Possible complaint outcomes

The Commission assesses all written complaints carefully by gathering relevant information to determine the appropriate outcome. This may involve an assessment officer speaking with the complainant, seeking information from the provider and obtaining other records and information. The Complaints Management Framework outlines the way the Commission manages complaints.

When assessing a complaint the Commission has several options, including to:

RESOLVE THE COMPLAINT

During the assessment process, the assessment officer may be able to help resolve issues by speaking with both the complainant and the provider about the concerns. In some cases this communication can help to address issues and to bring the matter to a satisfactory conclusion for all parties.

You can read some case studies about complaints that were resolved during assessment here.

REFER THE COMPLAINT FOR ASSISTED RESOLUTION

Some complaints raise important issues that may be resolved with the help of the Commission’s Resolution Service.

Complaints can be complex and often involve experiences that have been highly distressing for the parties involved. The Commission understands the vital importance of rebuilding trust and ensuring continuity of care. The Resolution Service provides an option of independent facilitation to help complainants and providers reach understanding and to agree on action. Assisted Resolution can provide opportunities for important learnings and improvements in health service delivery.

The process is voluntary and tailored to meet the needs of the parties involved.

You can read about assisted resolution cases here.

REFER THE COMPLAINT FOR LOCAL RESOLUTION

Public health organisations and private health facilities are often willing and able to work directly with patients and their families to resolve concerns. The Commission refers complaints to public health organisations and private health facilities for local resolution when it believes this is the most suitable and effective way to address the concerns and issues raised in a complaint.

This may include cases where there is an ongoing service relationship, communication issues; or the complaint relates to local policy matters.

Examples of complaints that might be referred for local resolution:

• Discharging a patient without sending the discharge summary to their GP.
• Inadequate communication with patient and family members.
• Complaints about rudeness of staff members.
• Concerns about waiting times in the ED.
• Facility issues such as cleanliness, access to parking, quality of food etc.

Once a complaint has been referred for local resolution someone from the local health service or the private health facility will contact the complainant directly to determine the most appropriate way to resolve the issues. The Commission is not involved in the local resolution process, although on completion of the process the health service provides a summary of the outcome to the Commission.

If local resolution does not resolve the concerns, complainants can contact the Commission for further information. You can read some case studies about local resolution here.

REFER THE COMPLAINT TO THE RELEVANT HEALTH PROFESSIONAL COUNCIL

When dealing with complaints about registered health practitioners, such as doctors, nurses and dentists, the Commission consults with the relevant professional council to determine an appropriate outcome.

In some cases complaints raise issues that are considered to require intervention of a non-disciplinary nature. These matters are referred to the relevant Health Professional Council.

Health Professional Councils have conduct, health and performance pathways that support safe and ethical practice. The aim of these pathways is to improve a practitioner’s ability to perform their work. You can read more about the role and powers of the Councils on the Health Professional Councils Authority website.

You can read some Referral to Council case studies here.

REFER TO ANOTHER BODY

Some complaints raise issues that are best addressed by another body. For example, if a complaint raises issues about gaining access to a health record, the appropriate body to deal with that concern would be the Information and Privacy Commission. Another example would be a complaint about the systems in place at an Aged Care facility, in which case referral to the Aged Care Quality and Safety Commission would be most appropriate.

You can read about cases that were Referred to Another Body here.

INVESTIGATE THE COMPLAINT

The Commission investigates complaints that raise serious issues of public health or safety, or could lead to disciplinary action against a practitioner.

During an investigation, the Commission obtains evidence from complainants and other relevant witnesses, such as statements, information and medical records. An expert may give advice on the quality of clinical care or conduct.

Before deciding upon the outcome of an investigation, the Commission seeks submissions from the affected health provider. At the end of an investigation, a report is prepared that sets out the Commission’s findings.

An investigation into a registered practitioner may result in:

• the matter being referred to the independent Director of Proceedings to determine whether to prosecute the practitioner where there is evidence of ‘unsatisfactory professional conduct’ or professional misconduct.
• referring the practitioner to the relevant Health Professional Council for their action where the issues are considered to require intervention of a non-disciplinary nature.
• comments made to the practitioner to improve future practice or treatment.
• no further action being taken.

Where there is evidence of possible criminal conduct, the complaint can be referred to the Director of Public Prosecutions to consider possible criminal charge(s).

An investigation into an unregistered health practitioner may result in the Commission:

• issuing and publishing a prohibition order or public warning, where findings show the practitioner has breached the Code of Conduct and poses a risk to the health or safety of members of the public.
• making comments to the practitioner to improve future practice or treatment.
• taking no further action.

An investigation into a health organisation may result in the Commission:

• making comments where the care has been inadequate but measures have been implemented to address the issues.
• making recommendations where systems can be improved for better care in future. The Commission will monitor the implementation of all recommendations.
• making prohibition orders or public statements in relation to relevant health organisations.

At the end of any investigation, the Commission will write to the relevant parties advising them of the outcome of its investigation.

You can read some case studies about complaints that have been investigated here.

DISCONTINUE THE COMPLAINT

There are a number of reasons why the Commission may decide to take no further action.

• After assessing all of the information we may consider that the care and treatment provided was of an appropriate standard and there are no risks to public health and safety that require further action.
• The complaint is vexatious, frivolous or not made in good faith.
• The complaint is already the subject of legal proceedings, or investigation by another person or body.

All complaints made in good faith are valuable, and even when the Commission decides not to take further action, complaints can provide an opportunity for practitioner reflection and health system learnings.

DISCONTINUE WITH COMMENTS

In some cases, where a complaint raises issues that are of a lower risk we may decide to make comments to the provider about their practice, before discontinuing the complaint.

All complaints made in good faith are valuable, and even when the Commission decides not to take further action, complaints can provide an opportunity for practitioner reflection and health system learnings.