a right of patients (individual dimension) (2)patients (individual dimension) (2)

HowHow does the patient want to achieve this:does the patient want to achieve this:

* Disclosure of the relevant facts and * Disclosure of the relevant facts and informationinformation

* Informal procedures, close to where the * Informal procedures, close to where the complaint originatedcomplaint originated

* Preferably not: lengthy and distressing * Preferably not: lengthy and distressing formal legal procedures formal legal procedures

The Netherlands: the complaints The Netherlands: the complaints pyramidpyramid

Legal procedures (civil, criminal orLegal procedures (civil, criminal or

disciplinary)disciplinary)

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Complaints committeeComplaints committee

for care providersfor care providers

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Informal handling of Informal handling of

complaints (complaintscomplaints (complaints

officer, patient officer, patient

advocate etc)advocate etc)

Complaint systems for patientsComplaint systems for patients The health professional or service concernedThe health professional or service concerned

Complaints officers and/or complaint committees (local, regional or national)Complaints officers and/or complaint committees (local, regional or national)

Ombudsman (local, regional or national)Ombudsman (local, regional or national)

Health commissioner (national)Health commissioner (national)

Professional bodies or organisations (regional, national)Professional bodies or organisations (regional, national)

Medical or disciplinary tribunals (regional, national)Medical or disciplinary tribunals (regional, national)

Civil courtsCivil courts

Medical or Health Councils (regional, national)Medical or Health Councils (regional, national)

Inspectorates (first instance and/or appeal)Inspectorates (first instance and/or appeal)

Complaint systems for patients: Complaint systems for patients: Netherlands (Netherlands (♫)♫)

The health professional or service concerned The health professional or service concerned ((♫)♫)

Complaints officers and/or complaint committees (local, regional) Complaints officers and/or complaint committees (local, regional) ((♫)♫)

Ombudsman (local, regional or national)Ombudsman (local, regional or national)

Health commissioner (national)Health commissioner (national)

Professional bodies or organisations (regional, national)Professional bodies or organisations (regional, national)

Medical or disciplinary tribunals (regional) (Medical or disciplinary tribunals (regional) (♫)♫)

Civil courts (Civil courts (♫)♫)

Medical or Health Councils (regional, national)Medical or Health Councils (regional, national)

Inspectorates (first instance and/or appeal)Inspectorates (first instance and/or appeal)

Relationship between the complaints Relationship between the complaints committee and the Inspectorate committee and the Inspectorate

(Netherlands)(Netherlands)

(Since 2005) If a serious complaint is filed (Since 2005) If a serious complaint is filed with the complaints committee and the with the complaints committee and the care provider does not solve the situation care provider does not solve the situation the complaint is about, the complaints the complaint is about, the complaints committee is obliged by law to report the committee is obliged by law to report the complaint to the Inspectoratecomplaint to the Inspectorate

This obligation is hardly ever practisedThis obligation is hardly ever practised

Handling complaints by Handling complaints by Inspectorates (public interest) (1)Inspectorates (public interest) (1)

Why does the Inspectorate handle complaints?:Why does the Inspectorate handle complaints?:-(a) to satisfy the needs of individual patients-(a) to satisfy the needs of individual patients-(b) to detect structural quality problems in -(b) to detect structural quality problems in health carehealth care

If (a): is the Inspectorate the most suitable body If (a): is the Inspectorate the most suitable body to address the needs of individual patients?to address the needs of individual patients?

If (a) and (b): is the Inspectorate able to perform If (a) and (b): is the Inspectorate able to perform both activities, and to prevent that one activity both activities, and to prevent that one activity (b) outshines the other (a)(b) outshines the other (a)

In other words: are both activities compatible?In other words: are both activities compatible?

Handling complaints by Handling complaints by Inspectorates (public interest) (2)Inspectorates (public interest) (2)

Points of discussion:Points of discussion:-Whose responsibility is it to handle complaints (care -Whose responsibility is it to handle complaints (care provider, inspectorate)?provider, inspectorate)?-Is the Inspectorate the right body to deal with -Is the Inspectorate the right body to deal with complaints from the perspective of the ‘individual complaints from the perspective of the ‘individual dimension’dimension’-Is there an alternative option?-Is there an alternative option?-To what extent do complaints provide a full view of what -To what extent do complaints provide a full view of what might be wrong?might be wrong?-What is the prevailing culture in your country (emphasis -What is the prevailing culture in your country (emphasis on individual rights, emphasis on public interest)?on individual rights, emphasis on public interest)?

Inspectorates: serving the public Inspectorates: serving the public interestinterest

Complaints are not the only input the Inspectorate receivesComplaints are not the only input the Inspectorate receives

Lost of others sources:Lost of others sources: Investigation at the initiative of the Inspectorate (‘fueled’ or not by information Investigation at the initiative of the Inspectorate (‘fueled’ or not by information

from other sources)from other sources) Various performance indicatorsVarious performance indicators Signals Signals Voluntary reporting systems (blame free reporting) at local or national levelVoluntary reporting systems (blame free reporting) at local or national level Mandatory reporting systems (serious incidents)Mandatory reporting systems (serious incidents) Reports in de media (newspapers, tv, internet)Reports in de media (newspapers, tv, internet)

Complaints as such handled by the Inspectorates… ?Complaints as such handled by the Inspectorates… ?

… … or used only to detect structural problems (and referred to other bodies to or used only to detect structural problems (and referred to other bodies to deal with the ‘individual dimension’) > the complaint is seen as a signaldeal with the ‘individual dimension’) > the complaint is seen as a signal

Specific issue (1): care providers Specific issue (1): care providers and patients crossing bordersand patients crossing borders

An increasing number of care providers An increasing number of care providers and patients is crossing borders: and patients is crossing borders:

-does one country inform the other about -does one country inform the other about complaints, pending procedures, complaints, pending procedures, convictions etc?convictions etc?

-is there a need to ‘harmonize’ supervisory -is there a need to ‘harmonize’ supervisory systems?systems?

Specific issue (2): the Inspectorate Specific issue (2): the Inspectorate as complainantas complainant

The Inspectorate acts as a complainant The Inspectorate acts as a complainant (e.g. procedures before a medical or a (e.g. procedures before a medical or a discplinary tribunal or medical council)discplinary tribunal or medical council)

If the Inspectorate does have this If the Inspectorate does have this authority: in which cases is it used?authority: in which cases is it used?

Final remarksFinal remarks Handling complaints: there is both a Handling complaints: there is both a relationshiprelationship

and a and a tensiontension between the ‘individual dimension’ between the ‘individual dimension’ and the ‘public interest’and the ‘public interest’

Patients who voice a complaint have specific Patients who voice a complaint have specific wishes and goals: the complaints system should wishes and goals: the complaints system should recognize thatrecognize that

We should have both “a fair and open We should have both “a fair and open complaints system” and “an efficient and reliably complaints system” and “an efficient and reliably supervisory system” (Council of Europe 2006)supervisory system” (Council of Europe 2006)

Mixing these systems is possible, but raises Mixing these systems is possible, but raises questions and requires careful considerationquestions and requires careful consideration