Health practitioner experience of Health and Disability Commissioner investigations

Abstract

INTRODUCTIONThe New Zealand Health and Disability Commissioner (HDC) Act 1994 was designed to protect the rights of consumers and provide a fair, simple, speedy, and efficient resolution to complaints. No recent studies have been published about the health practitioner experience of HDC investigations following a patient complaint, and none that include nurses and midwives. AIMTo use a restorative inquiry framework to understand the impacts and needs of health practitioners arising from an event that led to an investigation by the HDC during the last 10 years. METHODSA descriptive qualitative approach was used with data collected using semi-structured interviews with doctors, nurses, and midwives (n = 13). The data were analysed using thematic analysis. RESULTSParticipants worked in primary care, aged care, and services provided by public hospitals. The emotional impacts arising from the event and investigation were profound, with long-lasting effects on participants’ sense of self, reputation, and how, or if, they continued to practice. Participants indicated a need for support from colleagues and employers, a fair and relational investigation process, and a meaningful way of connecting to put things right. DISCUSSIONA shift to a restorative approach whereby people involved in a complaint come together to speak truthfully about what happened and its impact on their lives, offers hope for a process that repairs relationships and improves health services. Restorative approaches clarify accountabilities and could lead to more satisfactory outcomes for all parties. This study contributes to emerging thinking about the use of restorative approaches in health-care contexts.

Evaluation of a national database of completed investigations into radiology service complaints in New Zealand: What can the radiologist, and radiology service providers, learn?

“…The punitive steps the HDC can take at the conclusion of an investigation are limited and occur in a minority of investigations completed. However, research in New Zealand has shown that the process of undergoing an HDC investigation, even if it does not lead to censure, can be extremely emotionally distressing for clinicians and severely impact their personal and professional lives 9 . The more complex investigations often take around 2 years 10 .…”

“…However, research in New Zealand has shown that the process of undergoing an HDC investigation, even if it does not lead to censure, can be extremely emotionally distressing for clinicians and severely impact their personal and professional lives. 9 The more complex investigations often take around 2 years. 10 In 78% of the cases, the HDC recommended that the radiologist apologizes to the patient/family.…”

Preventing and responding to harm: Restorative and responsive mental health regulation in Victoria

“…Some have argued that restorative processes should replace investigative processes (Cunningham, 2004; Wilkinson & Marshall, 2021), arguing health practitioners are ‘second victims’ in many cases of medical error (Wu, 2000) and are further harmed by these processes. For example, Wilkinson and Marshall argue that such a shift would mean:

‘The focus would change from: Which right has been breached?, who is responsible for the breach?, and what sanction will be applied?

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“…For example, Wilkinson and Marshall argue that such a shift would mean:

‘The focus would change from: Which right has been breached?, who is responsible for the breach?, and what sanction will be applied? to: What happened?, what impacts have there been?, and what is now needed to repair the harms and prevent further harm?’ (Wilkinson & Marshall, 2021, p. 8).

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“…Carers, too, have questioned the effectiveness of complaints processes to address their needs (Martin et al, 2019). Meanwhile clinicians, in surrounding jurisdictions, have expressed concerns that complaints and investigations processes cause undue distress and do not lead to quality improvement measure (Wilkinson & Marshall, 2021). Greater clarity on the effective use of complaints regulatory mechanisms is therefore needed, and indeed has been called for at a national‐level (Productivity Commission, 2020, p. 1118).…”