Medical Matters: Fly, Bluebird, fly: Improvements to our complaints process get off the ground

Read time: 4 minutes

By: Dr. Dawn Hartfield, Assistant Registrar, Professional Conduct, and CPSA Complaints Director

The Professional Conduct team has undergone tremendous change in the past two years. We began our improvement journey (internally called Project Bluebird) in January 2021, with the goal of modernizing CPSA’s complaints process. Our anticipated outcomes were to improve the timeliness and quality of our work as well as the overall experience of complainants and regulated members as they move through the process.

A shift in focus

Modernizing our process included shifting from an approach of punishment to one of learning and practice improvement. Physician performance is a function of competency, but systemic (work environment) and personal (burnout, fatigue, personal stressors, health issues) factors can impact performance. When assessing complaints, we have integrated principles from patient safety, such as systems thinking, which involves evaluating the bigger picture and how all parts of a system can work together to improve outcomes and overall patient care. With the current state of health care in Alberta and the impact it continues to have on providers as we slowly emerge from the pandemic, this is critically important.

The changes in our approach have meant restructuring our team and workflows, changing how we communicate with complainants and physicians, and making some key shifts in our processes. Upon receipt of a complaint, prior to determining how the matter will be processed, we now request a response to the complaint from the physician. This way, we have both perspectives and can best assess the most appropriate next steps. This also encourages the physician’s involvement and engagement early in the process. After this initial part of the process, approximately 40 per cent of complaints are dismissed.

Additionally, we collaborated with our partners in health care to allow physicians direct access to medical records early in the process, which helps inform their initial response. This has improved our response time and we now receive the physician’s initial response within seven weeks over 90 per cent of the time. In the past, when CPSA gathered medical records to provide to the physician, the process would take three to six months.

Resolution through collaboration and improvement

We now seek expert opinions, which are essentially peer reviews, earlier in the process. In situations where the facts of the complaint are agreed upon and we require a review of care, we use expert opinions to determine if the care provided is to standard or if there are opportunities for improvement. If care is to standard, the complaint is dismissed and an explanation is provided to the complainant. If improvement opportunities exist, one of CPSA’s resolution experts facilitates resolution between the complainant and the physician. The focus is on providing information to the complainant and working on an improvement plan with the physician. This process is typically embraced by both parties and the majority of complainants are pleased to know their concerns have been heard and physicians are using their feedback to improve the care they provide.

Some external, expert support

Historically, we have had challenges with completing investigations in a timely manner, largely due to high volumes of files being assigned to our investigation team. With the more frequent use of early resolution and expert opinions, we are able to resolve some files in alternative ways. This has decreased the number of files requiring an investigation, which is used for the most complex files that need clarification and require interviews and extensive medical record review to understand the situation. We have expanded our pool of investigators to include external investigator firms who employ experts to work with health regulatory bodies like CPSA. Ultimately, our goal is to complete investigations within one year of receiving a complaint, and early data shows that with the changes currently being made as we address a backlog of previous investigation files, we anticipate consistently achieving this within the next year.

If there is no evidence of unprofessional conduct when an investigation concludes, a complaint is dismissed. Should the investigation show opportunities for improvement, the Complaints Director will invite the investigated member to respond to the findings in the investigation report. If resolution is appropriate, the same process is followed as with a resolution after expert opinion, and is facilitated by our resolution team. Again, the focus is on learning and improvement.

Lemonade from lemons

Rarely, complaints may be referred for a disciplinary hearing. In these cases, the complaint is reviewed by legal counsel for CPSA’s Complaints Director and sometimes requires further investigation. Only one to two per cent of complaints per year will proceed to a disciplinary hearing, the majority of which are boundary complaints, significant issues related to professional behavior, or care-related concerns. This means 98 to 99 per cent of the time, we resolve complaints outside of a hearing and approach them as valuable learning opportunities for regulated members.

Our team continues to work hard on improving the experience of everyone involved in the complaints process and we hope this will continue to make a difference. We know it is tremendously difficult and stressful for physicians to receive a complaint, even when it is regarding a less critical matter. We like to describe the process as making lemonade from lemons whenever possible—turning a complaint into an opportunity for learning and practice improvement.

Dr. Dawn Hartfield is CPSA’s Complaints Director and Assistant Registrar, Professional Conduct. She completed her medical education and training in pediatrics at the University of Saskatchewan and worked in community practice in Saskatchewan for several years before relocating to Edmonton. With a clinical focus on pediatric hospital medicine, Dr. Hartfield developed the pediatric hospital medicine program at the Stollery Children’s Hospital and was on the executive committee that established the Section of Pediatric Hospital Medicine for the Canadian Paediatric Society in the early 2000s. Dr. Hartfield has nationally-recognized expertise in quality improvement and patient safety as well as skills in change management and program implementation. Dr. Hartfield transitioned to a regulatory role at CPSA in 2020 with the goal of continuing to promote quality improvement and patient safety in the medical profession.