Epidemiology

Classification of complaints

Medical – real or perceived (~50:50)
1. Triage – esp parental overestimation of child’s illness
2. Diagnosis – missed fractures, worse if GP was correct and ED was incorrect
3. Treatment – inadequate analgesia, need for Xray, antibiotics
Interpersonal skills 32%
1. Identification – failure of doctors
2. Explanation of test, procedure, process
3. Insensitivity or roughness – real or perceived
4. Poor communication – language, use of jargon
5. Failure to explain triage system or reasons for waiting times (thank you for waiting)
Delays – perceived more important than actual
Environmental issues – comfortable WR, clean, private and temperature controlled, staff eating not seen by those waiting, meals for patients
Administrative – incorrect documentation, lost records, lack of confidentiality
Financial issues – esp private hospitals, incomplete or misleading medical certificates

Rectify source of complaint if possible, incl treat any outstanding/urgent medical issue
Personnel – one senior person
Acknowledgement – 24 hours for written complaint
Investigation – staff and records
Response – 3 days for written complaint, apologise for patient distress and dissatisfaction, without admitting liability
Documentation and appropriate involvement of hospital admin, MDU
Feedback to staff, QA, prevention

Supervise junior staff
Review pathology and radiology
Good communication – explanation of triage, management, follow up and supervision
Provide clean environment and separate place for staff to relax / eat

In any complaint question there are likely to be at least two parts to the question –
1. Manage the critical incident that the complaint cites
2. Manage the complaint

Immediate:
1. Apologise for patient dissatisfaction
2. Try to immediately address/rectify problem as appropriate
3. If unable, inform pt of hospital complaints process
4. Thank them for complaint as way to fix system problems
Manager:
1. Identify best person to handle complaint process
2. Identify best forum for handling complaint
3. Private, quiet, unhurried
Acknowledgement
1. Within 24 hrs
2. Phone / writing / face to face
3. Apologise for their dissatisfaction
4. Recognise seriousness of issue
5. Issue is being investigated
6. Will keep you informed of outcome of investigation
7. Who and how to contact re further info
Investigate
1. Interview complainant
2. Involved Staff
3. Medical records
4. R/V pt journey
Response / resolution
1. Try to answer within 72 hrs
2. Answer w/o judgement/emotion
3. Apologies:
  1. Honest and sincere
  2. Acceptable resolution in 25%
  3. May include apology for
    1. Communication / Misunderstanding
    2. Pt/Family distress / dissatisfaction
  4. Not formal admission of guilt/liability
  5. Not acknowledgement of incompetence/negligence
4. Respond to specific critical incident/adverse outcome as below
Consultoid: BΨSLEDP