1. Patient Literacy and Continuity of Care Tahlia Jones, Assistant Director Strategic Services and Community Engagement Dr Ann Choong, Medical Officer

2. About HaDSCO  HaDSCO is an independent statutory authority established in 1996.  HaDSCO’s services enable the agency to identify needs for service improvements and make recommendations to enhance health and disability service delivery in WA.

3.  Complaints can include allegations that a health or disability service provider has acted unreasonably: -by refusing to deliver a service -by providing a service that should not have been provided -in the manner of providing a service -by denying or restricting the consumer’s access to records -by charging an excessive fee -by failing to deal with a complaint effectively -by failing to comply with the Carers Charter -by failing to comply with the Disability Services Standards. What can be complained about?  HaDSCO can take complaints about any health or disability service provided in Western Australia. This includes public services, private services, prison services and services provided to involuntary patients.

4.  A complaint may be made by the consumer or by someone else on their behalf, such as a parent or carer. Who can make a complaint?  HaDSCO generally cannot deal with complaints when: - trivial, vexatious or without substance - they are more than two years old - they are not made by a user or their representative - they are verbal - reasonable attempts have not been made to resolve the matter - issues have already been determined by a court or registration board. Limitations

5. Complaints resolution process

6. HaDSCO–AHPRA consultation HaDSCO and the Australian Health Practitioner Regulation Agency (AHPRA) have been working together to effectively resolve complaints involving registered health practitioners. HaDSCO and AHPRA meet monthly to:  exchange notification spreadsheets  discuss each notification  decide which body will deal with the matter (AHPRA, HaDSCO, split, other)  review pending matters.

7. During complaint management the complaint may be processed through negotiated settlement or conciliation. Conciliation usually involves all parties engaging voluntarily in face to face meetings to discuss the complaint; this is conducted by a trained conciliator. Complaint Resolution processes

8. Negotiated settlement Involves an exchange of information between parties via a case manager. This may be conducted over the telephone or in writing and generally does not involve a face to face meeting.

9. HaDSCO closed 2,434 complaints in 2014-15 Complaints Overview Out of jurisdiction Complaints 14% Health Complaints 72% Mental Health Complaints 12% Note: Percentages do not equal 100% due to rounding Disability Complaints 3%

10. Health Complaints

11. Emerging Health Issues

12. External Complaints Data Collection Project Provider type# of providersTotal number of complaints 2014-15 All providers257,267 Private142,044 Public65,020 Not-for-profit5203

14. Top Five Sub-Issues Quality of Clinical Care

15. Top Five Sub Issues Communication

16. Top complaint issues for Services in SMHS, CARS and NMHS ‘Quality of Clinical Care’ and ‘Communication’ issues have consistently been the most frequently raised issues at SMHS, NMHS and CARS over the last three years. No. Issues raised Quality of Clinical CareCommunication 2012-13 1290848 2013-14 12811068 2014-15 14101196 Total 39813112

17. Quality of Clinical Care issues

18. Medication issues 2014-15 DoH Provider No. issues raised about ‘Medication’ Percentage of issues about ‘Medication’ CAHS1513% NMHS3710% SMHS709% WACHS205% Total1428%

19. Top five ‘Communication’ complaints

20. Resources available  Online charts on C&LC&L  Resources page with case studies and other useful tools relating to the management of complaints

21.  Independent – provider and patient perspectives  Support complaint resolution  Systems benchmarking Role Medical Review

22. Interfaces where issues occur  Between shifts  Between teams  At discharge  Communication between staff and with patient/family plays a key role Continuity of care

23. Case A - Anticoagulation  MVA – fractured pelvis managed conservatively with gradual mobilisation  On Diane OCP – cyproterone acetate and ethinyloestradiol  Anticoagulated on enoxaparin in hospital  Discharged after 10 days Mr T - 44 years old

24.  Slow to mobilise post discharge – mostly in wheelchair with minimal ambulating with Zimmer frame  2 months after discharge – presented with pain and swelling in left leg  Chronically stenosed IVC with acute thrombus distally including left femoral vein Case A - Anticoagulation

25. Benchmarking:  Mobilisation following discharge  Risks associated with OCP Case A - Anticoagulation

26. Case B - Anticoagulation Mrs B – 78 years old, seen at ED  3 months of urinary symptoms not responding to multiple courses of antibiotics  Medical History - polymyalgia rheumatica - type 2 diabetes - chronic kidney disease  On prednisolone

27. Case B - Anticoagulation  MSU – sent from ED  Diagnosed with possible prostatitis  Prescribed norfloxacin with follow up at urology clinic  2 and a half weeks later, presented with a ruptured Achilles tendon

28. Case B - Anticoagulation Benchmarking:  Risk factors  Follow up of MSU results  The role of consumer medical information in alerting patients to potential side effects

29. Good communication = better understanding and compliance

30. Thank You