Informal complaint resolution
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Expect the Unexpected: Are We Clearly Prepared?. “Informal Complaint Resolution”. Irene Clarke, Katja Lutte, Cheryl McDougall College of Physicians & Surgeons of Ontario. Framework for Resolution. Backdrop Past Processes Current Processes Case Examples.

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Informal complaint resolution

Expect the Unexpected: Are We Clearly Prepared?

“Informal Complaint Resolution”

Irene Clarke, Katja Lutte,

Cheryl McDougall

College of Physicians & Surgeons of Ontario

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Informal complaint resolution

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Informal complaint resolution

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Framework for resolution

Framework for Resolution

  • Backdrop

  • Past Processes

  • Current Processes

  • Case Examples

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Issues involved in public complaint investigations

Issues Involved in Public Complaint Investigations

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Backdrop committee decisions

Backdrop: Committee Decisions

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Outcomes

Outcomes

  • Complainant

    • frustration and disbelief

  • Doctor

    • stress and annoyance

  • Complaints Committee

    • $600,000 per year

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Past resolution processes

Past Resolution Processes

  • 1990-1998

    Committee Resolution

  • 1997-2001

    Informal Staff Resolution

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Committee resolution 1990 1998

Committee Resolution(1990 – 1998)

  • Complaints Committee Directed

  • Resolution by:

    • Staff facilitators

    • External mediators

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Committee resolutions 100 cases

Committee Resolutions 100 cases

  • Outcome

    Agreement –20%No Agreement –80%

  • Why

    Complainants

    • Process starts too late (after 1 year)

    • Process too slow (6-12mo)

    • Lawyer involvement

      Physicians

    • Process too slow

    • Mediator: no clinical knowledge

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Informal staff resolution 1997 2001

Informal Staff Resolution1997-2001

  • Complainants consented to resolution

    Via phone or letter

  • Patient Records

  • Written Physician Response

  • Written information

  • Committee Chair Approval

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Informal staff resolutions results 2001

Informal Staff Resolutions Results -2001

40%vs.20%resolve

157days vs.547 +days

$500,000 vs $600,000

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Complaints process survey 2001

Complaints Process Survey2001

  • Telephone Interviews

  • Satisfaction Indicators

    • process

    • quality

    • outcome

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Complaints process survey 20011

Complaints Process Survey 2001

  • Satisfaction Level

    • Desired Outcome

    • Time

    • Continual Communication

    • Investigator with clinical knowledge

    • Resolution vs. Decision

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Current process

Current Process

2001 – present

Proactive Staff Resolution

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Complaints per area of practice

Complaints Per Area of Practice

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Proactive staff resolution

Proactive Staff Resolution

  • Designated Staff

    • nurses, physiotherapists, social workers

  • With

    • significant clinical practice background

    • management or teaching experience

    • know health care system

  • Can communicate

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Investigator on call

Investigator on Call

  • Calls from our general inquiries area

  • letters

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Investigator on call 2005

Investigator on Call2005

  • 366 telephone inquiries forwarded to on-call investigators;

  • 26 converted to complaints.

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Investigator on call 20051

Investigator on Call2005

  • 145 letters earmarked for on call resolution

  • 9 converted to formal complaint

    (of those 9, 6 were resolved pre-committee review)

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Resolution criteria

Resolution Criteria

  • misunderstanding or miscommunication;

  • a known or common complication of a treatment/procedure;

  • an isolated incident of less serious conduct unbecoming a physician (i.e. not sexual abuse);

  • assistance to intervene beyond our jurisdiction;

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Resolution criteria1

Resolution Criteria

  • isolated incident of minor clinical mishap or oversight;

  • systems issue;

  • complainants indicate their wish to resolve;

  • complainant and respondent have agreed to the resolution process;

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


No resolution when

No Resolution When …

  • serious concern regarding clinical practice and/or conduct;

  • the complainant and/or subject physician are not receptive to resolution

  • the subject physician has a history of complaints pointing to a trend toward conduct or care that was inappropriate;

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


What investigators do

What Investigators Do

  • Telephone/Meet

    • Complaint as a “whole”

    • Records

    • Provide Context

    • Physician Verbal Response

    • Joint meeting

  • Medical Director Approval

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


What they do

What They Do

  • Joint Resolution with Hospitals

  • Meet

    • Complainant

    • Physician/s

    • Chief of Staff

    • Patient Rep

  • Records available at meeting

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


What are key actions

What are Key Actions?

  • Speedy assignment/ and contact

  • Establish rapport with both parties

  • Updates

  • Language

  • Paperless process

  • ‘See’ care in records

  • Collaborate with Chiefs of Staff

  • Systems Approach

  • Appreciation Letter

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


What makes it work

What Makes it Work?

  • Complainant open to explanation

  • Complainant wants ‘error’ fixed

  • Physician open to explaining

  • Physician willing to acknowledge

  • No Lawyers

  • Investigator Flexibility

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


How did we do 2004

How Did We Do?2004

58%resolved (up from40%)

62%resolved

65days(down from157 days)

$315,000(down from $500,000)

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Benefits

Benefits

  • Support for Process

    • CMPA

    • Chiefs of Staff

    • Hospital Risk Managers/Patient Reps

    • Individual Physicians

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Benefits1

Benefits

  • Educational Value

  • System Improvements

  • Increase in satisfaction for all parties, including investigators

  • Positive College Image

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Benefits2

Benefits

Patient Safety (Lucian Leape, MD)

Responding to the patient

What do patients want?

  • Know what happened (98%)

  • Receive an apology

  • Be assured the hospital/doctor is doing all that can be done to prevent a recurrence

    **$ is way down the list of patient “wants”

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Benefits3

Benefits

Patient Safety (Leape)

The power of silence

  • - destroys the patient’s trust

  • - destroys the physician’s integrity

  • - “wall of silence” is devastating for patients

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Fools rush in where angels fear to thread

Fools rush in where angels fear to thread

  • Cannot compel physicians to apologize

  • Can ask or convey the complainant’s wish for an apology

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Negotiating an apology

Negotiating an Apology

  • The complainant request apology and the physician volunteers to apologize

  • The complainant wants an apology and the physician needs encouragement

  • No request for apology, but one would be the best way to resolve a complaint

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Myth apology admitting guilt

Myth: Apology = Admitting Guilt

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Apology without implied guilt

Apology without implied guilt

  • I apologize if my behavior…

  • I apologize for causing you to believe I was angry

  • Please forgive me if I offended you, it was not my intention

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Components of suitable apology letter

Components of suitable apology letter

  • Apologizes/regrets the behavior

  • Explains what happens

  • Conveys sincerity by expressing remorse and displaying empathy

  • Reflects on the learning experience

  • Reiterates regrets and apology

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Apology busters

Apology Busters

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Wrapping it up

Wrapping it up

  • Ask the physician to cc me on letter

  • One to two weeks after letter sent, I contact the complainant to discuss

  • Obtain agreement to close the file

  • Obtain authorization to close the file from the medical director

  • Notify physician and complainant of closure

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Example 1

Example # 1

  • 28 years of age, TB, previously healthy

  • Same Dr. for extended family

  • Pt so stigmatize, she can’t ever utter “T.B.” – “ I have a disease”

  • In following up the contacts, the secretary confirms the identity of the index case to a family member

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Example 1 cont d

Example # 1 (cont’d)

  • The complainant wants the Dr. to be disciplined and to apologize (LOC)

  • The Dr. was very stressed about the complaint, wanted to apologize, did not know how to begin

  • A sample letter was provided

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Example 2

Example #2

  • 16 year old in ER with back pain, swollen abdomen, urine positive for pregnancy, the nurse hears fetal heart beat, patient never had sexual relations

  • Patient told she is pregnant, in denial

  • Mother not told anything because the patient is 16

  • Patient is discharged

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Is i m sorry an apology

Is “I’m sorry”, an apology?

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Is i m sorry an apology1

Is “I’m sorry”, an apology?

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Informal complaint resolution

QUESTIONS ???

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


Speaker contact information

Speaker Contact Information

Irene Clarke, Katja Lutte, Cheryl McDougall

College of Physicians & Surgeons of Ontario

80 College St., Toronto, ON, M5G 2E2

(416) 967-2600 ext: 408; 674; 494 (respectively)

[email protected]

[email protected]

[email protected]

www.cpso.on.ca

Presented at the 2006 CLEAR Annual Conference

September 14-16 Alexandria, Virginia


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