Making a Complaint
You’ve found this article because something serious has happened to you or a loved one. Take a breath, grab a cup of tea, pen and paper and let’s begin.
This is a step-by-step guide on making a complaint that will result in change.
As the general public, and as professional navigator/advocates, we would love to believe that every healthcare provider is doing their best work, with the best in mind for their patients, all of the time. Unfortunately, it’s just not reality. There are a lot of people in healthcare positions (from care aides to doctors) who are burnt out and overworked or not suited to the work they have taken on. Alarmingly, there are some who are minor bullies to the extreme of those who derive pleasure from inflicting pain and suffering on the most vulnerable. The more strapped for workers a health authority is, the more likely it is that those who should not be working in healthcare will slip through the cracks of the interview and reference process.
It’s the smaller, more insidious problems that go completely under the radar (preventable infections, medication errors) that cause the most harm and even death. As a patient or loved one to a patient it is your moral responsibility to stand up for safe and compassionate healthcare. The process starts with you. The more often people report poor to abusive care, the more hospitals and governments will take action.
Think and act according to the level of threat
Is the safety of you or your loved one at risk right now?
Assault
If there has been a physical assault to you, your loved one, or another patient, you have the right to have immediate action taken and the caregiver removed from the situation. Go through the steps below. If the doctor, nurse or care provider is not removed and the most appropriate senior nursing manager has not been notified, you have the right to call the police. Assault is a criminal offence, no matter where it occurs or who the perpetrator is.
The circumstances of your loved-one’s death is in question
If you think your loved-one has died under unusual or suspicious circumstances, immediately reach out the Coroners Service so they can make sure the body is held for examination and possible autopsy. See the Resources at the end of this chapter.
Think before you go to the Media
Are you or your loved-one in danger right now? When people are angry, this is the first thing they think about. But is it the best plan? Very few stories make it to the news and usually only when there has been a death due to perceived negligence. It might make you feel better in the short-term but the repercussions can be significant, especially if your facts are murky, not concise, or worse, inaccurate. Health authorities have staff dedicated to countering media complaints. Your public complaint may seriously affect future care for you or your loved one. Try to resolve your complaint through the channels below – unless you think that others’ lives are at risk and this is the fastest way to get the message out.
Take a witness
As quickly as you can arrange it and during all meetings with nursing staff and managers, make every effort to have a ‘witness’. Your witness should be allowed to make notes. A professional patient or legal advocate is the best person for this role but any calm, logical person is appropriate. It’s unfortunate, but everyone behaves better, and more honestly when a third party is in the room.
When Complaints Should be Initiated
There has been physical or emotional harm/abuse at the hands of a hospital or facility staff member to you, your loved one or you have witnessed an assault on another patient. (Yes, it is your right and obligation to report abuse to any other person—even when, and especially if, you are told it’s none of your business).
Your concerns and complaints regarding were not taken seriously or not addressed, especially in life-threatening circumstances.
Care was denied or withheld, especially as a ‘punishment’ for ‘bad behaviour’ or for speaking up against care received or the caregivers.
A serious error has taken place:
The wrong medication was administered;
Misidentification of the patient during any treatment, procedure or surgery;
Potential transfer of serious pathogen (for example, lack of hand washing or housekeeping exposing you or your vulnerable loved one to bacteria or viruses, especially pathogens that are antibiotic resistant ( Difficile, MRSA, VRE, and CRE.)
Basic Guidelines for an Ongoing Complaint
There is a very specific order in which to make a complaint regarding care within a hospital long-term care facility in British Columbia. Not following these steps will delay action being taken.
First and foremost, initiate these steps as logically as possible. Try to take the emotion out of your complaint (which can be very difficult when something dangerous or life-threatening has happened to you or your loved one at the hand of a hospital caregiver).
If there is still danger to the patient and ff the doctor, nurse or caregiver is not removed and the most appropriate senior nursing manager has not been notified, you have the right to call the police. Assault is a criminal offence, no matter where it occurs or who the perpetrator is.
How to make a complaint regarding care in a facility or hospital
There is a very specific order in which to make a complaint regarding care within a hospital or residential care (assisted living or long-term care facility in British Columbia. Not following these steps will delay action being taken. Here are some basic guidelines:
First and foremost, whenever possible, initiate these steps as logically as possible. Try to take the emotion out of your complaint (which can be very difficult when something dangerous or life-threatening has happened to you or your loved one at the hand of a hospital caregiver).
Take the time to take notes with the classic W5 reporting technique (see the education article, The Power of the Notebook.)
Who: Who was the patient and Who was the healthcare provider?
What: What happened? Try and give as many details as possible. What did you or your loved one do? Was it reported immediately? What was the outcome when it was reported?
Where: Name of the hospital, unit, room, location in room (ex., bathroom)
When: As close to an exact time as possible.
Why: What might have led to this event? (Example, state of mind of the patient, state of mind of the healthcare provider, how busy was the unit, was it understaffed?)
o Write down anything and everything that was said and done that will jog your mind later. These are your notes and should not be shared with hospital staff (i.e., do not let anyone take your notes and do not allow them to be photocopied).
Who to talk to:
With as calm a mind as possible, ask to speak to the ‘Charge Nurse’ – there’s one on every shift and on day shift they are most often called the Patient Care Coordinator (PCC) or, in a care facility, the RN on duty. Ask to sit in a quiet room. Do not speak openly in a public area, such as the nursing station. If your complaint is not taken seriously and/or is not resolved move on…
On a day shift, Monday through Friday, ask to speak to the Nursing Manager or Director of Nursing. You will likely get resistance at this point. Hospital Nursing Managers and care facility Directors of Care are often very busy. They rely on their charge nurses to resolve issues. However, you have every right to ask for the Nursing Manager od Director of Care and say that you will wait (whenever possible) but will expect to see him/her before end-of-day.
If the incident occurs in hospital on a weekend or in the evening (3:00 pm to 11:00 pm) or during the night (11:00 pm to 7:00 am), and ONLY if the situation can’t wait until morning, ask to speak with the Nursing Supervisor or Nursing Site Manager. Use your notes and be specific. Why does this require action and resolution right away?
Ask that an “Incident Report” be written and then read and ask to sign the report but only if it is accurate.
Making a Formal Complaint
If the issue is not resolved fully and to your complete satisfaction, contact the Patient Care Quality Office (PCQO), Assisted Living Registrar, or the Community Licensing Office (see the Resources at the end of this article). These are NOT emergency lines. The offices generally take 48 hours or more to respond, Monday through Friday.
Note: Wherever possible make your complaint in writing via email so that a chain of response will be established. If you must make a verbal complaint via voicemail, leave as much information as possible about the patient, the location, and clearly and slowly state your name and phone number. If you have not received a follow-up email or call within 42 to 72 hours, follow-up again. When you receive a return call, write down the name of the person you have talked to, their direct number or extension, their email, and the date and time you talked to them and as detailed notes as possible. (If you are not ready for the returned call, ask for a specific time for them to call back. Regain your composure and take control of the call. If you lose your composure – and certainly if you feel you are losing your temper – ask that the call be continued at a later date and time, or suggest you continue the complaint process via email.)
Be logical but stay angry and motivated.
Be assertive and follow-up, follow-up and follow-up some more.
You can make a difference!
The complaint process should be posted on large posters in the hospital or care facility near elevators. Or see the information for the appropriate health authority in the next chapter. (Note: The Patient Care Quality Office is completely different than the provincial Patient Care Review Board.) You will need all of the relevant information you’ve gathered as per the W5 above.
If the hospital, nursing staff, and PCQO are not responding or not responding appropriately and you require immediate resolution you can contact your MLA or the BC Ombudsperson but you will need to show what you’ve done to resolve this situation on your own.
After you have received a written response from the PCQO, and if you are not satisfied, you are encouraged to make a formal written complaint to the Patient Care Quality Review Board (PCQRB). The PCQRB has 120 BUSINESS days to respond (about 5 months) with their decision. Therefore, this is not a course of action for issues that need urgent resolution.
Patient Care Quality Offices (PCQO)
These office address complaints for their health authority for all acute care hospitals, clinics, and all publicly funded assisted living and residential (long term care) facilities. The PCQOs also oversee patient care in assisted and residential care facilities that are privately owned but ‘contract’ beds to the health authority. See Resources, below, for the listings of PCQO and “Facility Licensing”.
All of the contact emails and phone numbers are listed in the Resources, below.
As an experienced patient advocate, I have some very big concerns about the Patient Care Quality Offices (PCQO’s) but making a complaint to them is essential in the overall process.
The offices are understaffed with high turnover.
The turnaround time for a complaint is well beyond 48 hours and a final report can take weeks, months or, as one complaint that I have in process with a family, over a year.
They are like the police, policing the police. They work for the hospital or health authority. There is no immediate external accountability. Even when a complaint is taken to the next step of the Patient Care Quality Office Review Board (PCQRB) there is no requirement that recommendations are put into place.
There is often little investigation into the complaints and the response is often a rubber-stamped, “We’re very sorry for your experience (or the loss of your loved-one).”
In just about all complaint processes I have been a part of, the PCQOs have taken the side of the doctors, nurses, and management.
In the rare cases where suggestions were made for change, the PCQO has little in the way of authority to follow through to make sure these changes were made.
With all of that said, a complaint to the PCQO must be made in order to take next steps with other complaint procedures. And the PCQO’s lack of appropriate response should be a part of the next level of complaint.
Complaints Regarding Nursing Staff (Registered Nurses, Nurse Practitioners, Midwives, Licenced Practical Nurses, and Registered Care Aides)
If you have the name of the RN, or LPN, you can also make a complaint to the British Columbia College of Nurses and Midwives (BCCNM) If a registered care aide is involved in the incident, the employer is legally obligated to report the abuse to the BC Care Aide and Health Worker Registry.
Complaints Regarding Physicians
Doctors generally are not employed by the hospital and their actions (or inactions) within a hospital are not mandated or controlled by the hospital. Exceptions are: emergency room physicians, hospitalists, and critical care/intensive care specialists in the larger hospitals. However, all serious incidents and deaths that occur within the hospital are to be reviewed by a special review panel. Doctors are also required to communicate effectively and fully with all other care providers to ensure the best possible outcomes.
Any complaints about a physician should go to both the PCQO and to the College of Physicians and Surgeons of BC (CPSBC). (See Resources below.)
A suggested format for compiling and writing all letters of complaint
1. Gather the information. You will need to obtain as much written information as possible. A statement of complaint without backup information will most often result in delays when the PCQO and/or CPSBC and/or BCCN requests further information.
2. Know the names of those involved. You must know the names of the nurses, support staff, or physicians involved, thus the need for your notebook or obtained through your patient records.
3. Request hospital records (these must be requested by the patient or by the legal Representative). These records generally take an absolute minimum of 30 business days to be delivered, so start this request early in your complaints process. (See Resources for Health Records for your region and the correct form).
4. Request consultations. If your concerns or complaints are about a specialist regarding care received outside the hospital, obtain consultation reports from their office directly, or more often, more easily through your Primary Care Practitioner.
5. Review records and make thorough notes. This can be the most time consuming part of the process, especially if you are not used to medical terms and language. If possible, bring someone onto your team who is familiar with these terms and paperwork.
6. Be open to possibilities of how and why things happened. We want to attach blame and we tell ourselves a story that fits what we think ‘must have happened’. Was this something one person did or can you see increasing evidence that this was a bigger issue involving more staff, lack of staffing, lack of training, or issues with leadership?
7. Compile your complaint. To be taken seriously, it must be logical and not an angry rant.
8. What do you want to accomplish? Are their disciplinary actions or change to practice that you want to see? If so, out line them either at the beginning or the end of the complaint.
9. Use the W5 technique above to put your complaint together.
10. You may want to use variations of the same complaint to multiple agencies:
o PCQO: Concerns and complaints about care that management will need to address regarding their hospital or facility employed staff, policies and procedures.
o CPSBC: Concerns and complaints about physicians, whether the conduct happened in a hospital or facility, or in their public offices.
o BCCNM: Concerns and complaints about registered nurses, nurse practitioners, midwives, licenced practical nurses, or registered care aides, even if you are making a complaint to the PCQO. The BCCNM looks at licensing, education, and practise in a completely different light (and often much more seriously) than the PCQO. Note: nurses just use initials in their charting. Ensure that you receive the ‘signature record’ when you request your health records so you can identify the nurse or registered care aide. The BCCNM has ways to identify the nurses if you can’t, but they must have the date(s), the shift(s), the hospital/facility, and the unit.
See also: Resources for Making a Complaint in BC
