Where there is a possibility that a complaint may include an element of clinical, that complaint must be assessed by the Complaints Officer to determine if the complaint or parts of the complaint may be clearly defined as clinical judgment.
The Health Act 2004 defines clinical judgment as being:
“a decision made or opinion formed in connection with the diagnosis, care or treatment of a patient”
The person making a clinical decision or forming an opinion in connection with the diagnosis, care or treatment of a patient must be suitably qualified and registered with a Professional Body.
Solely Clinical – follow appropriate pathway
If a complaint is received by the Complaints Officer and following its assessment is determined to relate to matters solely relating to clinical judgment, it must be sent to the appropriate manager for follow up under the appropriate pathway, see Table 3: Complaints that cannot be managed using Part 9 of the Health Act 2004
Your Service Your Say and Clinical Judgment
If a complaint is received by the Complaints Officer and following its assessment is determined to relate to matters containing both clinical judgment and non-clinical elements the following steps must be taken:
- The Complaints Officer must discuss the clinical judgment issues with relevant parties (e.g. QPS, Clinical Director (etc).
(See the Stage 2: Letter Pack)
- Complaints Officer is to request the QPS/Clinical Director (etc.) input in relation to the clinical judgment issues (See the Stage 2: Letter Pack)
- Complaints Officer (or delegated administration support person) is to record all details of the complaint on the CMS system.
- The Complaints Officer should offer to facilitate a meeting between the complainant and QPS/Clinical Director etc. if appropriate and required.
- If the meeting proceeds and the matter is resolved to the satisfaction of the Complainant, a summary letter must be sent to them and include the response from QPS/Clinical Director. (See the Stage 2: Letter Pack)
- Complaints Officer to close off on the CMS system.
- Circulate anonymised learning as appropriate.
If a complaint contains both clinical judgment and non-clinical elements and could not be resolved at the informal stage the following steps should be taken:
- Complaints Officer to issue notification letter to QPS/Clinical Director (etc.) on receipt of complaint.(See the Stage 2: Letter Pack)
- Complaints Officer to issue an acknowledgement letter to the Complainant within 5 working days. (See the Stage 2: Letter Pack)
- Investigation by the Complaints Officer in relation to the non-clinical elements proceeds in parallel with the investigation by the QPS/Clinical Director (etc.) of the clinical judgment issues. Where either party requires additional time a letter updating the complainant of this should be sent by the Complaints Officer. The QPS/Clinical Director (etc.) must therefore keep the Complaints Officer appraised in relation to their section of the complaint. (See the Stage 2: Letter Pack)
- Investigate the complaint (Link to best practice and the steps)
- The Complaints Officer is responsible for the collation of both reports i.e. to ensure that both the non-clinical decision report (which is signed by the Complaints Officer) and the clinical judgment report (which is signed by QPS/Clinical Director (etc.) are forwarded to the complainant along with the cover letter. (See the Stage 2: Letter Pack)
- All complaint reports must include a recommendation(s). Where a complaint is not upheld the recommendation of the complaints officer is that the complaint is not upheld.
- The Complaints Officer should also forward the complaint report (with recommendations) to the relevant Head of Service (Accountable Officer).
- The relevant Head of Service (Accountable Officer) must send a letter to both Complainant and the Complaints Officer within 30 days detailing recommendation actions.
Letter required from Complaints Officer to Accountable Officer if no response issued within 30 days requesting the follow up actions taken.
- Complaints Officer to develop the anonymised learning summary (case books) and circulate as appropriate.