Complaint Resolution Applying Key Principles Dubai Health Regulation Conference October 2014

2 Overview Mandate of the medical regulatory authority Purpose of a complaints process Principles Processes and outcomes Variation across countries

3 Mandate Medical regulatory authorities: exist in legislation (delegated authority) Exercise their duty in the best interest of the public

4 Purpose of a complaints process To investigate concerns To identify unprofessional conduct To stop unsafe practice To resolve problems (To improve practice?)

5 Professionalism a statement of an individual physician’s obligations to his/her patients and a statement of physicians’ obligation, as a collective, to society

6 All seven roles important

7 Principles a)Fairness b)Timeliness c)Effectiveness d)Transparency

8 Fairness both parties have an opportunity to provide information enough information is collected to inform decision outcome of complaint is based on the evidence

9 Timeliness Economy and integrity of process is considered – not all complaints require the same level of investigation –ability to dismiss trivial complaints –early attempts at resolving misunderstandings No undue delay Keep complainant and regulated member informed throughout process

10 Effectiveness Unsafe practice is identified and stopped Sub-optimal practice is remedied if possible Allegations not supported by evidence are dismissed

11 Transparency publication / availability of information about individual physicians Information that identifies trends, even in the absence of a formal decision

12 Processes and outcomes Dismissal of the complaint Informal resolution Investigation of the complaint Discipline

13 Dismissal of a complaint Insufficient or no evidence of unprofessional conduct Complaint is trivial or vexatious

14 Informal resolution Complainant’s expectation is resolution, not discipline Issue appears straightforward and resolvable Works best for softer issues – communication, practice management Pt-physician relationship can be preserved Can be accomplished quickly

15 Investigation If allegation were true, it would amount to unprofessional conduct Alleged conduct is serious, e.g.: –Ethical breach –Lack of knowledge or skill –Boundary issue (zero tolerance) Independent evidence is needed Can be a lengthy and detailed process

16 Discipline Egregious conduct - boundary violation, serious ethical breaches Unsafe practice that cannot be dealt with in another way Very adversarial and time consuming

17 Voluntary undertaking Still serious, but not as serious as discipline The medical regulatory authority may choose to direct or accept the physician's agreement to participate in training or educational programs to improve his or her practice

18 Variations Canada Registration / Complaints responsibilities co-exist. Statutory obligation to consider all written complaints and proceed accordingly. United States of America Registration / Complaints co-exist in some state medical boards but not others. Disciplinary arm supported by the penal judicial system.

19 My most heartfelt thanks to Dr. Karen Mazurek, Deputy Registrar, CPSA

20 Thank you Fleur-Ange Lefebvre Executive Director & CEO x2602