1. Patient Smart. Quality at Waitemata DHB Complaint Resolution at the Coal Face Penny Andrew Clinical Lead, Quality

2. Patient Smart. Quality at Waitemata DHB What do we see? It is “all about culture”: creating, supporting and encouraging a consumer-centred culture “A complaint is a gift” – a valuable opportunity to learn and to improve systems BUT… Resolving complaints is challenging

3. Patient Smart. Quality at Waitemata DHB What are the challenges? Complaints are “toxic treasures” Ron Paterson Toxic treasure – refelections on complaints and disclosure Auckland DHB Clinical Directors’ Meeting, 13 April 2011

4. Patient Smart. Quality at Waitemata DHB The challenges Potential toxic effects  Disproportionate expenditure of resources  Adverse publicity with erosion of public trust  Consumers may go from hurt to grievance  Health professionals may become “second victims”  Distrust in the process

5. Patient Smart. Quality at Waitemata DHB The challenges Gap between  Consumers’ expectations  Health professionals’ expectations and practise

6. Patient Smart. Quality at Waitemata DHB The Expectation Gap When things go wrong consumers generally want 3 things: (i)someone to tell them what has happened (ii)A clinician to say he/she is sorry (iii)Action to ensure the event will not happen to anyone else Professor Lucian Leape The apology  Why is it so hard?  How do you get it right?

7. Patient Smart. Quality at Waitemata DHB Why is an apology so hard? Consumers’ expectations  want a “full apology”  Expression of regret  Explicit admission of error  Acceptance of responsibility Mazor et al 2006 Robbenolt 2003 Consumers don’t want  a “half apology”/ “non- apology”  We’re sorry if you…  I’m sorry if you felt I was…  I’m sorry if you found me…

8. Patient Smart. Quality at Waitemata DHB Why is an apology so hard? Multiple meanings of apology  For example, US “I’m sorry laws” ‘Any or all statements, affirmations, gestures, conduct, expressing apology, fault, sympathy, commiseration, condolence, compassion, or a general sense of benevolence’

9. Patient Smart. Quality at Waitemata DHB Health professionals’ expectations Admitting responsibility/mistakes  invokes the ‘blame and shame’ mentality  precipitates  Loss of referrals  Loss of preferred provider status  Loss of hospital admission privileges  Litigation  Loss of certification/licence Levinson W, Gallagher TH. 2007

10. Patient Smart. Quality at Waitemata DHB Health professionals We are asking health professionals to do something that can be really hard In some cases health professionals do not & will not agree they are “wrong” Individual blame will put pay to a thorough investigation, openness & transparency Need to help health professionals to understand that in a consumer-centred healthcare system it is the effect on the consumer which matters

11. Patient Smart. Quality at Waitemata DHB Complaint resolution Meeting with the consumer How meaningful is an “ordered apology”? Does being required to apologise make a difference to the consumer?

12. Patient Smart. Quality at Waitemata DHB Medical The doctor also yearns to be free. So she tells us the thing exactly. Bill Manhire