Written by Associate Professor Grant Davies, Health and Community Services Complaints Commissioner

Expectations of health and community service consumers are high and are only likely to increase as people become more engaged in their care.  Good complaints management has substantial benefits both systemically and for the individual.

Health and community services complaints are nothing new.  Services deal with these types of complaints regularly.  So, what do we mean when we talk about a complaint and why does it matter?

The Australian and New Zealand Standard (for complaints management) (1) states a complaint is:

Expression of dissatisfaction made to or about an organisation, related to its products, services, staff or the handling of a complaint, where a response or resolution is explicitly or implicitly expected or legally required.

Complaints can be in the form of feedback, be informal or formal, written, verbal, online, or in any form where an expression of dissatisfaction can be made and are rarely vexatious.

Organisations like mine have various means of managing complaints described as a “regulatory pyramid”(2) ranging from providing advice on how to manage complaints through to prosecution in the most serious of cases.  When people complain, they want an apology, explanation, a change in practice or process, ensuring it does not happen to anybody else, compensation, people being sacked, being listened to, or a combination of some or all of these. (3)  These are all individual outcomes but there are significant systemic outcomes that derive from complaints which are improvement of the quality of care, improved communication, ensuring the safety of care, providing an accountability mechanism, and educative features.

Quality changes include outcomes such as a change in practice or procedure as a result of identified deficiencies in complaints and changes in policy, for example inclusion of the importance of complaints in the National Clinical Governance Standards and the Australian Charter of Health Care Rights. (4)

Substantial focus on communication and partnership between service providers and consumers (5) has seen the emergence of bodies like South Australia’s Commission on Excellence and Innovation in Health and Safer Care Victoria as well as instruments to measure patient-reported outcomes and experience. (6)  Indeed, improving health literacy is critical for effective communication in health care and an important resolution tool in complaints resolution. (7) (8)  Most of the complaints received by the Office of the Health and Community Services Complaints Commissioner have some poor or miscommunication aspect to them and, with the availability of information online, we see very engaged and informed consumers.

The most significant instruments in the complaints management toolbox relate to ensuring safe care. (2)  All health complaints entities around Australia have the capacity to investigate complaints (9) while currently some have the capacity to prohibit unregistered health care workers with the view to have all states and territories do so in the future. (10)  Breaches of the Code can result in prohibition and prosecution for failure to comply.

Other mechanisms which serve as accountability mechanisms for service providers include the provision of compensation, annual reporting by health complaints entities and making public statements in the media, in the annual report and in published investigation reports.

The other systemic advantage of complaints management is through education on multiple levels such as a change in practice or procedure, to front line staff on complaints management, undergraduate and post graduate health practitioners and experienced health practitioners. (11)

On an individual level, complaints resolution has the benefit of repairing relationships, largely through conciliation processes, with outcomes like an apology, an explanation of what happened, the consumer feeling ‘heard’ and unrealistic expectations being managed. (3) (8)

In short, rather than the negative connotation of the word ‘complain’, complaints can help us to drive positive systemic change towards the quality of care we might all expect. This includes highlighting where research is needed to support or inform these changes.

References

1. The Australian and New Zealand Standards. Guidelines for complaint management in organizations. 2014. Vol. 10002:2014.
2. Health Ombudsmen in Polycentric Regulatory Fields: England, New Zealand, and Australia. Healy, J. and Walton, M. 4, s.l. : Australian Journal of Public Administration, 2016, Vol. 75.
3. Remedies sought and obtained in healthcare complaints. Bismark, Marie M., Spittal, Matthew J., Gogos, Andrew J., Gruen, Russell L., Studdert, David M. s.l. : BMJ Quality and Safety, 2011, Vol. 20.
4. Care, Australian Commission on Safety and Quality in Health. Australian Commission on Safety and Quality in Health Care. Safetyandquality.gov.au. [Online] [Cited: 1 July 2020.] https://www.safetyandquality.gov.au/publications-and-resources.
5. Approaching Difficult Communication Tasks in Oncology. Back, Anthony L., Arnold, Robert M., Baile, Walter F., Tulsky, James A., Fryer-Edwards, Kelly. May/June, s.l. : CA: A Cancer Journal for Clinicians, 2005, Vol. 55. 3.
6. Patient-reported outcomes measures and patient-reported experience measures. Kingsley, Charlotte and Patel, Sanjiv. s.l. : British Journal of Anaesthesia, 2017, Vol. 17. 4.
7. Australian Commission on Safety and Quality in Health Care. National Statement on Health Literacy. s.l. : Australian Government, 2014.
8. The power of explanation in healthcare mediation. Behrenbruch, C. and Davies, G. s.l. : Australasian Dispute Resolution Journal, 2013, Vol. 24. 1.
9. Health complaints and practitioner regulation: justice, protection or prevention. Carney, Terry., Walton, Merrilyn., Chiarella, Mary and Kelly, Patrick. s.l. : Griffith Law Review, 2017, Vol. 26. 1.
10. Council of Australian Governments Health Council. Council of Australian Governments. [Online] 17 April 2015. [Cited: 29 June 2020.] https://www.coaghealthcouncil.gov.au/Portals/0/A%20National%20Code%20of%20Conduct%20for%20health%20care%20workers.pdf.
11. Australian Council for Safety and Quality in Health Care. Complaints Management Handbook for Health Care Services. 2005.