The Evolution of the HQCC Dr Kim Forrester Barrister-at-law Assistant Commissioner (Legal) HQCC

The Evolution of the HQCC

Dr Kim ForresterBarrister-at-lawAssistant Commissioner (Legal) HQCC

• Background• Commission structure• Health Quality and Complaints Commission Act

2006• Activities of the Commission

Contents

• Bundaberg Hospital surgical outcomes and associated health system issues; April 2003 - early 2005.

• Bundaberg Hospital Commission of Inquiry .• Qld Public Hospital Commission of Inquiry ( Davies Report).• Qld Health Systems Review (Forster Review).• Health Quality and Complaints Commission Act 2006.• Health Quality and Complaints Commission; 1 July, 2006.

Background

Davies Report

Identified systematic failures resulting in unsafe practices:

• Badly administered /insufficient funds;• Poor credentialing/ clinical privileging and

performance management;• Culture of concealment.

Forster Review

Found:Need for more accessible, responsive and patient

focused complaints system;Medical Practitioner’s accreditation system did not

adequately ensure the quality of the health system;Required body to deal with health care complaints and

oversee health quality.

Forster Report

• Establish and health commission under new enabling legislation:

“…would assume the role of the current Health Rights Commission as well as oversee the development and implementation of quality, safety and clinical practice standards throughout the state’s public and private health facilities”.

Health complaints

Historically, complaint potentially involved:HRC, Crime and Misconduct Commission, Health Practitioners

Registration Board, QNC, Professional Conduct Review Board, Qld Ombudsman, Adult Guardian, Public Trustee, Commission for Children and Young People, Child Guardian, Local Member of Parliament, Q Health (hospital/dept liaison officers, District Manager, Complaint Coordinator, D-G Health, Minister), Private Health Advisory Unit, Chief Health Officer, Coroner.

Establishment of Health Quality and Complaints Commission

Role:Consolidate and manage complaints process;Identify systematic issues;Oversee improvements in the quality of Health Services in both

public and private sectors;Work with providers to improve health quality and services.

• One Commissioner and six Assistant Commissioners (lawyer, medical, nursing, allied health, consumer, safety and quality) part-time

• Office of the Commission – CEO, Executive and approx 60 staff

• Consumer and Clinical Advisory Committees

Commission structure

Health Quality and Complaints Commission Act 2006 – In performing its functions or exercising its powers, the

Commission must:• observe natural justice• act as quickly, and with as little formality and technicality, as

practicable• act independently, impartially and in the public interest

Health Quality and Complaints Commission Act

Main objects of the Act section 3:• Oversight and review of, and improvement in, the quality of health

services and• Independent review and management of health complaints.A health service is defined in section 8 as: • a service provided to an individual for, or purportedly for, the benefit of

human health; includes an administrative process or service related to a health service.

A provider is defined in section 9 as:a person who provides a health service or as a registered provider.

HQCC Act continued

Section 20: Duty of Provider:A provider must establish, maintain and implement reasonable processes to improve the quality of health services provided by, or for the provider, including processes

- to monitor the quality of health services - to protect the health and well being of users of the health services

Section 21 - Information Section 22 - Standards Section 23-30 - Compliance

HQCC Act – Chapter 3 Quality of health services

• Standards Development• Quality Monitoring• Complaints Resolution• Investigation

Main Activities of the Commission

• Standards framework • Code of health rights and

responsibilities • Future:

– Medication safety - Review & reconciliation

– Communication– Not for resuscitation

1. Review of Hospital Related Deaths 2. Credentialing3. Surgical safety

– Correct surgery– DVT prophylaxis– Antibiotic Prophylaxis

4. Hand hygiene5. Complaints Management 6. Management of Heart Attack

Following Discharge7. Providers’ Duty to Improve the

Quality of Health Services (Interpretation of Section 20)

Standards Development

Section 31:HQCC required to develop a Code of Health Rights and Responsibilities within 2 years

of establishment.Section 34:Principles: Decision making involvement;

Active role in health care;Provision of care;Confidentiality;Access to records;Recognition of the carer/provider;Access to redress grievances

Code of Health Rights and Responsibilities

• Self assessment • Accreditation reports • Routine reporting - incidents, complaints, sentinel events, root

cause analysis• Passive surveillance - pathology, morbidity• Inspections / audits

Quality Monitoring

• Health service and health quality complaints• Early resolution• Assessment• Action after assessment - conciliation, investigation,

referral to boards, nil• No power to award financial settlements – can be

negotiation in conciliation

Complaints Resolution

• Health service complaints• Health quality complaints• Death of a person (Coroners Act 2003)• Referral from the Minister

Investigations

ALL ENQUIRIES & COMPLAINTS RECEIVED*by Quarter (Total = 6207)

(1 July 2006 – 31 October 2007)

1143967

1174 11301246

547

0

200

400

600

800

1000

1200

1 Jul 06 - 30 Sept

1 Oct - 31 Dec

1 Jan - 31 Mar

1 Apr - 30 June

1 Jul 07 - 30 Sept

1 Oct - 31 Oct

Num

ber

* Enquiries usually concluded with one contact

Complaints may involve multiple contacts

ENQUIRIES & COMPLAINTS CLOSEDby Quarter (Total = 6067)

(1 July 2006 – 31 October 2007)

818

10371184

13461200

482

0

200

400

600

800

1000

1200

1400

1 Jul 06 - 30 Sept

1 Oct - 31 Dec

1 Jan - 31 Mar

1 Apr - 30 June

1 Jul 07 - 30 Sept

1 Oct - 31 Oct

Num

ber

COMPLAINTS CLOSED by district (Total = 1116)Year To Date (1 July 2007 – 31 October 2007)

Cairns & Hinterland, 29

Cape York, 2

Central Qld, 24

Central West, 1

Fraser Coast, 23

Gold Coast, 115

Mackay, 23

Mt Isa, 6

Northside, 111

PA Hospital, 35RBH & RCH Hospital, 42

Southside, 87

South West, 3

Sunshine Coast & Coolola, 50

Torres Strait, 0

Toowoomba & Darling Downs, 33

Townsville, 29

West Moreton & South Burnett, 32

Wide Bay, 59

Unknown, 399

Mater Hospital, 13

COMPLAINTS CLOSED by Provider (Total = 1116)Year To Date (1 July 2007 – 31 October 2007)

Aged Care, 18

Allied Health, 34

Community Health, 13

Dental / Dentist, 74

Hospital - Private, 48

Hospital - Public, 334

Mental Health, 36

Medical Practitioner, 410

Not a Health Service, 9

Nurse, 20

Other, 40

Pharmacy/Pharmacist, 13

Queensland Health, 6

Radiology, 11

Medical Centre, 50

COMPLAINTS CLOSED by Issue (Total = 1116)Year To Date (1 July 2007 – 31 October 2007)

Access to Service, 127

Communication, 91

Consent, 25

Corporate Services, 44

Cost, 62

Grievances, 3

Privacy/Discrimination, 60

Rights, 1

* Treatment, 652

Professional Conduct, 51

* Examples of treatment include misdiagnosis, medication and wrong or painful treatment

INVESTIGATIONS (Total = 86)Year To Date (1 July 2007 – 31 October 2007)

Finalised, 23

In progress, 63

INVESTIGATIONS by Origin (Total = 86)Year To Date (1 July 2007 – 31 October 2007)

Minister, 2

State Coroner, 18

CMC, 2

CCYPCG, 2

Queensland Police, 1

HQCC, 36

HQCC "Own Motion", 5

Whistleblower, 2

Conclusion