Management and outcomes of health practitioner complaints in Australia: a comparison of the national and New South Wales systems.

Abstract

The aim of this study was to summarise the process and outcomes of complaints from five regulated health professions in Australia, and to compare these between the national and New South Wales (NSW) systems. This is a retrospective cohort study of all complaints lodged from 1 July 2012 to 31 December 2013 for medicine, nursing and midwifery, dentistry, psychology and pharmacy registered practitioners. Data were extracted from the Australian Health Practitioner Regulation Agency, the NSW Health Professional Councils' Authority and the NSW Health Care Complaints Commission databases. The main outcome measures were frequencies and percentages of process decisions and outcomes. Systems differed in classification of complaints as conduct (national 47%; NSW 22%) and performance (national 45%; NSW 71%). Thirty-eight per cent of complaints were investigated or managed through a health or performance stream (national 40%; NSW 34%), but the national system investigated more matters (national 35%; NSW 6%). Over 50% of complaints resulted in 'no further action' (national 60%; NSW 70%). The most common action was caution or counsel (national 12%; NSW 15%), followed by conditions, (national 10%; NSW 5%). Practitioner registration surrender was more common with the NSW than national system (national 0.1%; NSW 1.3%), but registration suspensions or cancellations were similar (national 0.6%; NSW 1.0%). The main difference between the two systems is the administrative decision as to how complaints are assessed. In NSW, a classification of a complaint as 'performance' usually means the complaint is not investigated; rather, the practitioner is assessed by peers and may be required to undergo further education and training. Reaching agreement and understanding of complaints that should be investigated and those appropriate for performance review would strengthen a national approach to health complaint regulation. What is known about the topic? The national system of managing healthcare complaints is relatively new (since 2010) compared with the NSW system (since 1993). Annual reports of the regulatory authorities provide summaries of types and outcomes of complaints separately for each profession, and separately for NSW and the national system, but we do not know how the two systems directly compare in terms of complaint management or their outcomes. What does this paper add? This study examined how different types of complaints are managed between the two systems and whether there are any differences in outcomes. The types of complaints are almost identical between the two systems, but classification of complaints as 'performance' or 'conduct' differed. Immediate action is more common in the national than NSW system, especially for health impairment and boundary crossing. Health impairment complaints are much less likely to be discontinued at the assessment stage in NSW compared with the national system. The NSW and national systems are similar in terms of complaints proceeding to either an investigation or performance or health assessment, but the national system investigates more than the NSW system. For many types of complaints the outcomes were similar between systems, but there were clear differences for some types of complaints, such as health impairment and boundary crossing. What are the implications for practitioners? An efficient and fair regulatory system is crucial for maintaining practitioner trust, as well as trust of the public. This study shows that there are many similarities between the national and NSW systems in terms of process and outcomes, but there are differences in the way some types of complaints are assessed between the two systems. This knowledge may assist regulatory authorities in their efforts to achieve a nationally consistent approach to complaints.