All health care providers (HCPs) require an adequate complaints procedure to be in place.  The principle of providing the best service for their clients/ patients, healthcare providers should ensure that:

• They make the care of their patients their first concern
• Maintain their own competencies and keep their professional knowledge up to date
• Take prompt action if patient safety is potentially compromised
• Maintain trust by being open, honest, and acting with integrity

Stage 1 Complaint Process

1) Patient sends details of their complaint to the competent authority within the Health Care Provider.

2) Patient now enters the HCP’s complaints pathway.

3) The HCP provides the complainant with a template to indicate:

(a)   The nature of the complaint

(b)  The nature of the procedure/ treatment/ process/ situation that led to their involvement with the HCP

(c)   How this relates to their complaint

(d)  When this occurred

(e)   What the adverse effect– financial, emotional, physical or other

(f) Any other information the complainant feels is relevant

4) The HCP provides an initial response within 3 days, but ideally within 24 hours apologising with empathy and explaining the review process of their complaint and when they will come back with a formal response.

5) HCP does a formal investigation of the formal complaint and responds to the complainant with resolution option(s).

6) If the Complainant is not satisfied with the resolution options, which normally should include a goodwill gesture, proposed by the HCP the Complainant can avail themselves of either adjudication in Stage 2 or the Courts.

If no resolution has been achieved, then the case will be submitted to HSCAMP for independent evaluation and adjudication on the decision of the complaint.

Stage 2 Adjudication Process

1) HSCAMP will respond to both the provider and the complainant.  The initial response to both will include:

1. Acknowledgement of receipt of the request to assess the case.
2. Request consent to be sent by both parties involved, for full disclosure of the case history.
3. Inform the provider of the timeframe required to upload the full set of notes in chronological order into the Adjudication CRM.
4. Also, to indicate that if any information is missing at this stage, then this will be re-referred to the providers/ complainant to provide this information, prior to formal adjudication taking place.

2) Once this information is complete, then the case will be reviewed and passed on to the relevant specialist adjudicator(s)

3) The fee paid for this service will be paid by the HCP and sent to HSCAMP

4) The complainant will receive a letter outlining the Terms and Conditions of adjudication.

5) On the basis that the Complainant wishes to proceed the Adjudicator will render his/her decision within 30 days from the commencement of Stage 2, unless impossible to do by actions of either party.

6) The decision of the adjudicator will be deemed final (i.e. no right of appeal) and binding on the HCP.  If the Complainant is still not satisfied it has the right to escalate this matter to the Courts. 

7) The response of the adjudicator will include:

1. Recommendations of apologies where shortcomings in treatments or processes were highlighted and identified quite clearly and were directly related to the complaint submitted
2. Potentially a goodwill payment to aid resolution

8) Providers will pay any goodwill payments to the complainants within 30 days of receipt of the response.

9) HSCAMP will provide final copies of the decisions for the Claimant and HCP’s records.