Quality and Safety

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Complaint or concern about a clinician (MCCC)

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FAQ

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What is the purpose of the initial review of the complaint?

To facilitate the decision-making process and ensure the selected process is commensurate with the seriousness of the complaint or concern. A complaint may be re-examined if further information becomes available suggesting the complaint or concern is more or less serious than initially reported.

How do I select the appropriate method for management of a complaint or concern about a clinician?

• Who is making the complaint?
• Have there been any previous related incidents or issues or is this an isolated incident?
• What are the key components of the initial information?
• Are there any peripheral issues from the initial information?
• Is there evidence to support the complaint or concern?
• Is it possible that there has been a genuine misunderstanding of the facts?
• Does the complaint relate to patients, staff or both?
• Does the complaint or concern need to be referred to an external investigative or other body?
• Which NSW Health policies need to be taken into account in the management of the complaint or concern?

What are the steps to take in reviewing a complaint?

1. Contact the complainant, explain the complaints process, obtain further or better particulars, clarify their concerns and identify the issues requiring attention.
2. Identify the information needed and how it will be obtained.
3. Advise the respondent clinician of the concern, its nature and the proposed course of action, except where to do so would prejudice the complaints process or place a person, including the complainant, at risk. A respondent clinician should be advised of what material will be taken into account in reviewing a complaint. At least 24 hours notice should be given, where possible, of the need to attend a meeting to discuss a complaint.
4. Determine the scope and method of the complaints process. The method adopted will depend on local circumstances and the nature of issues in the complaint. The process may involve a structured investigation and/or observation of performance, review of records, indicator data and variation reports and may identify appropriate standards and acceptable variations to these (if any).

What are the possible outcomes of the initial review?

• Further investigation
• Referral to relevant registration board
• Referral to Healthcare Complaints Commission
• No further investigation. Usually this is because a complaint is trivial, vexatious, too remote in time, not in good faith or without apparent foundation

Regardless of the outcome, any actions taken in regard to the complaint or concern about a clinician need to be documented. For example, if the decision is taken not to progress the investigation further then this will need to be documented along with the rationale for this decision.

What is the purpose of the investigation process?

To establish what, why and how the event occurred resulting in the complaint of concern about a clinician, and what actions can be taken to prevent recurrence. All investigations need to consider the possibility that any failure to meet expected professional standards may be the result of systems or health issues.

It is important to keep the respondent clinician informed of the process and progress of the investigation. One person needs to be assigned as the contact person for the respondent clinician.

Who will undertake the investigation?

Investigators need to be of suitable seniority, have no conflict of interest and not be involved in any subsequent disciplinary proceedings. Useful questions to consider when deciding who will undertake the investigation are:

• How many investigators are needed?
• Who will need to be interviewed?
• Where will the interviews take place?
• What evidence will be needed?
• Who needs to know, what will they be told?
• How will confidentiality be maintained?
• Is a media strategy needed?

What are the elements of an investigation?

• Collecting relevant facts
• Determining the chronology of the incident
• Identifying care delivery problems such as failure to monitor, observe or act, incorrect (with hindsight) decision and not seeking help where necessary
• Identifying contributory factors (if any)
• Analysing information collected
• Makin findings about the events and the underlying cause(s) of the complaint
• Considering strategies and recommendations to address the findings
• Writng a report
• Sendig the report to the Chief Executive

What points should I consider when documenting findings of an investigation?

• Name of person requesting the report
• Name(s) of those involved in the investigation
• The policy/procedure guiding the investigation
• Details of the original complaint
• Details of the scope of the investigation
• Information about what has been done to manage the situation to date (education, counselling).
• A list of any witnesses
• Supporting information, eg medical records
• Facts that have arisen from the investigation
• Findings from the investigation
• Where applicable, copies of witness statements and other relevant information as an Appendix to the main report.

What points should be included in the investigation report?

The report should include enough information for those responsible to make a decision about whether:

• there is suspected professional misconduct or suspected unsatisfactory professional conduct
• there is a health issue requiring further investigation
• there are performance problems
• further information is required
• there is no further action required against the clinician
• the issue needs to be referred to the relevant credentialing committee an action plan needs to be developed to address systems issues, policy failure or other organisational issues.

Should the investigator make decisions about actions to be taken based on the report?

No. The investigator could, however, make recommendations to the Chief Executive.

What resources can I refer to when investigating a complaint or concern about a clinician?

See our list of tools.