Purpose

To provide clear guidance to Hunter Primary Care Limited (HPC) staff in relation to complaints received from external stakeholders (including consumers) regarding services provided by Hunter Primary Care Limited.


Scope

This policy applies to all staff and to the management of all complaints received by HPC and any service delivered by HPC.


Policy Statement

This policy has been developed in order to provide an effective and fair organisation-wide framework for the receipt, capture and response to complaints received regarding HPC services.

In addressing all complaints, HPC will:

  • Ensure that a mechanism for making complaints is available to consumers and external stakeholders and includes a process for receipt of anonymous complaints
  • Ensure that no negative consequences or retribution occurs for consumers and external stakeholders
  • Ensure that a copy of HPC’s Complaints Management Policy is made available on the HPC website
  • Address complaints, where possible, at the first point of contact
  • Investigate all complaints in an equitable manner and in accordance with this policy
  • Treat all complaints with respect and sensitivity, and in accordance with HPC’s Privacy Policy (GEN 12 Privacy)
  • Collect sufficient information to allow for assessment and assigning priority to the complaint by a person or team that specialises in the complaint topic
  • Provide a mechanism for review if the complainant is not satisfied with the outcome of the initial investigation
  • Report monthly to the Executive on the status of received complaints to identify trends and eliminate causes of complaints, and to improve the organisation’s operations
  • Ensure all complainants are able to access any supports required to assist them with making and resolving a complaint, including advocates, interpreters and communication aids.

How complaints can be made

External stakeholders (including consumers) may make a complaint via any of the following mechanisms:

  • Face to face meeting
  • Telephone
  • On-line from the Hunter Primary Care website Contact Us page (Contact Us – Hunter Primary Care)
  • In writing to Hunter Primary Care, PO Box 572, Newcastle NSW 2300

Supporting Procedures

The procedures for managing complaints involve the following steps:

  • Receiving the complaint
  • Registering and acknowledging the complaint
  • Initial assessment of the complaint
  • Investigation
  • Responding to the complaint
  • Resolving the complaint

Receiving the complaint

Complaints may be received in person, over the telephone, in writing (including email), via the HPC electronic feedback form or in person. Staff at all levels in the HPC must accept complaints and know what action they can take to resolve them.

With complaints received verbally staff should: 

  • Give a calm explanation of what happened, if they do know what happened and why.
  • Offer an apology if warranted.
  • Encourage the complainant to discuss their concerns with the relevant staff member. 
  • Identify if the complainant would like to nominate a key contact at HPC regarding the complaint.
  • Speak to the relevant staff member on behalf of the complainant.
  • Advise the complainant of the complaint management process.
  • Advise the complainant about supports available to them to assist them with making the complaint including, where appropriate an:
    • advocate or support person
    • interpreter
    • communication aids 
  • Know when to refer the complaint on.
  • Comprehensively record the conversation and concerns, along with all necessary details (including contact details).
  • If possible, provide a copy of the completed record to the complainant to ensure they agree that it is factually correct.
  • Advise the complainant of the appropriately identified person if they wish to send any written correspondence.
  • Commence actioning the complaint if possible or appropriate.

Registering and acknowledging the complaint

As soon as a complaint is received: 

  • It must be recorded in Folio via the on-line Incident Report Form.
  • The Service Manager or Executive will assign the complaint in Folio to an appropriate person to conduct the initial assessment and manage the complaint.
  • The Investigating Officer will acknowledge receipt within 5 calendar days. Acknowledgement may be verbally or in writing. Acknowledgements should:
    • Explain the complaints process
    • Identify contact person/details for the complainant
    • Indicate expected timeframes and what might be requested from the complainant.
  • Assess the complaint and assign it to the relevant person, or key HPC contact if nominated by the complainant, to coordinate its management.

Note: If the complaint is about a service that HPC has engaged a sub-contractor to perform, the complaint will be referred to the sub-contractor for investigation and resolution of the complaint. HPC will retain ultimate responsibility for ensuring that the complaint has been investigated and managed appropriately

Initial assessment of the complaint

The purpose of the assessment process is to: 

  • Classify the complaint appropriately to determine the appropriate action 
  • Ensure the process is commensurate to the seriousness of the complaint and the issues raised 
  • Ensure fairness to any staff, volunteers or contractors concerned.

There are several steps HPC must take in assessing a complaint:

  • Identify the issues raised
    • Identify the issues for resolution, which includes the key concerns raised by the complainant, as well as any other issues that arise or are identified by HPC.
    • If any or all of the issues are unclear, before progressing the matter, clarify them with the complainant.
  • Identify the parties involved
    • The relevant parties are those key people involved with the complaint plus those involved with the incident that is the subject of the complaint. They may not always be a respondent to the complaint, but may be key people in the provision of the service under inquiry.
    • If individual staff members, volunteers or contractors are identified in a complaint then they must be advised of the concern and the relevant Executive will determine the appropriate person to conduct the investigation, other than the identified staff members.
  • Obtain client authorities
    • Client authorisation is required whenever:
      • The complaint relates to the services received by the client and the complainant is not the client.
      • The complaint investigation requires information from services provided outside of HPC.
    • In these instances, an authority to release information is required in order to provide confidential information to the third party.
      • If the client is a child, is deceased or too ill, the person responsible, guardian, person with power of attorney or executor is able to sign on the client’s behalf.
      • Obtain an authority when information on the client’s health status and history must be obtained from outside HPC, for example from private practitioners or hospitals, or from an Area Health Service.
  • Rate the severity of the complaint

The Severity Assessment Code (SAC) is determined using the Consequence Matrix and Likelihood Table in the Risk Management Guide.

The severity assessment will help determine:

  • Who will deal with the complaint;
  • Who needs to be notified both internally and externally;
  • The best method to achieve resolution.

Escalate all significant complaints (Severity Assessment Code 1, 2 or 3) to the relevant Executive for action and further escalation to the CEO, Chair and relevant Board Committee as per the Risk Management Framework. Assessment results include:

  • Provide information, reassurance, or an apology for perceived unsatisfactory conduct or service.
  • Conduct a face-to-face meeting using facilitated resolution or mediation.
  • Conduct an investigation

Investigation

Information collection

All complaints require a greater or lesser degree of fact-finding process in order to determine what has happened and what course of action is required in response. Consideration is required to determine:

  • What information to obtain, e.g. client records, witness statements, etc.
  • Where it is to be obtained
  • How it should be best collected, and
  • How it is communicated

Sufficient information is required in order to construct a chronology of events, or flow chart, particularly if the matter is complex and to determine the applicable standards/procedures/policies and whether they were adhered to.

Analysis and review

As information is collected, it must be analysed and reviewed.  Analysis includes identifying:

  • What can be agreed upon between the parties
  • What facts are in dispute
  • Is information provided relevant and reliable
  • Sufficient information has been gathered to determine whether particular standards have been met
  • Whether there are inconsistencies
  • Whether independent verification has been obtained – What systematic and performance factors led to the outcome

Responding to the complaint

Once the information has been analysed, the person managing the complaint makes findings and recommendations for action. Actions taken must be based on the evidence, address any system, process or service issues, and are informed by the principles of public interest and good governance.

Options for appropriate action may include:

  • Offering an apology
  • Developing or amending a policy and/or procedure 
  • Training/education of staff or clients 
  • Modification of the environment 
  • Ongoing monitoring of an issue, or
  • No action recommended.

The Senior Manager/Executive must ensure that the outcome and recommendations are clearly communicated to the client, staff and management.

Resolving the complaint

The target for finalising complaints is 35 calendar days.

Final responses will be in the form of a letter from the CEO or delegate. The final response must be factually correct and:

  • Include an apology. This is not necessarily about accepting blame or fault, but will sometimes be an acknowledgement of the complainant’s experience and their feelings.
  • Address each of the points the complainant has raised with a full explanation or give the reason(s) why it is not possible to comment on a specific matter. 
  • Give specific details about the investigation, i.e. sources of information, what was discovered, etc. 
  • Give details of actions taken as a result of the complaint. 
  • Provide the name and telephone number of the investigating officer for further queries/discussion.
  • Offer to meet the complainant with the key staff involved. 
  • If there is a reason why a specific issue cannot be addressed this should be stated.  Include further action available to the complainant. 
  • Be in accordance with the Open Disclosure Guidelines when appropriate

As far as practicable, the staff members involved are to be given the opportunity to see the final response before it is sent for final signature.

The final response will be: 

  • Sent to the complainant 
  • Copied to the relevant manager 
  • Copied to any relevant parties, e.g. Ombudsman, HCCC 
  • Attached to the Folio complaint record

The Folio record will be closed at this time.

Review mechanism

If a complainant is not satisfied with the outcome of a complaint investigation, they have the right to seek a review of the initial outcome.

An application for a review must be lodged with the CEO of HPC within 30 days of the complaint investigation outcome having been sent to the complainant.

A Complaints Committee will be formed to consider the application for a review.

The Complaints Committee will comprise the following

  • The CEO
  • The Executive of the business unit that the complaint relates to
  • A Clinical Director or equivalent person with a high level of expertise relevant to the subject matter of the complaint
  • Any additional persons required as determined by the CEO
  • If the complaint is about the decisions or actions of a specific staff member, then that person will be excluded from the Complaints CommitteeThe Complaints Committee will review the matter. The complainant has the right to make a written submission to the Complaints Committee. This needs to be provided to the CEO within 14 days of the application for a review being lodged. The Complaints Committee may, at its discretion, interview the complainant and other relevant persons if the Committee feels that this will assist in its deliberations.The Complaints Committee will reach a decision on the matter and provide a written report to the complainant within 14 days of the conclusion of the investigation outlining its decision and the rationale for that decision.The complainant has the right, if dissatisfied with the outcome of the review, to take the matter to the relevant external complaints organisation, e.g. NSW Ombudsman.

Complaint handling considerations

Anonymous complaints

Anonymous callers should be advised than an investigation is made more problematic if they do not divulge identities as this severely limits HPC’s ability to obtain information. They should then be informed of confidentiality, as applied to the complaint management process, to encourage them to reveal their own and/or the subject’s identity. The complainant needs to be informed:

  • There will be disclosure of information to any respondents identified;
  • There is “nothing off the record” in information provided to HPC;
  • What will happen with the information given to HPC.

However, the complainant’s wishes should be respected, as an assurance of absolute confidentiality cannot be given.

Anonymous written complaints may reveal the identity of the complainant or it may be apparent from the complaint details. An inquiry may still be possible and may be warranted if the complainant raises health and safety concerns.

Old complaints

Normally a complaint will be made within a short period of time from the event that caused the problem. If the passage of time has been considerable, it may affect HPC’s capacity to investigate a complaint and these constraints should be discussed with the complainant. Although it may not be possible to investigate the facts of the case, attempts should be made to achieve resolution.

Declining to deal with a complaint

HPC may decide to decline to deal with a complaint because it is:

  • Vexatious or frivolous,
  • Outside HPC’s jurisdiction, or
  • The subject matter of the complaint has been or is under investigation by some other competent person or body or has been or is the subject of legal proceedings.

Care needs to be taken in assessing these complaints to ensure that every effort is made to understand the information the complainant is attempting to convey.

If a complaint has been declined, complainants should be advised of the reasons for the decision as well as other agencies that may be able to assist them with their concerns.

Mandatory notifications

In some cases a complaint raises issues that require mandatory external notification or referral. This may only become apparent once preliminary inquiries are made. Other external bodies that may need to be involved in a complaint include:

  • Health Care Complaints Commission
  • Ombudsman’s Office
  • Coroner – in the case of a reportable death
  • Professional registration body
  • NSW PoliceFurther guidance in relation to mandatory reporting is available in:
  • Mandatory Notification of Health Practitioners HR 69
  • Child Protection and Risk of Harm Notification GEN 46
  • Responding to Allegations of Risk of Harm to Individuals GEN 53

Progress reports for complaints exceeding 35 days to resolve

If at 35 days from the date of receipt of a complaint, the complaint has not been concluded, the complainant is to be contacted to provide an update about progress. The information provided should include:

  • An apology for the delay
  • An explanation of the delay
  • Details of the results of the enquiry to date if possible
  • The date by which a full response can be expected

References/ Related Documents

Contact Information for Health Care Complaints Commission

  • Toll Free in NSW 1800 043 159
  • TTY service for the hearing impaired: (02) 9219 7555
  • Fax: (02) 9281 4585
  • Email: hccc@hccc.nsw.gov.au
  • Office address: Level 13, 323 Castlereagh Street (corner of Hay St) Sydney NSW 2000
  • Post address: Locked Mail Bag 18 Strawberry Hills NSW 2012

Contact Information for NSW Ombudsman

  • Make a complaint online – NSW Ombudsman
  • Toll Free 1800 451 524
  • Fax (02) 9283 2911
  • Address: Level 24, 580 George Street Sydney NSW 2000
  • Translating and Interpreter Service (TIS) 131 450
  • National Relay Service
  • Speak and Listen users phone 1300 555 727 then ask for (02) 9286 1000