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

Background Background Aims Aims Participants Participants Method Method Results Results Future directions Future directions

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

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.

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)

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

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

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.

Results Response rate to questionnaire

Response Rate for Metropolitan and Regional Hospitals RegionalMetropolitanTotal Responded 10 (63%)14 (67%)24 (65%)NS Non response 6 (37%)7 (33%)13 (35%) Total 16 (43%)21 (57%)37(100%)

Results Response rate to questionnaire Response rate to questionnaire CLO profile CLO profile

Results Response rate Response rate CLO profile CLO profile Issues categories Issues categories

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. 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. Treatment issues were significantly lower where there were specialist CLO staff.

Results Response rate Response rate CLO profile CLO profile Issues categories Issues categories Total numbers of complaints Total numbers of complaints

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

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

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

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

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

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

Focus group UnsupportedIsolated 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:

‘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.’

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.