Faster, better, less agonizing: How one college is building a more efficient, less punitive complaints process

It used to take an average of three years for complaints at the College of Physicians and Surgeons of Alberta to go from receipt to hearing. For the doctors and patients involved in these complaints, that wait can be agonizing. But since the college brought in a number of measures to improve its complaints process, that waiting period has shortened significantly—from a median of 1,051 days between receipt of complaint to hearing in 2020 to just 424 in 2022. “Many of the changes we made were practical workflow changes that helped to nudge things along,” explained CPSA complaints director and assistant Dr. Dawn Hartfield, whose medical career includes numerous leadership roles in safety and quality improvement. “Regulators often struggle with how to get their work done in a timely manner while still maintaining a high level of quality. A common approach has been to throw more resources at the problem, such as hiring more investigators, but the results tend to be a temporary fix and not a sustained change.” Timeliness is just one of several criteria the CPSA took into account as it looked for ways to improve its complaints process. A particularly important consideration was ensuring that patients and doctors felt heard, said Dr. Hartfield. The college also wanted to shift towards a greater focus on learning and practice improvement, and less on punishment. “It’s particularly hard for doctors to go from being an expert that patients go to for help to getting criticism—it can be very distressing for some people,” she added. “We wanted physicians to be engaged in the process, to get something out of it.” Read: Ontario’s digital health program has a data quality problem, despite billions in spending Dr. Hartfield said the CPSA started its overhaul with “a whole bunch of background research” that included an assessment of the existing system and numerous conversations with other healthcare professional regulators, and with lawyers who have experience representing physicians in college complaints. Based on what it learned, the CPSA made a number of key changes that have, so far, yielded positive results. Timely access to medical records In the past it sometimes took as long as six months for physicians to gain access to all of the relevant medical records of the patient who had filed a complaint. This delayed the physician’s response to the college and, in turn, lengthened the college’s response time to patient and physician. To resolve this issue, the CPSA worked with system partners to give doctors direct access to medical records early in the complaints process, said Dr. Hartfield. Peer reviews early in the process The college also sought to involve peer reviews early in the process, which Dr. Hardfield said has been a game-changer, particularly in cases where all parties involved agree to the facts of the complaint. By getting peer-to-peer assessments early in the process, the college can determine quickly whether or not the standard of care was met. It it was, the complaint is dismissed and the college gives the patient an explanation. “We can sit down and explain, for example, that the doctor did not do an MRI on your back for these reasons,” he said. “A lot of complaints are related to communication and perception, or even not understanding office procedures.” When the early review finds that the standard of care wasn’t met, the college works with the doctor on an improvement plan and communicates this to the patient. Most complainants are satisfied with this approach and outcome, said Dr. Hartfield. Read: Manitoba college launches Quality Improvement Program Collaboration on improvement plans Under the revised process, complaints that call for an improvement plan are advanced towards resolution. The college sends the peer assessment to the physician, along with feedback and suggestions, and engages the doctor in a discussion of what practice changes may have been made already since the complaint and what other improvements can be made. “This is a faster process and takes things out of the investigation pool which we’re reserving for more complex complaints,” said Dr. Hartfield. More help from more experts To whittle down its backlog, the college has augmented its internal investigations team with experts from private firms that specialize in helping health regulatory bodies. The college also plans to add more internal investigators in the near future. At the same time, the college has trained its frontline complaints intake staff on resolution and mediation, said Dr. Hartfield. Addressing the ‘junk mail’ issue As the college was going through its process improvement, a frontline staff noted that sometimes physicians don’t even know a complaint has been filed because the messages sent from the college’s system email address get filtered and tagged as junk mail. The complaint is delayed as a result and the physician may inadvertently appear to be disregarding the complaint. To fix this problem, the CPSA now sends all its correspondence to physicians from its portal email and from a CPSA staffer’s individual email address. “We really looked at all the possible ways to improve our process—nothing was out of bounds,” said Dr. Hartfield. “We continue to look for ways to improve;” Feedback so far While it’s still early days in the CPSA’s process improvements journey, so far a number of doctors and lawyers familiar with college complaints have registered positive reactions, said Dr. Hartfield. In particular, the idea of engaging physicians in resolution—where there’s a two-way discussion about what went wrong and what can be improved—has been lauded by many. “In the past physicians would wait months for their case to be concluded and in the end they would received feedback in a report—in a vacuum—that basically told them they did bad things,” said Dr. Hartfield. “The response I’m getting now from a lot of people is that the process is so much better. It’s faster and it provides a path to help patients and doctors learn and move forward.” Read: Ontario college introduces new alternative to full investigation process

Faster, better, less agonizing: How one college is building a more efficient, less punitive complaints process

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