Quality of Care

COMPLAINTS RESOLUTION ADVISORY COMMITTEE

2013 ANNUAL REPORT

 
The College of Physicians and Surgeons of Saskatchewan continues its statutory obligation to review complaints registered against physicians. Complaints are accepted when a complainant has concerns about the care provided by a physician and/or the conduct of a physician.

Verbal complaints reported to the College are resolved by administrative staff in an informal manner when appropriate.  Written complaints are accepted through the Complaints Resolution Advisory process and typically represent issues surrounding physician communication and attitude or concerns about the standard of care.

In 2013, the College received ­­­­2,363 expressions of concern or requests for information, the majority of which were dealt with by administrative staff.

In 2013 the Committee met on seven occasions.  The yearly work of the Complaints Resolution Advisory Committee is comprised of cases registered in two calendar years. The Committee completed 51 open cases from 2012 and reviewed a portion of the 171 cases registered in the 2013 calendar year. Of the 171 new cases registered in 2013, 36 cases are being held over to 2014; 12 cases were resolved without Committee assistance, three cases were withdrawn and three cases were referred to the Registrar for consideration of furthest action.

There were 329 individual allegations contained in the 186 closed cases from 2012 (51) and 2013 (135). These are the outcomes of the 329 allegations that were registered:

Founded – 94                                      Unfounded - 158

Partially Founded – 39                          No Determination – 22

Patient Responsibility – 6                      Resolved Without Committee – 4

System Error – 4                                 Withdrawn - 2

 

The following table groups the allegation and determination for the completed cases in 2012 and 2013 into four broad categories.

2013 COMPLETED CASES

 

Treatment and Management

61%        (200/329)

Communication

34%        (112/329)

Ethical Concerns

  4%        (14/329)

System Issues

   1%       (3/329)

 

The following chart reveals that 11 allegations accounted for 80% of the findings. Inadequate communication, inappropriate comments, insensitive care and incorrect/missed diagnosis had the highest founded determinations.  Inadequate communication represented 17%, insensitive care was 14% and inappropriate comments was 7.5% of the total founded determinations.


Complaint Trends

 

Inadequate Communication

 

Of the 2012 and 2013 completed files, the most frequent founded allegation was inadequate communication.  Sixteen of the 31 inadequate communication allegations were founded.  This remains a significant issue for many complainants.

In the eyes of the patient or family, inadequate communication can overshadow or negate the best technical care. It can lead to poor clinical outcomes if patients do not understand their illness or what to expect. Generally patients and families feel more empowered when they are included in the care process as fully informed participants.

Insensitive Care

Of the completed files in 2013, the second most frequent founded allegation was insensitive care.  Fourteen of the 35 allegations were founded.

Taking the time for open, respectful and compassionate discussion with patients and families goes a long way in avoiding complaints about insensitive care.  

“In many busy clinical practices, lack of time for in-depth conversations with patients is likely to limit opportunities to understand patients in all their complexity. Mutual comprehension takes time and sustained dialogue; this applies to all patient-physician encounters and is not limited to exchanges involving patients and caregivers from different cultural backgrounds.”   Turner, L. Is cultural sensitivity sometimes insensitive? Can Fam Physician. 2005 April 10; 51(4): 478–480

In addition, the growing cultural diversity of Saskatchewan is requiring physicians to develop new and innovative communication methods.

“Cultural competency in medical practice requires that the physician respects and appreciates diversity in society. Clinicians acknowledge differences but do not feel threatened by them . . . Awareness of one’s own culture is an important step towards awareness of, and sensitivity to, the culture and ethnicity of other people. Clinicians who are not aware of their own cultural biases may unconsciously impose their cultural values on other people.” 1

"Culturally competent communication leaves our patients feeling that their concerns were understood, a trusting relationship was formed and, above all, that they were treated with respect . . . As physicians, we must make multiple communication adjustments each day when interacting with our patients to provide care that is responsive to the diverse cultural backgrounds of patients in our highly multicultural nation."2

1.  “Part 1 - Theory: Thinking About Health Chapter 3 Cultural Competence and Communication” AFMC Primer on Population Health, The Association of Faculties of Medicine of Canada Public Health Educators’ Network, http://phprimer.afmc.ca/Part1‑TheoryThinkingAboutHealth/Chapter3CulturalCompetenceAndCommunication/Culturalawarenesssensitivityandsafety (Accessed March 18, 2014). License: Creative Commons BY-NC-SA

2. Caron N. Caring for Aboriginal patients: the culturally competent physician. Royal College Outlook 2006; 3(2):19-23


Inappropriate Comments

Of the completed files in 2013, the third most frequent founded allegation was inappropriate comments.  Seven of the 13 allegations were founded.

The use of inappropriate words or actions by a physician is disrespectful and disruptive to the therapeutic relationship.  Professional decorum is an essential component of physician skill and performance.

The following are examples of inappropriate words and comments taken from Physician Behaviour in the Professional Environment, a policy of the College of Physicians and Surgeons of Ontario:

  • Profane, disrespectful, insulting, demeaning or abusive language;
  • Shaming others for negative outcomes;
  • Demeaning comments or intimidation;
  • Inappropriate arguments with patients, family members, staff or other care providers;
  • Inappropriate rudeness;
  • Gratuitous negative comments about another physician’s care (orally or in chart notes);
  • Passing severe judgment or censuring colleagues or staff in front of patients, visitors or other staff;
  • Insensitive comments about the patient’s medical condition, appearance, situation, etc.;
  • Jokes or non-clinical comments about race, ethnicity, religion, sexual orientation, age, physical appearance or socioeconomic or educational status.

 

 

Summary

 

Although the Committee continuously strives to complete cases in a timely fashion, there are limiting factors such as the number and timing of Committee meetings and the increasing complexity of the files being reviewed. 

The vast majority of physicians subject to a complaint respond promptly. On occasion, a significant delay in the receipt of a physician’s response unduly prolongs the process. Physicians are reminded it is a College regulatory bylaw requirement to respond to a request for information from the College within 14 days of the request being received. 

Not responding in a timely fashion results in a more lengthy process than necessary. It also places additional stress on all parties including the complainant and medical colleagues who may be involved in the complaint. Complainants are more likely to be dissatisfied with the physician’s response if it is significantly delayed or it is perceived to be defensive and evasive.

Physicians are reminded that the Complaints Resolution Advisory process is educational and non-punitive. On rare occasions, matters that fall substantially below the expected standard of care or that are found not to be amenable to an educational approach are escalated to the Registrar and Council for consideration of further action.

Complaints and responses are shared with the parties in an open and transparent fashion. Physicians are advised to respond objectively to the questions posed without attempting to blame, discredit or impugn the complainant. Responses that are prepared with sensitivity, compassion and humility are generally well received by complainants and are often resolved more expeditiously. Physicians are also advised to have their responses reviewed by a trusted advisor before they are submitted to the College.

As Medical Manager of the Complaints Process, I would like to take this opportunity to thank the Complaints Department staff, Melissa Hoffman, Alyssa Van Der Woude, Leslie Frey and Tracy Hastings for their ongoing support of the Committee’s work and for their dedication and patience in assisting the public with their questions and concerns. 

I would also like to thank the current Committee members for their dedication and hard work.  Non-medical public members are Ms. A. Brayshaw, Ms. V. LaCroix of Saskatoon (chairperson), and Mrs. S. Lougheed of Beechy.  Physician members are Dr. L. Baker, family physician in Rosthern; Dr. M. Plewes, family physician in Moosomin; and Dr. V. Olsen, general surgeon in Prince Albert.

Any physician who has an interest in serving on the Complaints Resolution Advisory Committee in the future is asked to submit their expressions of interest to OfficeoftheRegistrar@cps.sk.ca  for consideration by the Registrar.

 

Respectfully submitted, 

Dr. David Poulin, Medical Manager

Mrs. Tracy Hastings, Regulatory Services Coordinator

Ms. Leslie Frey, Regulatory Services Coordinator

Ms. Melissa Hoffman, Complaint Coordinator

Ms. Alyssa Van Der Woude, Administrative Assistant

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