Guide to Complaint Handling in Health Care Services

Sample Complaint
Management Procedure
1. Complaint entered in Department Complaint
Register by frontline complaint handler.
2. Assigned a complaint number.
3. Complaint handler tries to resolve complaint
locally.
4. Complaint handler identifies the
Seriousness/Probability Score using SAM.
SAM score of 3, 2 or 1 generates an
automatic flag to: Department Manager and
complaints manager
SAM score of 2 or 1 generates additional
automatic flags to: Executive Management,
Quality Team, Director of Medical Services,
Director of Nursing
5. If unresolved locally, complaint referred to
Department Manager or complaints manager.
6. Complaint investigated.
7. If an adverse event (actual or ‘near miss’) is associated
with complaint, complete an
incident report.
8. Resolution/outcomes determined.
9. If unresolved, refer to Health Services
Commissioner if appropriate.
10. Provide information on outcomes to consumer,
staff, executive management and quality teams.
Role of complaints manager
The complaints manager is responsible for:
• monitoring all registered complaints,
• investigating complaints/co-ordinating
investigation,
• communicating with consumer,
• liaising with external bodies such as the Health
Services Commissioner,
• maintaining complaint data,
• ensuring outcome is reported to consumer
and staff,
• ensuring relevant legislation is adhered to,
i.e. privacy, public records,
• preparing a formal report to Executive
Management on a regular basis.
Reporting
The organisation needs to decide what information
should be reported on. The report to management
can include the following:
• number of complaints – and whether active
or closed,
• breakdown of complaints, cross-tabulated by
department and type of complaint,
• detailed report on the more serious complaints
(classified as 1 or 2 in SAM),
• number of complaints requiring legal advice,
• how complaints have been resolved and what
changes have been implemented.
There also need to be reports to staff meetings –
particularly if complaints are showing communication
or staff behaviour to be a problem.
38 Setting up your system/tools