Patient Literacy and Continuity of Care

Tahlia Jones, Assistant Director Strategic Services and Community Engagement

Dr Ann Choong, Medical Officer

About HaDSCO

HaDSCO is an independent statutory authority established in 1996.

HaDSCO’s services enable the agency to identify needs for service improvements and make recommendations to enhance health and disability service delivery in WA.

Complaints can include allegations that a health or disability service provider has acted unreasonably:

- by refusing to deliver a service- by providing a service that should not have been provided- in the manner of providing a service- by denying or restricting the consumer’s access to records- by charging an excessive fee- by failing to deal with a complaint effectively- by failing to comply with the Carers Charter- by failing to comply with the Disability Services Standards.

What can be complained about? HaDSCO can take complaints about any health or disability service provided in

Western Australia. This includes public services, private services, prison services and services provided to involuntary patients.

A complaint may be made by the consumer or by someone else on their behalf, such as a parent or carer.

Who can make a complaint?

HaDSCO generally cannot deal with complaints when:

- trivial, vexatious or without substance- they are more than two years old

- they are not made by a user or their representative

- they are verbal

- reasonable attempts have not been made to resolve the matter

- issues have already been determined by a court or registration board.

Limitations

Complaints resolution process

HaDSCO–AHPRA consultation

HaDSCO and the Australian Health Practitioner Regulation Agency (AHPRA) have been working together to effectively resolve complaints involving registered health practitioners.

HaDSCO and AHPRA meet monthly to:

exchange notification spreadsheets discuss each notification decide which body will deal with the matter (AHPRA, HaDSCO, split, other) review pending matters.

During complaint management the complaint may be processed through negotiated settlement or conciliation.

Conciliation usually involves all parties engaging voluntarily in face to face meetings to discuss the complaint; this is conducted by a trained conciliator.

Complaint Resolution processes

Negotiated settlement

Involves an exchange of information between parties via a case manager. This may be conducted over the telephone or in writing and generally does not involve a face to face meeting.

HaDSCO closed 2,434 complaints in 2014-15

Complaints Overview

Out of jurisdiction Complaints

14%

Health Complaints

72%

Mental Health Complaints

12%

Note: Percentages do not equal 100% due to rounding

Disability Complaints

3%

Health Complaints

Emerging Health Issues

External Complaints Data Collection Project

Provider type # of providers Total number of complaints 2014-15

All providers 25 7,267

Private 14 2,044

Public 6 5,020

Not-for-profit 5 203

Quality of clinical care

Communication

Access

Rights, respect and dignity

Corporate services

0 500 1000 1500 2000 2500 3000 3500 4000 4500

Top issues, 2011-15

2014-15

2013-14

2012-13

2011-12

Top Five Sub-Issues Quality of Clinical Care

Inadequate treatment/ therapy

Inadequate assessment

Poor co-ordination of treatment

Discharge or transfer arrangements

Failure to provide safe environment

0 200 400 600 800 1000 1200

2011-12

2012-13

2013-14

2014-15

Top Five Sub Issues Communication

Inappropriate verbal/non-verbal communication

Misinformation or failure in communication (but not 'failure to consult')

Failure to listen to consumer/consumer representative/carer/family

Inadequate information about services available

Inadequate written communication

0 100 200 300 400 500 600 700 800 900 1000

2011-12

2012-13

2013-14

2014-15

Top complaint issues for Services in SMHS, CARS and NMHS

‘Quality of Clinical Care’ and ‘Communication’ issues have consistently been the most frequently raised issues at SMHS, NMHS and CARS over the last three years.

No. Issues raised

Quality of Clinical Care Communication

2012-13

1290 8482013-14

1281 10682014-15

1410 1196Total

3981 3112

Quality of Clinical Care issues

0

50

100

150

200

250

300

350

400

450

2012-13 2013-14 2014-15

No. Issues

Financial Year

Inadequate treatment/therapy

Inadequate assessment

Discharge or transferarrangements

Poor co-ordination oftreatment

Medication

Medication issues 2014-15

DoH ProviderNo. issues raised about

‘Medication’Percentage of issues about

‘Medication’

CAHS 15 13%

NMHS 37 10%

SMHS 70 9%

WACHS 20 5%

Total 142 8%

Top five ‘Communication’ complaints

0

50

100

150

200

250

300

350

400

2012-13 2013-14 2014-15

No. Issues

Financial Year

Inappropriate verbal/non-verbal communication

Misinformation or failure incommunication (but not'failure to consult')

Failure to l isten toconsumer/consumerrepresentative/carer/family

Inadequate writtencommunication

Resources available

Online charts on C&L

Resources page with case studies and other useful tools relating to the management of complaints

Independent – provider and patient perspectives

Support complaint resolution

Systems benchmarking

Role Medical Review

Interfaces where issues occur

Between shifts

Between teams

At discharge

Communication between staff and with patient/family plays a key role

Continuity of care

Case A - Anticoagulation

MVA – fractured pelvis managed conservatively with gradual mobilisation

On Diane OCP – cyproterone acetate and ethinyloestradiol

Anticoagulated on enoxaparin in hospital

Discharged after 10 days

Mr T - 44 years old

Slow to mobilise post discharge – mostly in wheelchair with minimal ambulating with Zimmer frame

2 months after discharge – presented with pain and swelling in left leg

Chronically stenosed IVC with acute thrombus distally including left femoral vein

Case A - Anticoagulation

Benchmarking:

Mobilisation following discharge

Risks associated with OCP

Case A - Anticoagulation

Case B - Anticoagulation

Mrs B – 78 years old, seen at ED

3 months of urinary symptoms not responding to multiple courses of antibiotics

Medical History- polymyalgia rheumatica- type 2 diabetes- chronic kidney disease

On prednisolone

Case B - Anticoagulation

MSU – sent from ED

Diagnosed with possible prostatitis

Prescribed norfloxacin with follow up at urology clinic

2 and a half weeks later, presented with a ruptured Achilles tendon

Case B - Anticoagulation

Benchmarking:

Risk factors

Follow up of MSU results

The role of consumer medical information in alerting patients to potential side effects

Good communication = better understanding and compliance

Thank You