Meeting Purpose

This BC-PAN meeting was part of a two day Zoom conference on November 23 and 24, 2020. The purpose of this day was to learn about the public advisors’ experiences and recommendations for improving the Colleges’ complaints processes.

Key messages from public advisors

• Colleges can take measures to equalize the power imbalance between the complainant and the registrant during the complaints process by supporting complainants throughout the process.
• Providing of opportunities for feedback and review of the outcome, and notifying complainants of its availability, helps to establish trust and willingness to participate.
• Regular communication to the complainant, even when there are no new actions taken, aids in avoiding discouragement and frustration.

Regulators and the complaints process

Eric Wredenhagen, CMTBC registrar, presented a brief explanation of the complaints processes led by
BC health regulators.

• In Canada, professional regulatory bodies are created by the Health Professions Act (HPA), with their powers and duties defined and limited by their statutes.
• Colleges regulate individual health practitioners – they do not have authority over systems or institutions.
• Section 32(I) of the HPA requires a person who wishes to make a complaint against a registrant to deliver the complaint in writing to the registrar.
  • Colleges cannot accept anonymous complaints, and complaints may be delivered through an online submission, email, or letter – depending on the college.
• An Inquiry Committee, consisting of registrants and public representatives, reviews and investigates the complaint.
• Options for resolution of a complaint by the Inquiry Committee includes:
  • Dismiss the complaint.
  • Resolve the matter between the complainant and registrant.
  • Reach an undertaking or consent agreement with the registrant.
  • Direct that a citation should be issued for a discipline hearing.
• Discipline hearings are formal adjudicative processes; hearing panels consist of registrants and public representatives.

Advisor questions and comments

• What is the reporting line/complaints process for registrants employed by health authorities?
  • Anyone can lodge a complaint – from health authorities it may be a patient, manager, another professional, etc.
• Who decides on the public representatives?
  • Public representatives on the Board are appointed by the Minister of Health. The selection is done by the Crown Agencies and Board Resourcing Office (CABRO).
• As a result of the Cayton Report, colleges are required to ensure that there are no board members on the inquiry committee. 

Advisor feedback on complaints process videos

Public advisors were provided background material prior to the meeting, with three videos to watch. Susanna replayed the videos for attendees to review:

Videos:

1. BCHR
2. College of Pharmacists of BC

(a third video was also provided in pre-readings, College of Occupational Therapists of BC)

The public advisors were separated into break out groups to discuss their thoughts on each video.

• Simple, calm, and concise videos are easy to follow.
• Include key words alongside images.
• Less professional and more patient focused is encouraged.
• Videos describe the process but not where to go to make a complaint.
  • Including contact information in the video is helpful, or ways to get more information.
• It is important to have representation; videos should reflect diversity.
• Sharing a complaint as a story may be beneficial and more accessible.
• Subtitle options should be included to help with language barriers.

Advisor experiences with college complaints processes

Susanna shared feedback that advisors provided about their personal complaints experience:

• Correspondence was useful but took a long time.
• Advisors felt that although they had personal capacity and skills, it was still a challenging process and must be much more challenging for those who lack their capacity.
• Most felt validated by the process, the degree of justice, and felt that the process was meaningful.
• There was frustration that their experience was not reflected in the final decision. Although the practitioner was within standards, it personally did not feel reasonable or acceptable.

Colleges’ understanding of the patient experience with the complaints process

Anita Wilks, CDSBC Director of Strategy and Engagement, gave a presentation outlining CDSBC’s
understanding of the complaints process:

• In 2016 CDSBC started to measure registrants and complainants experience of the complaints process through an exit survey.
• General findings:
  • Most agree that their complaint was handled with courtesy and respect, but mixed feedback on how fair, thorough, and timely complaints were investigated.
  • When the outcome of the complaint matched the participants expectations, their satisfaction with the process is higher.
• CDSBC’s action plan, following the Cayton Report:
  • Re-evaluate information needed to inform process improvements that will enhance the patient experience.
  • Develop new opportunities to collect input from patients throughout the process.
  • Capitalize on existing opportunities to document feedback from the public.
  • Review and enhance survey.
• CDSBC established the Voice of Patent program, a research-based measure to understand the factors that drive positive and negative experiences.

Dianne Millette explained that several health regulators have embarked on a quality improvement project for colleges’ complaints process. Six of the seven colleges involved are also members of the BC-PAN. The project is supported by a research firm and is in its early phases, which includes:

• Conducting a mapping exercise to look at the complaints process across regulators.
• Cross tabulation to recognize relationships between outcomes.
• Exploring and understanding the perceptions and experience of all users in the complaints process.

The partners in the project are looking to identify opportunities to improve and provide recommendations for next steps.

Successfully engaging the patient throughout the complaints process

Joelle Berry, Manager of Inquiry and Discipline at CPTBC, walked the advisors through the main touch
points that a complainant will have with the college during the complaints process. She mentioned that
colleges tend to have similar touch points, and although legislation may be coming to impact the
process, the purpose of this meeting is to identify current opportunities in the current framework to
improve the patient experience.

Colleges complaints process overview

Awareness of the Complaints Process

1. Understanding – Knowing what a college can investigate, and what a college cannot do as part
   of the complaints process. Understanding limitations on the results of a complaint. Colleges
   accept complaints about conduct and competence.
2. Sharing – Speaking to someone about their concerns before filing a complaint. College staff is
   available to assist complainant in recognizing whether their experience can be filed as a
   complaint.

Filing a Complaint

3. Filing – The Health Professions Act requires a complaint to be made in writing to the registrar of
   the college. Most colleges accept fax, mail, and some may have online portals.
4. College response – Colleges will acknowledge the receipt of a complaint by mail or email. A file
   number will be assigned.

Investigation into a Complaint

5. Roles – Include the complainant, registrant, and others. Others are witnesses and/or
   organizations that may have relevant information. The college staff manages the process,
   decisions are made by the inquiry committee, and the colleges investigator is charged with
   conducting a fair, neutral and balanced investigation.
6. Timelines – The length of the process is dependent on several factors. Under the Health
   Professions Act, colleges are required to resolve a complaint within 120 days, but extensions
   allow up to 255 days. If the investigation has not been resolved by 255 days, the complainant or
   registrant can request a review by an oversight body.
7. Withdrawals – There is no mechanism for withdrawing a complaint. The complainant can
   withdraw their participation in the process, meaning they will not receive notice of the
   resolution nor can they request a review.
8. Evidence – During the investigation process, colleges gather evidence such as written interviews,
   related clinical records, and information from other organizations.
9. Updates – Some colleges will provide regular unsolicited updates; others may only connect
   when needed. The Health Professions Act requires that parties are notified when deadlines are
   met.

Results of a Complaints Investigation

10. Decision – Colleges provide the complainant and registrant with an investigation report. The
    decision is communicated to parties by a written letter, which outlines a brief summary of the
    complaint, relevant legislation, and reasoning for the decision. If parties are unsatisfied with the
    outcome, they can request a review board.
11. Wrap up – There is no further contact with the college unless initiated by the complainant. If the
    matter goes to a discipline hearing, a different phase begins, and the complainant will be
    notified about next step information.

Advisor input: Supporting the patient experience in the complaints process

Advisors were separated into break out rooms to following Joelle’s presentation. They were asked:

After thinking about the whole process, what are the most important ways to support the patient’s
experience at each stage of the complaints process, and why?

Before a complaint is filed:

• What would make a complainant feel safe to call college staff for information?
  • Quality customer service throughout the process.
  • Contacting colleges by phone to speak with a real, trained person provides a human element and helps to show compassion.
• Notifying complainants that exit interviews are available during the initial conversation offers comfort in undertaking the process.
• Complainants should be asked their preferred method of communication. Some may prefer the intimacy of a phone call rather than formal emails.
• There is a perception that making a complaint may be permanently on a patient’s record and impact future care.
• Materials about the complaints process should be available at visual points of care such as clinics and offices.
• Clarify in the initial contact the roles and expectations of the parties involved.

During the process:

• Timely contact is important to avoid frustration or discouragement. Regular communication helps for reassurance, even if there has been no further action taken.
• Complainants need transparency, resources and support to have confidence in their ability to participate in the process.
• Sensitivity should always be exercised – colleges should assume that the person may be physically or mentally traumatized from their experience.
• Clarify that complainants can include a person for their support other than lawyers.
• Materials about the complaints process should be available at visual points of care such as clinics and offices.
• A Patient Relations Expert would be helpful to implement to explain and support complainants.
• Complainants are sometimes emotionally, physically, mentally, and financially unprepared to undergo the complaints process – support needs to be provided to them.
• Power imbalance concerns include unequal access to legal consults, lack of understanding of regulatory processes, and perception that colleges favour registrants.

After the outcome:

• Provide support for the complainant to review and understand the outcome of a complaint. Letters that communicate the outcome should be written in plain, understandable English.
• Sharing the outcome in a form other than a letter would be helpful; when the complaint is resolved that favours the registrant, the complainant may be discouraged and confused.