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

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

2. Contents • Background • Commission structure • Health Quality and Complaints Commission Act 2006 • Activities of the Commission

3. Background • 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.

4. Davies Report Identified systematic failures resulting in unsafe practices: • Badly administered /insufficient funds; • Poor credentialing/ clinical privileging and performance management; • Culture of concealment.

5. 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.

6. 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”.

7. 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.

8. 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.

9. Commission structure • 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

10. Health Quality and Complaints Commission Act 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

11. HQCC Act continued 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.

12. HQCC Act – Chapter 3 Quality of health services 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

13. Main Activities of the Commission • Standards Development • Quality Monitoring • Complaints Resolution • Investigation

14. Standards framework Code of health rights and responsibilities Future: Medication safety - Review & reconciliation Communication Not for resuscitation Review of Hospital Related Deaths Credentialing Surgical safety Correct surgery DVT prophylaxis Antibiotic Prophylaxis Hand hygiene Complaints Management Management of Heart Attack Following Discharge Providers’ Duty to Improve the Quality of Health Services (Interpretation of Section 20) Standards Development

15. Code of Health Rights and Responsibilities 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

16. Quality Monitoring • Self assessment • Accreditation reports • Routine reporting - incidents, complaints, sentinel events, root cause analysis • Passive surveillance - pathology, morbidity • Inspections / audits

17. Complaints Resolution • 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

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

19. ALL ENQUIRIES & COMPLAINTS RECEIVED*by Quarter (Total = 6207)(1 July 2006 – 31 October 2007) * Enquiries usually concluded with one contact Complaints may involve multiple contacts

20. ENQUIRIES & COMPLAINTS CLOSEDby Quarter (Total = 6067)(1 July 2006 – 31 October 2007)

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

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

23. COMPLAINTS CLOSED by Issue (Total = 1116)Year To Date (1 July 2007 – 31 October 2007) * Examples of treatment include misdiagnosis, medication and wrong or painful treatment

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

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

26. Conclusion