Question 22

College answer

Candidates commonly discussed how to have a family meeting where the family have some difficult questions or issues they would like answered. Few candidates spoke about the nature of the complaint, and therefore would it be informally dealt with, require a formal process, or even referral. No candidate spoke about either hospital, LHD, or state guidelines for dealing with complaints. Virtually all trainees discussed the need for empathy and an apology.

Discussion

Reading the question stem, one would have to agree with the comments made by the examiners, insofar as a family meeting is only one aspect of the "stepwise processes" involved in managing a complaint. To be fair, the candidates are likely end-stage ICU trainees who have been largely insulated from this sort of thing by senior staff, and would probably have no direct experience of managing complaints in any formal sense, except where they are confronted with the complaint directly and need to meet with the family (hence this tendency to focus on the face-to-face Q&A with a bunch of angry people). 

• Receive the complain - this is usually the part that requires a face-to-face or telephone meeting with the complainant, where empathy is essential
• Identify and log the complaint. This is an essential part of the process, and usually consists of a written notification made to the person who handles such complaints, or a submission into a centralised system that compiles and archives these events for audit (which most large health services will have).
  • Determine whether a response is required: A complaint is often something that requires addressing and following up with a response, whereas feedback from patients and families does not necessarily require follow-up.
• Acknowledge the complaint. This usually requires the complaints manager to
  • contact the complainant (ideally, soon)
  • Make an apology
  • assure them the complaint has been considered
  • indicate a contact person for them to have access to if they have further questions, and 
  • establish a timeframe over which the response should be expected
• Assess the complaint. 
  • This likely requires somebody senior to look at the complaint and determine the level of seriousness, which will then determine the priority and the need for escalation
  • This requires some risk assessment, to determine whether the complaint raises "significant operational, legal, financial or reputational risks" to the organisation.
  • Information needs to be gathered to identify the personnel involved and the issues raised, to help determine the level of risk (but this is not the investigation phase)
• Address the complaint
  • Depending on the type of complaint, possible outcomes include something informal, like an apology and acknowledgement without investigation, or an internal investigation, or even an escalation of the referral 
  • This will depend on what was complained about, and this process should be collaborative,i.e. the complainant's expectations of what needs to happen should be taken into account.
  • The solutions may include some (or all) of the following:
    • Making an apology in some formal sense
    • Providing the complainant with information
    • Meeting with the complainant to have ongoing discussion
    • Escalating the complaint to a regulatory body
    • Investigating the allegations made in the complaint
  • Not all complaints will require an investigation, but where they do, the investigation must be impartial, confidential, and fair.
• Communicate the outcome
  • This may be in the form of a written statement or another meeting
  • Any decisions, as well as the reasons behind them, including remedial actions or preventative measures, would be important here
  • System issues should be fed back to any staff or agencies involved in the complaint or otherwise.
• Finalise the complaint
  • ​​​​​​Determine whether the complainant is satisfied with the outcome
  • Invite them to access review and escalation options
  • Update the record of the complaint to reflect the end of these events