Case Studies
Addressing telehealth service quality
Background
A parent contacted us to discuss their experience in attempting to access a health care service on behalf of their child. They suspected that their child demonstrated tonsillitis symptoms, which they explained to the health care provider’s staff. The staff advised that since the symptoms also presented as flu-like, they would have to organise a telehealth appointment as opposed to an in-person consultation. The parent was concerned with this arrangement as they did not feel that it would allow the health care provider to accurately assess their child’s health. They explained this to the health care provider’s staff who advised that their policy would not allow in-person visits for clients who demonstrate flu-like symptoms. When they attended the telehealth appointment, they were then informed that they would have to schedule an in-person appointment to receive an accurate assessment. The parent contacted the health care provider’s staff to express their dissatisfaction regarding the process and were advised to locate a different health care provider before being placed on hold indefinitely. The parent was keen to identify a resolution and contacted HaDSCO to discuss their options.
What did we do?
The HaDSCO Complaints Team contacted the service provider who was willing to engage in the complaint resolution process. An officer from the team then agreed to facilitate a Negotiated Settlement process that allowed the parent to resolve their concerns with the health care provider. The process allows a HaDSCO team member to encourage and support both parties to reach an agreement though complaints resolution procedures. The complaint resolution process provided the service provider with an opportunity to review their telehealth process, and customer service.
What was the outcome?
The service provider manager expressed that they were grateful that the situation was bought to their attention, advising it was an opportunity to grow and learn. Although the staff had followed their required protocols, they had not provided the high-quality customer service expected by their management team. The manager apologised to the parent for their experience and advised that staff would engage in additional customer service training. They also explained their infection control requirements, and why these steps are important protection measures to avoid the spread of infectious diseases.
Improving clinical communication
Background
A carer was visiting a health provider who was managing their relative’s end-of-life care. As the patient’s health deteriorated the service provider had agreed to let the carer know if their family member passed while they were away from the facility. When the carer visited their relative, they found that their relative had passed which caused them distress as they had not been notified. When they enquired about this, the health care provider was initially unsure how the carer had not been contacted. The carer contacted us and advised they were distressed and unsatisfied with the explanation from the health care provider.
What did we do?
A HaDSCO case officer considered that a conciliation process may provide a satisfactory outcome for the carer. The conciliation process involves a face-to-face meeting facilitated by HaDSCO. A Complaints Officer encourages an outcome through informal discussions and encourages the parties to resolve the complaint collectively. The conciliation process assists the parties to identify ways to reach an agreement in a non-legal environment. The service provider and carer both agreed to meet and discuss the issue, and it resulted in a frank but respectful exchange.
What was the outcome?
As a result of HaDSCO’s role in the conciliation process, the carer was able to further explain to the service provider the distress caused through the communication breakdown. The service provider’s representative advised that the staff involved were devastated about what had occurred, and the incident would be used as a case study to prevent similar instances from re-occurring, in particular around palliative care requirements and family engagement. The service provider also agreed that their process had not been observed and acknowledged their role in not informing the carer about information relating to their relative. They apologised unreservedly and committed to exploring ways to ensure the situation would not repeat with other health consumers in their care.
Investigating bulk billing and provider fees
Background
A patient with a Pensioner Card contacted us to explain that they believed they had incurred incorrect fees from a health care provider. The provider had changed their payment policy to a mixed billing system that included some exceptions, for clients like pensioners and infants. This meant that, while most clients would be subject to a fee for a consultation, certain clients could still access bulk billing. The patient had accessed a service that they thought would be bulk billed but were informed after the service that they were required to pay the consultation fee. The health care provider had displayed signage which advised that clients with Pension Cards qualified for bulk billing but, when the patient disputed their fee, the staff advised they were unable to provide a refund. The patient attempted to discuss their concerns with the provider, but the provider maintained that they had been correctly charged for the service they received.
What did we do?
The HaDSCO Complaints Team reviewed the case and determined that a resolution could be achieved through the Negotiated Settlement process. A team representative liaised between the health care provider and the patient to determine the cause of the miscommunication and supported both parties to reach an agreement. Our enquiries with the health care provider about their billing arrangements showed that in this case the patient had been incorrectly charged.
What was the outcome?
The health care provider acknowledged that their staff required more policy training, particularly on client payments and bulk billing eligibility. The staff completed their training and felt confident that they now have an improved understanding of the policy. The provider offered an apology and a refund for the patient who was satisfied that their situation had been resolved.
Working with Department of Justice
Background
A person in custody at a correctional facility contacted HaDSCO to advise that they had a health concern which had not been addressed by the Prison Health Service Provider. Procedures are in place to ensure that health care treatment is available for people in custody, and in this way the system aligns with health care in the wider community. The person advised that they raised their health concern with medical staff at the Prison Health Centre, but they felt that it was not addressed. They also explained that their health concern was further impacted due to other underlying health concerns they had previously reported. They described the situation to our Complaints Team who agreed that a negotiated settlement process could provide an explanation for the person in custody.
What did we do?
A HaDSCO case officer worked with the person to engage with the Department of Justice as part of the negotiated settlement process. The process demonstrated that the Department of Justice team was concerned about the person’s mental health as it may have been preventing them from accessing treatments. The team noted that the person had difficulty attending previously offered appointments and treatments due to an inability to engage with them. At the time of the complaint, the patient’s medical interventions were impacted by an acute mental health episode.
What was the outcome?
As a result of HaDSCO and the Department of Justice’s collaboration, the person’s medical record was reviewed, and their issues were addressed. HaDSCO’s engagement led to the person’s health concerns being noted for attention and assessment as soon as their condition allowed for safer treatment options. Medical appointments were booked in anticipation of the person’s recovery with assessments to be conducted as soon as the patient’s mental health could be stabilised. The result was achieved through the collaborative efforts of HaDSCO with the Department of Justice and reflected the strong working relationship between the agencies.
Working with advocacy agencies
Background
An advocacy group contacted HaDSCO to advise that they had a client who was concerned about medical treatment they had received. The client was seeking treatment for a range of complex mental health issues and required support from an advocacy group. Advocacy groups can act on behalf of a client when the person requires extra support to access services, communicate their needs and understand what their role is within their treatment plan. The advocacy group advised that the health care provider placed their client on a form of injectable medical treatment, and this form of administration left their client feeling concerned. The client was distressed about the medical treatment as they felt it could cause them further harm, and possibly cause their progress to regress. The client discussed this with the health care provider, but they did not feel like their concerns were heard. They requested that their medical records reflect their feedback on the medical treatment be taken into account for future treatment plans. The situation could not be resolved so the client with the support of the advocacy group contacted HaDSCO for assistance.
What did we do?
HaDSCO agreed to independently engage in a negotiated settlement process with the advocacy group, their client, and the health care provider. The Complaints Team identified that the client required an explanation of the health care provider’s medical treatment plan.
What was the outcome?
The advocacy group and the client received an explanation from the health care provider on the rationale for the medical treatment that was provided, and the health service provider apologised for the distress felt by the patient. They were also able to explain the processes they had in place to support patient safety, including updating medical records that helped to inform future health care decisions.