Executive Summary

This investigation by the Office of the Ombudsman looks at how public hospitals in Ireland handle complaints about their services. In particular, it looks at how well the HSE and public hospitals (including voluntary hospitals) listen to feedback and complaints and whether the HSE and public hospitals are learning from complaints to improve the services they provide.

At the outset of this investigation, this Office sought the views of members of the public who had complained about a hospital service, either as a patient or a relative and/or carer.

One of the key points that emerged from this public engagement was:

• many users of hospital services (whether patients or relatives/carers) do not know
• how to make a complaint about a hospital service and are not aware of the support available to help them to do so, including the right to escalate the complaint to this Office.

The main barriers to giving feedback or making a complaint were identified by participants as:

• a fear of repercussions for their own or their relatives’ treatment;
• a lack of confidence that anything would change as a result of complaining.

This Office surveyed all public hospitals to gain a better understanding of the complaints process as it operates across the country and visited 8 randomly selected hospitals for a more in-depth study of their processes. We met with senior management from the HSE, the Department of Health, representative organisations and health sector regulators. We also received submissions from other representative organisations and patient advocacy groups.

The key findings that emerged from this investigation include:

1. Feedback should be encouraged – Members of the public reported a lack of knowledge   about how to give feedback or make a complaint. The HSE and hospitals must publicise the information and supports available in order to encourage and assist people to share their experiences of hospital care and make the process more accessible for all. Complaints should be seen as a positive way of ensuring that healthcare services continually improve.
2. Learning from complaints is essential – Hospital staff reported to this Office that there was  often a difficulty in getting internal feedback on the outcome of complaints. In view of this, and the belief among the focus group participants that nothing happens as a result of complaining, there is a need for a new focus on learning (and sharing the learning) from complaints. Responding effectively to complaints and learning from them is essential to providing a high quality service. In this regard, learning from complaints should sit alongside learning from other sources such as adverse events or “near misses”.
3. There is a role for senior managers within the complaints process – Senior managers must be active and visible in promoting and reinforcing a positive complaints culture within hospitals.
4. Outcomes need to be publicised more – It is important that the HSE and hospitals highlight complaint outcomes which led to improvements and changes in procedures and inform people (the public, hospital staff and the hospitals) what these improvements are. As a result of these findings, the Ombudsman has made a number of recommendations. These recommendations include:

• A no “wrong door” policy should be developed so that wherever a complaint is raised, it is the system and not the complainant that is responsible for routing it to the appropriate place to get it resolved.
• Independent advocacy services should be sufficiently supported and signposted within each hospital so patients and their families know where to get support if they want to raise a concern or issue.
• A standard approach should be adopted by all hospitals in relation to the information available to the public.
• A standardised structure for collecting and documenting a complaint should be developed across the hospital groups outlining the nature of the complaint, the preferred method of communication and desired outcomes.
• The outcome of any investigation of a complaint together with details of any proposed changes to be made to hospital practices and procedures arising from the investigation should be conveyed in writing to the complainant with each issue in the complaint responded to.
• Each hospital group should provide a six monthly report to the HSE on the operation of the complaints system detailing the issues giving rise to complaints and the steps taken to resolve them and the HSE should publish an annual commentary on these six monthly reports.
• Each hospital should develop a learning implementation plan arising from any recommendations from a complaint which should set out the action required, the person(s) responsible for implementing the action and the timescale required.
• Each hospital group should publicise (via the development of a casebook) complaints received and dealt with within that hospital group. This casebook should contain brief summaries of the complaint received and how it was concluded/resolved (including examples of resulting service improvements) and should be made available to all medical, nursing and administrative staff as well as senior management.

The Ombudsman intends to ask the HSE and each of the voluntary hospitals to develop an action plan in order to monitor the implementation of these recommendations.