Who do you complain to? New regulation expands complaints process but also adds confusion

Making a complaint within a health care setting has always been a delicate process.

It used to be in home care the terms of your service suggested that if you complained too much, you could actually lose service.

This may not have necessarily changed. We recently heard from a reader who suggested that complaints he made about the rushed nature of his wife’s home care resulted in a scaling back of service. Suddenly the respite care they received was reduced from once a week to every other week. How any individual could ever reasonably prove such cause and effect remains an open question.

Similarly in Ontario’s nursing homes a complaint can affect the relationship a resident has with staff who do provide care. For the frail elderly, this can be intimidating. It is therefore surprising that more than 2,000 complaints come into the provincial hotline each year that require subsequent investigation by an inspector.

When the province introduced the Excellent Care for All Act in 2010, hospitals were required to put in place practices for handling patient complaints. That includes reviewing and resolving complaints made by patients and caregivers, recording and monitoring key information about the complaints, and informing the complainant of the results of such a review.

The Act also requires patient engagement in designing, reviewing and maintaining the process. While it does suggest aggregate data be presented to the organization’s quality committee, there is no requirement to make any of this public. We have no idea if the end result is a positive change, or whether hospitals have simply become good at placating those who feel ill served.

While investigations around nursing home complaints are posted on a public website, we have no idea how many complaints hospitals receive.

Now the province has introduced a new regulation that will expand that basic in-house complaints obligation to other health care providers. How will it work within smaller health care providers that only have a handful of staff? What quality committee will a small agency be reporting aggregate data to? We have no idea.

Curiously, when Premier Wynne expanded the Ombudsman’s scope to include much of the so-called MUSH sector – Municipalities, Universities, School boards and Health care, the latter was left out. Instead health care was to get its own unique patient ombudsman.

We get it that the Wynne government has found new religion in establishing greater transparency, especially after such scandals as the Gas Plant cancellation and the remarkable entitlements at Orng and e-Health.

We don’t know if adequate resources will be made available to the new patient ombudsman, or whether they will have the experience of the current provincial office.

While health care providers will have to publicly post a contact for complaints under the new regulation, we don’t know how confused the public will be regarding who exactly they are directing their complaint?

For Ontario nursing homes residents and caregivers, will it mean having to sort out whether their complaint is directed at the in-house complaint taker, the existing provincial hotline, or to the new patient ombudsman (and not the general ombudsman)?

With no obligation to report such internal complaints, we have no idea how the process played out for hospitals. If the government has the benefit of analysis they have not shared it.

If a complainant is not satisfied with the response of their health care provider, the good news is they can soon kick it up to the patient ombudsman. The question is, will providers see this as a real process, or simply see the regulation as an opportunity to placate a complainant before it reaches the hands of the new patient ombudsman?

In our view, the new patient ombudsman shouldn’t make an internal complaint a necessary requirement before taking it on. Patients and caregivers should decide themselves where their entry point is. Some may not wish to escalate a complaint by taking it beyond the provider, others may worry that a direct complaint may indeed create hardship for those presently in care.

Then again, once a patient has emerged from the other side of their acute care, maybe they just want to release some steam. In that case, this may all seem a bit much.

The current draft regulation is open for consultation. To see the full regulation and to comment, click here.

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