Are hospitals and doctors accountable to patients?

[A Former User]

Hi Kurtis

check here https://patientombudsman.ca/Complaints/Before-you-make-a-complaint

There is a patient Ombudsman I worked with him and others recently on a committee reviewing the above website. Though his scope is small and only includes hospitals CCAC and long term care. They also ask that you first try other processes and they are used to review complaints that have not been solved by other agencies below them.

I’m sure the Patient Ombudsmans back log is unmanageable as is that of the Ontario Ombudsman. I find a change in government never helps either, just slows down the process even further until new policies are in place and government changes again. It’s never ending.

[A Former User]

Dear Gwen,

Thank you for your post. The Patient Ombudsman has had my file for more than 18 months. The Ontario Ombudsman has already formally intervened once and provided advice to me for a second time very recently.

I had exhausted all other channels of having my concerns addressed before going to the Patient Ombudsman, so it has been almost exactly 2 years since I have been seeking to have my concerns addressed.

I would be grateful if you are able to share the name of a contact person at the office of the Patient Ombudsman who would be willing to receive feedback on their processes and how it feels from a patient's point of view not to have concerns addressed for 18 months. There is still no end in sight in my particular case.

Thanks again

Kurtis

[A Former User]

Kurtis, I am so dismayed but not surprised by your experience. Your original post caught my eye because I have felt that the system sees accountable very differently from how patients do. The accountability seems to be all to the payor (government) for money spent with a nod to "outcomes". The patients is the inert object being acted upon in this thinking.

There, as you so clearly demonstrate, no accountability to patients. I have been wondering how we turn this around. Unlike consumers, we can really pick and choose what treatments to have and who will deliver them if at all. The "consumer" model doesn't work for me for this reason.

Just musing.... what about provincial patient/caregiver tribunals (or other body) who hear issues like yours and have the power to fine, recommend for disbarment, post public results of hearings, etc? What about the requirement to have "contract" type care plans with consequences for providers given that the patient does their bit?

Thoughts? Alies

[A Former User]

Dear Alies,

Thank you for your post. I have been working with the Patient Ombudsman in Ontario for 19 months now, but the hospital still has not answered my questions. The Patient Ombudsman initially closed the file--because, according to them, the hospital had a complaints process in place and that was all the Patient Ombudsman felt it important to investigate. The Ontario Ombudsman intervened and asked the Patient Ombudsman to reopen the investigation, but almost a year later on the 2nd investigation and all the Patient Ombudsman has said is that the hospital seems to have followed its own internal process for responding to complaints. The fact that they have not addressed my concerns or worked with me to achieve a resolution is not an issue the Patient Ombudsman can hold the hospital accountable for. Nor can the Patient Ombudsman hold the hospital for not having a complaints process that is consistent with the hospital's client statement of values. Both the complaints process and the client statement of values are required by the Excellent Care for All Act in Ontario, but that piece of legislation (and the supporting regulations) leaves it open to hospitals to design their own processes, does not require them to communicate with patients in any particular way and does not require hospitals to resolve complaints. The legislation does not give any detail about what is meant by ensuring that the complaints process in a hospital is aligned with its client statement of values. So, breaches of privacy, failure to communicate, failure to involve clients in the process, failure to respect the dignity of a patient, failure to take responsibility for mistakes and correct them--none of these things are required of a hospital. The hospital's code of conduct for all staff (including administrators) states that all staff have a primary fiduciary duty to the patient, that staff must take responsibility for their actions and correct errors, that they must work collaboratively with patients, etc., but if the hospital does not hold its own staff accountable for their actions, nobody can do anything to address the problem.

You mention provincial patient/caregiver tribunals--is there something in ONtario beyond the Patient Ombudsman? The Patient Ombudsman has no power to level fines, post results of their investigations or anything else. All they can do is to make recommendations to the hospital.

The Patient Ombudsman apparently can look to see if there is a pattern of similar complaints relating to a particular hospital, but the process of making a complaint and following through is so emotionally difficult and onerous in terms of writing letters that it is unlikely that a patient in distress will ever be able to come forward, let alone see the process through to its end. I happen to be well educated and have lots of practice writing letters, but this has been the most difficult thing I have done in my life--doing a PhD was a breeze compared to this.

YOu also mention the requirement to have contract type care plans with consequences for providers who don't honour their end of the bargain. What are you referring to? I didn't know about this? Any illumination on this would be helpful.

I am now part of a continuous quality improvement consortium whose sole focus is addressing patient dissatisfaction with discharge planning and transitions in the mental health care system. At a recent meeting, the representative from the hospital in question did not participate in the root cause analysis that was the focus of the daylong meeting hosted by the hospital in question. That was astonishing.

Anyway, I am doing all I can to make change in this area so patients in the future may be spared the horrors I have experienced.

Hospitals seem to put all of their energy into shielding themselves from liability and pay little to no attention to the impact of their actions on patients. I don't know by what right such institutions even have the nerve to call themselves hospitals.

The funders of hospitals in this province have performance agreements that do not specify much--if anything--that hospitals must demonstrate to be eligible for ongoing funding. So, for example, a mental health hospital's performance agreement lists cardiac procedures, hip replacements and dozens of other criteria, but then indicates that these things are not applicable. The only customized performance indicator relates to connectivity, leaving even the quality of patient care and patient experience out. I don't know what governments are thinking.

Anyway, happy to hear other suggestions and if you think there are other groups/associations I could be involved with as a volunteer to help make change in this area, please let me know.

Thanks again

Kurtis

[A Former User]

Kurtis, I wish there were tribunals and contract care plans. These unfortunately they are only thoughts about how to address the issues you raise and how to find ways to make the individuals and orgs in the system accountable TO PATIENTS!!!

Your story is replicated everywhere and yet no one addresses accountability to the patients and how to design, systems, mechanisms, funding to support that. I do think if we put our heads together, we might come up with some good ideas we can shop around.

I feel like we keep demanding that the systems/processes we have currently should change but in fact, they are doing what they are designed to do. It just isn't accountability to patients or problem-solving for patients however they market it.

What if patients came up with solutions based on us instead of the system? What would that look like? How could we get decision-makers to come on board? Thoughts? Alies

[A Former User]

As a member of a Consumer Advisory Council for my local hospital for the past 3 years I have noticed that the community is nowhere close to being the main focus of the hospital priorities. And if they aren't really community oriented how can they be truly considering the individual patient?

What I have seen is lots of partnerships with other large organization for their mutual benefit through consolidating services and swapping types of patients. When they look at outpatient services (which I think encompasses community) it's with an eye to cutting what does not make a profit.

The idea of having hospitals in charge of most of our Ontario Health Teams is concerning - how can orgs with decades of being controlled and in effect managed by the Ministry through their budgets suddenly develop an ability to lead us to a seamless experience of care?

Annette

[A Former User]

Thank you, Annette. Yes, hospitals are compensated by flipping patients out of beds and for procedures performed. Transitions are not part of their DNA. I don't know how change will come about but I have a few years left in me and will keep doing what I can in the hope that we will see transformation some day. Hospitals have not yet adopted the language of recovery and when they mouth the language of patient centred care they are only using the words and are either not aware of their meaning or believe that they are doing what they are supposed to be doing regardless of patient feedback.

Kurtis

[A Former User]

Kurtis, I am learning more and more about the new Ontario Health Teams (OHTs) and the new Super Agency. While many of us a little (or a lot) alarmed by the magnitude and speed of change, within all this is opportunity. I also get the sense there is a real desire to actually make things better for patients. So I'm seeing opportunity here -- call me Pollyanna!

A couple of things I've heard: Initially it seemed the 30-50 OHTs were seen to be hospital-based -- now I'm hearing quite to the contrary, the Govt want proposal where leads are community-based orgs. Obviously it is still up in the air but if this is the case, it is promising. I am on a board of a little Family Health Team with a focus on a highly specific disadvantaged population. In our area, there are 19 such orgs never mind other care providers. I am hoping some good combination of these could be an OHT. Also, patient engagement (PE) is a requirement for the OHTs. We all need to be involved when and where we can. My guess is, the Govt will review the several different models at some point and lean towards the couple or more how are most successful. Who knows! They are also talking a lot about the Accountability Care Organizations in the US. I don't know, but are there elements to those that actually allow for accountability to patients? Should we learn from them?

Secondly, I know the person, Susan Fitzpatrick, who is the new interim chair of the Super Agency. She is the most excellent former CEO of the Toronto Central LHIN. I can't think of a better person who totally "gets" care transitions, has sponsored good projects in that area and is committed to PE. She is also most adept at dealing with bureaucracy and government.

While none of this directly deals with your issues, I do hope a) that you are feeling the winds of change a little and are a touch optimistic and b) that you will keep your eyes and ears open for where you can influence things in this changing environment.

Love discussing all this with you,

Alies

[A Former User]

Thank you, Alies. I very much appreciate your insights in this area. I am on the patient advisory council of an academic family health team and am working very closely with a community health centre. Both are doing all they can in the patient engagement area, as is CMHA Ottawa, where I am on the peer engagement advisory council. I am still in my 50s and will keep my eyes and ears open and spend my time supporting organizations that are interested in ensuring healthy transitions. In the end, I believe it will be shown that not only is this a more humane approach, but it will also save the health care system money in the long term and actually help patients to be more informed users of health care and to take charge of their own recovery journey.

Please let me know if the Super Agency opens any discussions in this area, and I will certainly do my best to contribute.

thanks again

Kurtis

[A Former User]

Kurtis, I will let you know about anything I hear. Cheers! Alies

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