Notifications – towards a better complaints process
Being the subject of a complaint is never a pleasant experience, and can often be very traumatic for doctors and their families.
But it is clear that the notification system overseen by the Australian Health Practitioner Regulation Agency has been unnecessarily lengthy and distressing for many, and the AMA has been working with both AHPRA and the Medical Board of Australia to improve the way it operates.
At a workshop in March, five AMA representatives met with officials from AHPRA and the Medical Board to work on ways to improve the practitioner experience when a notification is made about them to the Board.
We reviewed de-identified case examples to identify where processes fail practitioners, and to explore improvements. Extensive background information – decision making protocols, guidance and policies, as well as current data on timelines, volumes and outcomes – were used as reference material during the analysis.
I reported in detail on the outcomes of the workshop in the 16 March edition of Australian Medicine (see ausmed/when-complaint-made-%E2%80%93-improving-ahpra-…). It resulted in a number of recommendations and changes for improving the way the system operates, which are set out below.
Regulatory principles – the regulatory principles that the Board and AHPRA staff use to guide their investigations and decision making would be included in the guide for practitioners and be attached to the initial letter that the practitioner receives about a notification (the principles can be viewed at: http://www.ahpra.gov.au/About-AHPRA/Regulatory-principles.aspx).
Initial assessment response – the letter inviting an initial response from the practitioner would include details about when they will be notified of any further developments, including any decision for no further action or investigation, or any other action that is available to Board. The letter would also include contact details for a person to handle further inquiries.
The letter would reassure the practitioner that the process was not intended to punish practitioners, is part of arrangements for protecting the public, and that due process would be followed.
Reflective lessons – in cases where investigations result in no further action, the Medical Board would examine the factors that were known at the time of notification and consider how these might inform the notifications vetting process. The Board would also consider what more could be done to help the practitioner understand the issue that contributed to the notification, and the action they could take to improve the quality of their practice.
Investigations beyond 12 months – where the notification process takes longer than a year, there would be more frequent updates for practitioners about how their matter was progressing and the reasons for delay. This would be supplemented with the publication of more general information for the public about the most common reasons for lengthy delays.
Transparency about decisions where a board member is professionally associated with the practitioner being reviewed – the Medical Board and AHPRA have clear processes in place to manage potential conflicts of interest. AHPRA and the Board undertook to explain to practitioners how such issues are dealt with.
Expert reports – practitioners would be provided with a copy of any expert report obtained regarding them, except when there were specific risks associated with doing so.
Assessment costs – the Medical Board undertook to clarify that travel costs incurred by practitioners attending assessments as directed by the Board would be paid by it.
Reworking letters to practitioners – the letters sent to practitioners would be improved to provide more and better information about the process.
Feedback from practitioners – AHPRA undertook to explore cost-effective ways to elicit practitioner feedback about how they feel they were treated during an investigation.
It was an extensive to-do list, but pleasingly there is already signs that the practitioner experience is getting better.
AHPRA’s Annual Report, released on 2 November, paints a picture of improved performance:
- a 25 per cent reduction in open notifications;
- average time for assessment cut from 142 to 73 days;
- the number of investigations taken longer than 12 months fell by 18 per cent to 360;
- the closure rate for investigations has improved for three consecutive years;
- there has been a 32.8 per cent fall in administrative complaints about its work, down to 469;
- there has been a 55 per cent decline in complaints referred by the National Health Practitioner Ombudsman;
- 80 per cent of panel members completed a training program to deliver more consistent decision-making nationally;
- a national three-day training program for all AHPRA investigators was established to strengthen consistency in approach and performance in managing notifications; and
- customer service teams resolved 93.6 per cent of telephone calls at first contact.
This shows that, with goodwill and a spirit of collaboration, the AMA can work constructively to bring about improvements.
To continue these efforts, in February AMA representatives will again meet with the Board and AHPRA to explore further areas for improvement.
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