Policy and Procedure Practice Manual · Web viewPolicy Our practice provides respectful and...

The following template policies and procedures are based on the requirements of the

RACGP Standards for General Practices (4th Edition)

TABLE OF CONTENTS

1 RESPECTFUL AND CULTURALLY APPROPRIATE CARE (CRITERION 2.1.1).................11.1 Patients’ rights......................................................................................................................11.2 Mutual respect for successful collaboration.........................................................................21.3 Second opinions...................................................................................................................31.4 Medical practitioner requests transfer of care......................................................................31.5 Refusal of treatment or advice.............................................................................................41.6 Patient requests for transfer of care.....................................................................................41.7 Managing health inequalities................................................................................................41.8 Managing patients who are distressed.................................................................................51.9 Respectful patient health records.........................................................................................51.10 Cultural safety and competence...........................................................................................6

1.10.1 Definitions........................................................................................................................61.10.2 Cultural Awareness Training............................................................................................7

2 PATIENT FEEDBACK AND COMPLAINTS (CRITERION 2.1.2)...........................................82.1 Obtaining written feedback...................................................................................................82.2 Collecting patient feedback on a day-to-day basis...............................................................92.3 Face-to-face complaints.......................................................................................................92.4 Managing complaints.........................................................................................................103 PRESENCE OF A THIRD PARTY (CRITERION 2.1.3).......................................................113.1 Prior consent......................................................................................................................113.2 Chaperones........................................................................................................................113.3 Third parties such as family or carers................................................................................113.4 Students on clinical placement...........................................................................................12

Chapter two: Rights and needs of patients

1 RESPECTFUL AND CULTURALLY APPROPRIATE CARE (CRITERION 2.1.1)

Policy

Our practice provides respectful and culturally appropriate care for patients.

1.1 Patients’ rightsAll members of our staff will treat patients in a respectful, polite and professional manner.

Where a carer plays an ongoing role in the day-to-day care of a patient, it is advisable to include the carer in the doctor-patient relationship with the permission of the patient (if the patient is competent to give such consent) at the discretion of the medical practitioner.

No member of staff will act in a discriminatory manner to any person based on:

gender (as defined by the patient);

religion or culture;

race;

age;

disability;

sexuality; or

any other personal characteristic.

Information contained in this manual is current at February 2015

Policy and Procedure Practice Manual I [Type the company name] 1


1.2 Mutual respect for successful collaborationEvery staff member is an ambassador for this practice and is committed to quality patient care. All staff respect the rights and needs of all patients. No patient is refused access to our doctors on the basis of gender, age, religion, ethnicity, sexual preference or medical condition.

Friendliness, fairness and open communication are the best antidote to the risk of patient dissatisfaction, grievance, complaint or legal action.

It is for these reasons that the following principles apply in this practice.

Staff are to be courteous at all times. Speak slowly and clearly and repeat the information if it is thought that the patient has not heard or understood.

Staff are understanding of patients who may be anxious, frightened or unfamiliar with the practice.

Patients are treated with warmth, empathy and consideration.

In difficult situations, staff will attempt to ascertain all of the facts by giving patients time to communicate.

Patient appointments are adhered to whenever possible. If the doctor is behind schedule, staff will notify and explain to patients as soon as possible.

Telephone calls are to be dealt with as detailed in Practice services, Chapter 2 - Telephone and Other Communications. Doctors may not always be able to take calls and staff are required to respectfully explain this to patients and accommodate them as best as possible.


2 Policy and Procedure Practice Manual I [Type the company name]


1.3 Second opinionsAll patients have the right to seek further clinical opinion from other healthcare providers.

Our clinical team will record in the patient’s health record any indication that a patient intends to seek a further clinical opinion.

Patients are encouraged to notify their medical practitioner when they are choosing to follow another healthcare provider’s management advice. This will allow the medical practitioner the opportunity to reinforce any potential risks of this decision.

Where patients do seek further clinical opinion, our clinical team will consider an appropriate risk management strategy including documenting this decision in the patient’s health record. In addition, the medical practitioner is encouraged to document in the patient’s health record an explanation of the actions taken when a patient seeks a further clinical opinion, including referral to other care providers if arranged.

1.4 Medical practitioner requests transfer of careWhere a medical practitioner no longer considers it appropriate to treat a patient (eg when a patient has behaved in a threatening or violent manner, or where there has been some other cause for a significant breakdown in the therapeutic relationship), the medical practitioner has the right to discontinue treatment of the patient. This may occur especially when the medical practitioner believes they can no longer give the patient optimal care.

In such circumstances the medical practitioner will:

Raise the circumstance with the clinical leaders of the practice.

Document a process to be followed by practice staff if the patient makes any subsequent contact with the practice.

Record the reasons and method and any communication with the patient in their patient health record.

Irrespective of a decision to discontinue the treatment of a patient, there is still a professional and ethical obligation to provide emergency care.

See also:

Practice services, Chapter 2.1.10 - Handling difficult patients




1.5 Refusal of treatment or adviceIf a medical practitioner becomes aware that a patient has refused advice, procedures or treatments our clinical team will consider an appropriate risk management strategy including recording of such refusals in the patient’s health record, including referrals to other care providers and an explanation of the action taken.

1.6 Patient requests for transfer of careFrom time to time patients may request to be transferred to the care of another medical practitioner in another practice.

For more information please see policies on:

Practice services, Chapter 13.3 - Transfer of health information – To another practice

1.7 Managing health inequalitiesOur practice team recognises that nationally there are some significant differences in key indicators of general health and wellbeing. This information highlights the need for primary healthcare interventions tailored to specific groups within the Australian community.

We understand that health gains have not been equally shared across all sections of the population and today Australia is characterised by large morbidity and mortality inequalities between population subgroups.

This includes homeless youth, children of single parent families, people with developmental disabilities, Aboriginal and Torres Strait Islander people, refugees and those from culturally and linguistically diverse populations.

For example, the Australian Institute of Health and Welfare (AIHW) report, Australia’s Health 2010 (available at www.aihw.gov.au/publication-detail/?id=6442468376 ) identifies that Aboriginal and Torres Strait Islander people have a life expectancy that is significantly less than that of other Australian men and women.

In an effort to combat these inequities, our staff will accommodate the specific health needs of individuals who may be suffering disadvantage.

Resources related to managing the chronic health conditions of Aboriginal and Torres Strait Islander people are available at:

Australian Indigenous HealthInfoNet www.healthinfonet.ecu.edu.au


Practice services, Chapter 17.3 - Recording cultural background Practice services, Chapter 17.4 - Recording Aboriginal and Torres Strait Islander status

This information is also recorded in: Practice services, Chapter 10.4 - Health inequalities



http://www.healthinfonet.ecu.edu.au/

http://www.aihw.gov.au/publication-detail/?id=6442468376


1.8 Managing patients who are distressedPatients in distress are to be regarded as urgent medical matters whether the contact is in person or by phone. Occasionally patients will arrive in the waiting room in a state of physical or emotional distress. Such patients may present as tearful, bleeding, aggressive, in pain or in a comatose/unconscious state.

1. Refer to Practice services, Chapter 1.2 - Triage to correctly handle such a situation.

2. Notify the doctor immediately. Be prepared to call an ambulance if requested.

3. Provide an alternative area for the patient to wait, for example, the treatment room.

4. Remain with the patient and reassure them while they are waiting.

5. Avoid touching a patient who is being difficult to deal with or aggressive.

This information is also recorded in: Practice services, Chapter 1.2.5 - Patient discomfort in waiting room

1.9 Respectful patient health recordsAt no time will our clinical team record any derogatory, prejudiced, prejudicial or irrelevant statements about patients in their patient health records.


Practice services, Chapter 17 - Patient Health Records




1.10 Cultural safety and competence Our practice respects the rights and needs of patients and provides respectful and culturally appropriate care for our patients.

1.10.1 DefinitionsThe terms ‘cultural awareness’, ‘cultural safety’, ‘cultural respect’ and ‘cultural competence’ are commonly used in the Australian health care system. The following definitions will help you to understand what they mean as practical knowledge of these issues will mean safe, effective and appropriate clinical communication at all times:

Cultural awareness is sensitivity to the similarities and differences that exist between two different cultures and the use of this sensitivity in effective communication with members of another cultural group. It is also the awareness that one’s own cultural values are not universal, nor automatically ‘better’ than another set of values.

Cultural safety involves actions that recognise, respect and nurture the unique cultural identity of a person and safety meets their needs, expectations and rights. It means working from the cultural perspective of the other person, not from your own perspective.

Cultural respect can be defined as the ‘recognition, protection and continued advancements of the inherent rights, cultures and traditions of a particular culture.’

Cultural competence means becoming aware of the cultural differences that exist, appreciating and having an understanding of those differences and accepting them and being prepared to guard against accepting your own behaviours, beliefs and actions as the norm. Cultural competence includes the ability to translate awareness into a positive outcome from an exchange between yourself and a person from a different cultural background.

Personal cultural competence is the actions we personally take to expand our knowledge of other cultures and how we use that to shape service to those people. This is especially important in effective health professional:patient relationships.




1.10.2 Cultural Awareness Training Our medical practitioners will participate in a recognised cultural awareness training session within twelve months of starting with our practice. Nursing and administrative staff will also be offered and recommended to participate in cultural awareness training. Certificates of completion will be recorded in the staff personnel file.

For up-to-date information on relevant courses please visit the Australian Indigenous HealthInfoNet website www.healthinfonet.ecu.edu.au/key-resources/courses-training

Some examples include:

Online Cultural Orientation for Health Professionals, Western Australian Centre for Rural Health http://www.healthinfonet.ecu.edu.au/key-resources/courses-training?fid=324

Aboriginal and Torres Strait Islander Cultural Awareness in General Practice, Royal Australian College of General Practitioners http://www.racgp.org.au/yourracgp/faculties/aboriginal/education/resources-for-gps-and-practice-staff/cultural-awareness/

Cultural Awareness Module for PIP Indigenous Health Incentive, Australian College of Rural and Remote Medicine http://www.acrrm.org.au/search/find-online-learning/details?id=1058

Australian Aboriginal Child Health, Royal Australia College of General Practitioners https://www.racp.edu.au/fellows/resources/rural-health-continuing-education-program/australian-and-aboriginal-child-health-modules

Cultural Safety Learning Module, Services for Australian Rural and Remote Allied Health https://www.sarrah.org.au/content/cultural-safety



https://www.sarrah.org.au/content/cultural-safety

https://www.racp.edu.au/fellows/resources/rural-health-continuing-education-program/australian-and-aboriginal-child-health-modules

https://www.racp.edu.au/fellows/resources/rural-health-continuing-education-program/australian-and-aboriginal-child-health-modules

http://www.acrrm.org.au/search/find-online-learning/details?id=1058

http://www.racgp.org.au/yourracgp/faculties/aboriginal/education/resources-for-gps-and-practice-staff/cultural-awareness/

http://www.racgp.org.au/yourracgp/faculties/aboriginal/education/resources-for-gps-and-practice-staff/cultural-awareness/

http://www.healthinfonet.ecu.edu.au/key-resources/courses-training?fid=324

http://www.healthinfonet.ecu.edu.au/key-resources/courses-training


2 PATIENT FEEDBACK AND COMPLAINTS (CRITERION 2.1.2)

Policy

Our practice seeks and responds to patients’ feedback on their experiences with our practice to support quality improvement activities.

Despite the best intentions complaints may arise. These need to be dealt with in a courteous and understanding manner. Perceptions of what is reasonable and fair can change when patients are unwell or anxious.

The Government of Western Australia – Health and Disability Services Complaints Office (HaDSCO ) details are displayed on the PRACTICE INFORMATION SHEET. In the event of a complaint not being dealt with appropriately by this practice, patients are entitled to forward their complaint to the HaDSCO. To avoid this, we attempt to address any grievances promptly and effectively.

A patient’s complaint and the practice’s response will be documented and filed in the patient’s record.

It is the responsibility of the practice manager to ensure that complaints are dealt with quickly and in a fair manner.

2.1 Obtaining written feedbackOnce every three years, our practice actively seeks feedback about patients’ experiences of our practices by:

Select the most appropriate option for your practice or create your own procedure.

<Option 1>

Using a validated patient experience questionnaire that has been approved by the Royal Australian College of General Practitioners (RACGP).

<Option 2>

Developing and using our own individual practice specific method that adheres to the requirements outlined in the RACGP Patient feedback guide: Learning from our patients (questionnaire or focus group or patient interviews).




2.2 Collecting patient feedback on a day-to-day basisThe practice will encourage patients to raise any concerns with the practice team directly and attempts should be made to resolve such concerns within the practice.

Select the most appropriate option for your practice or create your own procedure.

<Option 1>

A suggestion box is situated in the waiting room. This provides a means for patients to make complaints or suggestions in a manner that is less threatening than face-to-face contact.

The feedback obtained is passed on to the practice manager for action.

<Option 2>

This practice has an information sheet that encourages patients to give positive and negative feedback.

The feedback obtained is passed on to the practice manager for action.

2.3 Face-to-face complaintsThe following procedure is to be adopted by staff when dealing with face to face complaints:

1. Listen to the complaint. Be understanding. Acknowledge the grievance/comments and pass them on to the practice manager.

2. In the case of a complaint against a doctor do not become involved in the detail, but rather encourage the patient to agree to a meeting with the practice principal to discuss the grievance.

3. Staff must not admit responsibility for complaints of a serious nature and must consult with the practice manager.

4. Generally it is advisable to request all grievances be written and the practice principal made aware as soon as possible of an incident.




2.4 Managing complaintsThe practice will attempt to resolve complaints internally in accordance with Section 3 of the Medical Board of Australia Code of Conduct.

The practice will: Acknowledge the patient’s right to complain.

Work with the patient to resolve the issue.

Provide a prompt, open and constructive response, including an explanation and if appropriate, an apology.

Ensure the complaint does not adversely the patient’s care. In some cases, it may be advisable to refer the patient to another doctor.

Comply with relevant complaints law, policies and procedures.

Make contact with the relevant insurer if a complaint is made against a member of the clinical team, in order to seek advice on resolving the complaint before any action is taken.

If the matter cannot be resolved, the Health and Disability Services Complaints Office can be contacted to assist in resolving the issue.

Complaints and their management should not be recorded in the patient’s file as these are accessible by the patient.

The following steps are to be adopted when investigating a complaint:

Problem analysis What (if anything) did we do wrong/poorly? What system, procedure or person may have been involved?

Generate strategy What can occur to rectify/amend the problem?

Provide feedback When and in what form feedback should be given to the patient?

Forward planning What steps can be taken to prevent future complaints of a similar nature and how can we learn from this experience?

Patient complaints and their outcomes will be discussed at practice team meetings to enable both medical and non-medical staff to understand the nature of the complaints received and the possible ways to reduce such complaints being made in the future.




3 PRESENCE OF A THIRD PARTY (CRITERION 2.1.3)

Policy

The presence of a third party observing or being involved in clinical care during a consultation occurs only with the prior consent of the patient.

3.1 Prior consentOur practice team will obtain the consent of a patient for the presence of a third party during a consultation. Patients must be asked to provide consent for the presence of a third party before the consultation commences, such as at reception, and then by the medical practitioner at the start of the consultation.

It is not acceptable to firstly ask the patient for their permission in the consulting room, as some patients may feel ‘ambushed’ and unable to refuse.

3.2 ChaperonesIn some circumstances, the patient or general practitioner may feel more comfortable if there is a chaperone present during an examination. Appropriate consent needs to be obtained from the patient where the doctor requests the presence of a third party for this purpose.

The RACGP has a position statement on the use of chaperones available at www.racgp.org.au/support/policies/clinical-and-practice-management/

3.3 Third parties such as family or carers Third parties can be interpreters; carers; relatives; friends; medical, allied health or nursing students on placement; general practice registrars or chaperones.

Where a patient is accompanied to the practice by a third person (such as a family member or carer) it is important to ensure that the patient consents to the presence of that person in their consultation and medical practitioners will consider recording this consent in the consultation notes.

Practice staff will need to be mindful of the particular needs of people with intellectual disabilities who may not be able to provide consent. In such cases a legal guardian or advocate may have been appointed to oversee the interests of the patient.

More information on guardianship can be found at

http://www.publicadvocate.wa.gov.au/G/guardianship.aspx?uid=1541-4327-7273-5606



http://www.publicadvocate.wa.gov.au/G/guardianship.aspx?uid=1541-4327-7273-5606%20

http://www.racgp.org.au/support/policies/clinical-and-practice-management/


3.4 Students on clinical placementThis practice encourages our general practitioners to participate in the supervision of medical students. When a student is in residence and observing the general practitioner:

Patients will be advised on arrival that there will be a student observer.

Patients are given the option for the student to be present or not.

A notice will be clearly available on the reception counter and placed on the doctor’s door advising patients of the student observer.

See MEDICAL OBSERVER NOTICE


Practice management, Chapter 3.5.2 - Medical students



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