Sharing the pain: lessons from missed opportunities for healthcare improvement from patient complaints and litigation in the Australian health system

Abstract

Learning from medical errors to prevent their recurrence is an important component of any healthcare system's quality and safety improvement functions. Traditionally, this been achieved principally from review of adverse clinical outcomes. The opportunity to learn systematically and in a system manner from patient complaints and litigation has been less well harnessed. Herein we describe the pathways and processes for both patient complaints and medicolegal claims in Victoria, and Australia more broadly, and assess the potential for these to be used for system improvement. We conclude that both patient complaints and medicolegal claims could afford the potential to additionally inform and direct safety and quality improvement. At present neither patient complaints nor medicolegal claims are used systematically to improve patient safety. We identify how this may be done, particularly through sharing findings across agencies. Patient complaints and medicolegal claims are accepted parts of the healthcare industry. However, using these in a shared and collated manner as part of an improvement agenda has not been widely considered or proposed. This paper provides a summary of the patient complaint and medicolegal landscape in public hospital system in Australia broadly, and Victoria more specifically, identifying the agencies involved and the opportunities for sharing learnings. The paper draws on existing literature and experiences from both Australia and elsewhere to propose a framework whereby complaints and claims data could be shared systematically and strategically to reduce future harm and improve patient care. We offer an approach for practitioners, healthcare managers and policy makers in all Australian jurisdictions to design and implement a statewide capacity to share patient complaints and medicolegal claims as an additional component of system quality and safety.

Identifying quality improvement opportunities using patient complaints: Feasibility of using a complaints taxonomy in a metropolitan maternity service

“…53 Independent of coded domain, communication was an underlying theme in many complaints, a finding consistent with the observations of others 52,54 and reinforced by the wealth of evidence supporting the link between communication and patient complaints. 46,51,53,[55][56][57][58][59] The differences between our findings and those of the HCCC again likely relates to complaint severity. 30 Many complaints relating to poor interpersonal communication will be handled at the level of the health service and will not require escalation to a HCCC.…”

“…Prior to being reported to a tertiary manager, patients will typically have reported their complaint to either the practitioner or health service concerned, and many less severe complaints will be managed during this contact. 46 Indeed, the NSW HCCC recommends complainants 'first discuss the complaint with the health service provider'. 47 In Victoria, a new health complaints act repealing the Health Services (Conciliation and Review) Act, Victoria, 1987 was enacted in 2017.…”

“…30 As previously stated, in these settings there exists a recommendation or obligation to seek to resolve the complaint directly with the provider prior to escalation (Health Complaints Act, Victoria, 2016). [46][47][48] Another explanation for the differences in complaint distribution is that treatment issues are known to be more commonly reported to health complaints commissions. 26,34,35 The NSW HCCC analysis likely compounded this difference by restricting their sample to only 'serious' complaints.…”

Preventing critical failure. Can routinely collected data be repurposed to predict avoidable patient harm? A quantitative descriptive study

“…Seven organisations collecting and holding quality and safety data were identified using a data-sharing framework developed as a specific response to the Targeting Zero report 16. These organisations were the Health Complaints Commission, the Victorian Managed Insurance Authority (referred to as the State Insurer), the Consultative Council on Obstetric and Paediatric Mortality and Morbidity, the Victorian Department of Health and Human Services, the Paediatric Infant Perinatal Emergency Retrieval (PIPER), the Australian Health Practitioner Regulation Agency (referred to as the Professional Regulator) and complaint records from the index hospital.…”

Using medico‐legal claims for quality improvement in maternity care: application and revision of an NHSLA coding taxonomy

“…Learning from avoidable harm is an important pillar of healthcare improvement. However, the role that medico‐legal claims could play in the surveillance of healthcare performance to inform improvement has been largely overlooked and certainly underutilised . This is perhaps surprising given that in the UK the financial burden of medical negligence is approaching a level that is undermining operational funding .…”