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Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia “Informal Complaint Resolution” Irene Clarke, Katja Lutte, Cheryl McDougall.

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Presentation on theme: "Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia “Informal Complaint Resolution” Irene Clarke, Katja Lutte, Cheryl McDougall."— Presentation transcript:

1 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia “Informal Complaint Resolution” Irene Clarke, Katja Lutte, Cheryl McDougall College of Physicians & Surgeons of Ontario Expect the Unexpected: Are We Clearly Prepared?

2 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia

3 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia

4 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Framework for Resolution Backdrop Past Processes Current Processes Case Examples

5 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Issues Involved in Public Complaint Investigations

6 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Backdrop: Committee Decisions

7 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Outcomes  Complainant frustration and disbelief  Doctor stress and annoyance  Complaints Committee $ 600,000 per year

8 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Past Resolution Processes  1990-1998 Committee Resolution  1997-2001 Informal Staff Resolution

9 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Committee Resolution (1990 – 1998)  Complaints Committee Directed  Resolution by: Staff facilitators External mediators

10 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

11 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Informal Staff Resolution 1997-2001  Complainants consented to resolution Via phone or letter  Patient Records  Written Physician Response  Written information  Committee Chair Approval

12 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Informal Staff Resolutions Results -2001 40% vs. 20% resolve 157 days vs. 547 + days $500,000 vs $600,000

13 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Complaints Process Survey 2001  Telephone Interviews  Satisfaction Indicators process quality outcome

14 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Complaints Process Survey 2001  Satisfaction Level Desired Outcome Time Continual Communication Investigator with clinical knowledge Resolution vs. Decision

15 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Current Process 2001 – present Proactive Staff Resolution

16 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Complaints Per Area of Practice

17 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Proactive Staff Resolution  Designated Staff nurses, physiotherapists, social workers  With significant clinical practice background management or teaching experience know health care system  Can communicate

18 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Investigator on Call  Calls from our general inquiries area  letters

19 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Investigator on Call 2005  366 telephone inquiries forwarded to on- call investigators;  26 converted to complaints.

20 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Investigator on Call 2005  145 letters earmarked for on call resolution  9 converted to formal complaint (of those 9, 6 were resolved pre-committee review)

21 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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;

22 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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;

23 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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;

24 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia What Investigators Do  Telephone/Meet Complaint as a “whole” Records Provide Context Physician Verbal Response Joint meeting  Medical Director Approval

25 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia What They Do  Joint Resolution with Hospitals  Meet Complainant Physician/s Chief of Staff Patient Rep  Records available at meeting

26 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

27 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia What Makes it Work?  Complainant open to explanation  Complainant wants ‘error’ fixed  Physician open to explaining  Physician willing to acknowledge  No Lawyers  Investigator Flexibility

28 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia How Did We Do? 2004 58% resolved (up from 40%) 62 % resolved 65 days (down from 157 days) $315,000 (down from $500,000)

29 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Benefits  Support for Process CMPA Chiefs of Staff Hospital Risk Managers/Patient Reps Individual Physicians

30 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Benefits  Educational Value  System Improvements  Increase in satisfaction for all parties, including investigators  Positive College Image

31 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Benefits Patient Safety (Lucian Leape, MD) Responding to the patient What do patients want? 1.Know what happened (98%) 2.Receive an apology 3.Be assured the hospital/doctor is doing all that can be done to prevent a recurrence **$ is way down the list of patient “wants”

32 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

33 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Fools rush in where angels fear to thread Cannot compel physicians to apologize Can ask or convey the complainant’s wish for an apology

34 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

35 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Myth: Apology = Admitting Guilt

36 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

37 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

38 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Apology Busters

39 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

40 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

41 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

42 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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

43 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Is “I’m sorry”, an apology?

44 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Is “I’m sorry”, an apology?

45 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia QUESTIONS ???

46 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 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) iclarke@cpso.on.ca klutte@cpso.on.ca cmcdougall@cpso.on.ca www.cpso.on.ca


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