Hospitals, physicians, and other health professionals strive to provide safe, quality care for their patients. Occasionally, patients, their families or representatives may express concern or dissatisfaction with the care the patient received in a hospital setting. Complaints to a hospital may extend to specific physicians. For physicians, knowing that the hospital will respect and follow a fair process to resolve the issue — and that the CMPA is available to help — can alleviate some of the anxiety associated with being the subject of a hospital complaint.
Legislation and hospital or regional health authority bylaws establish the framework under which physicians provide clinical care within a particular institution and provide the mechanisms for handling patient complaints. Hospital complaints involving physicians typically concern issues around the care that was provided, and difficulties contacting the physician or related communication issues. In some cases, a complaint is launched as a consequence of a series of missteps on the part of one or more individuals, or due to system failures. Patients may be left with a negative perception of the physician, the hospital, or the quality of healthcare generally.
Case example: Inadequate communication leads to complaint
A 35-year-old female presents to a busy emergency department, complaining of fever, sore throat, and difficulty breathing. She is seen by the emergency department doctor, who briefly examines the patient and informs her it could be the flu or bronchitis, though he states he is uncertain. The physician recommends bedrest and acetaminophen, to which the still-anxious patient reflects that she could have just stayed home and avoided the two-hour wait at the hospital. The doctor shrugs his shoulders and walks away.
Later the patient shares her story with friends who have similar experiences of being sent home without their concerns being adequately acknowledged. Her friends believe her problems were abruptly dismissed. The apparent lack of attention leads the patient to conclude the hospital doesn't care about its patients. The patient complains to the hospital, naming the emergency department doctor. The doctor is informed he has been named in a complaint and participates in the investigation as requested. Following the investigation, no sanctions are imposed; however, the doctor is counselled to improve his communication skills and professionalism to avoid similar issues in future.
Handling a complaint
Physicians may experience anxiety and stress when the care they provided is questioned. On receiving a complaint through the hospital, it is important for physicians to engage in the resolution process to ensure the patient and family are given accurate information to understand what had happened. Most hospitals have protocols for receiving and handling complaints, and these are described in the hospital's or regional health authority's bylaws. These processes can vary significantly, depending on the jurisdiction and the institution itself. In Québec, the hospital complaint process is legislated in all public healthcare facilities. In British Columbia, patient care quality offices and review boards review complaints in each health authority.
In most hospitals, the resolution process begins with a review of the care provided. This may be done through discussion between the physician and reviewer, or may require the physician to respond in writing. It is important to carefully read the patient’s complaint to gain a complete understanding of the patient’s concerns. The response should provide a clear and factual account of what happened, and not appear defensive or argumentative. If the patient wishes to meet with the physician or the hospital leadership, such a meeting may help to resolve the issue. The CMPA is also available to provide advice on any aspect of this process.
Patients often make complaints in the hope of reducing the likelihood of future reoccurrences. They want to know what corrective actions the hospital will be taking to address the issue. The hospital's patient advocacy department (or equivalent) generally closes the feedback loop by communicating with the patient about the investigation’s findings and actions taken.1 It is important for physicians to be involved in these discussions in order to learn from a complaint or incident.
Consequences of a complaint
Most complaints can be resolved by engaging collaboratively with the hospital and health authority. In a small number of cases, the complaint may uncover some concerns regarding a physician’s medical care, communication practices, or behaviour. A remedial plan to deal with these concerns, agreed to by the department or hospital chief and physician, may be warranted.
As the majority of physicians with hospital practices provide patient care under the privileges model, on rare occasions the hospital may impose a sanction such as restricting, suspending, or terminating the physician's privileges. In each province and territory, legislation and regulations require procedures for restricting and ending privileges, which are typically set out in hospital or regional health authority bylaws. For physicians working under contract, the CMPA has encouraged that such contracts contain the same procedural protections as those under the privileges model. If the physician's privileges or contract status are affected, the legislation in some jurisdictions requires the hospital to report this to the medical regulatory authority (College). A report may also be required if a physician resigns in the midst of an unresolved complaint investigation.
Sometimes patients may take other actions if the hospital or health authority is too slow to respond or appears not to be taking the complaint seriously. They may, for example, complain to the College, contact the news media, or voice their feelings on social media. To reduce the likelihood of this occurring, it is crucial for the physicians involved to work with the hospital or health authority to deal with a complaint as soon as possible.
Coping with, and learning from, a complaint
Being named in a complaint can be time-consuming and emotionally taxing or even overwhelming. Many physicians fear the unknown about the process and consequences of a complaint. They may struggle to understand why a patient to whom they thought they had provided good care is now complaining, and may begin to question their own abilities.
Many excellent resources are available for physicians facing complaints. CMPA members are encouraged to contact the Association and speak to a physician advisor when informed of a hospital complaint. CMPA physician advisors are peers with training and experience in dealing with this type of issue and will provide guidance and support. Discussing the issue with a trusted colleague or department head may also be helpful in putting matters into perspective.
Although difficult at the time, it is always helpful to view a complaint objectively as an opportunity to learn and improve. The CMPA offers education programs and has extensive online resources to help physicians and other health providers improve skills and processes in such areas as communication, handovers of care, dealing with conflict, and managing stress.
In some jurisdictions, when a hospital's quality assurance committee reviews the incident, legislation prohibits the hospital from disclosing the investigation findings.