Client concerns within the Sunrise Health Region have been increasing over the past six years, but numbers still remain small in comparison to the overall number of patient visits.
"The Care Delivery concerns have been steadily increasing over the past six years," related the Sunrise Health Region Client Concern Management Annual Summary circulated to the regular Board of Directors meeting last week. "While these concerns are few given the overall care provided, it is important to the patients, families and care providers affected that we address these concerns in a satisfactory manner."
The Report summarizes concerns brought forward to the Sunrise Health Region Client Representative.
"This report speaks to our need to support the Ministry of Health's commitment to improve the care experience by providing quality health care in a responsive integrated, client-and-family-centred health care system," detailed the document.
"Client concern management provides a safe process for patients, families and health care providers to bring forward their concerns."
The survey fits with province initiatives.
"Recently the Sunrise Health Region has engaged with other health regions across the province and the Ministry of Health to implement the Lean Management System. Lean is a patient-centred approach to identifying and eliminating all non-value added activities and reducing waste. Improving the care experience for patients, families and health care providers is the overall goal of Lean," stated the report.
"While our current concern handling process does afford us the opportunity to bring together managers, physician, front-line health care staff, patients and families to address concerns, we are not always able to resolve the concerns in a timely manner. As we move forward in our Lean journey, we are excited about incorporating Lean methodologies and tools that will support a more timely response to care concerns. Ultimately, we would also anticipate a significant reduction in the number of concern calls received by the Client Representative Office
"The Lean Management System incorporates processes that will support a more immediate response to care concerns. As we implement the Lean Management System we will be able to achieve a health care system that provides Better Health, Better Care and Better Value for our patients, families and care providers."
In 2011/2012 all concerns including jurisdictional and non-jurisdictional concerns totaled 602 with 455 client contacts.
"This represents a decrease of 144 client contacts from the number of client contacts in 2010-2011. The total number of concerns also decreased in 2011-2012 by 184 concerns," stated the document.
Jurisdictional concerns totaled 441 of the 602 concerns with 294 clients contacting the Client Representative in 2011-2012. This report addresses the 441 concerns, a decrease of 141 concerns when compared to concerns registered in 2010-2011. There were also 134 fewer client contacts. The decrease of 141 concerns is primarily due to the reduction of concerns and questions about the Radiology Review from the previous year (138).
Non-Jurisdictional concerns totaled 602, 161 were outside the jurisdiction of the health region compared to the 204 (decrease of 43) Non-jurisdictional concerns registered in 2010-2011. These concerns represented 27 per cent of all concerns raised through the Client Representative Office.
There was a notable increase of 18 concerns from the previous year in the Emergency Services concern area. Care Delivery remained the highest concern type with an increase from the previous year of 51 concerns to 54 in this fiscal year. Access to Services increased by seven to 18 concerns and Communication also showed a slight increase by three to 14 concerns.
Of the 441 concerns lodged in the region in 2011/2012, 23 per cent were in the Acute Care-Medical area. There was an overall increase of 15 concerns in this area directed to the Client Representatives.
Within the Acute Care-Medical concern area, a further breakdown of the specific program or service area in which the concern was filed showed that Medicine accounted for 72 per cent of the concerns in this area, followed by Maternal/Child with 21 per cent of the reported concerns.
Well over half of the Acute Care-Medical concerns, 61 per cent pertain to Care Delivery, which refers to the nature and provision of a required health service including technical competence, confidentiality, responsiveness, deportment, and the provision and results of care.
Concerns of the Care Delivery type refer to concerns regarding the nature and provision of services delivered, and include technical competence of health care professionals, confidentiality, responsiveness, deportment and the provision and results of care.
Of the 441 concerns lodged in the region in 2011/2012, 44 per cent or 196 were of the type Care Delivery. This represents a small increase of five concerns.
Concerns of the type Access to Service, refers to the ability of a client to obtain a required health service. This includes concerns reported pertaining to waiting time for bookings/appointments, surgery, and assessment as well as refusal or denial of service, refusal or denial of access, and limited availability of service. Limited Availability refers to those services that are available but in limited quantity. Refusal or Denial of Services/Access refers to the actual or perceived withholding or denial of service provision. Waiting Time refers to the length of time from the initial request for service to the proposed date of service delivery.
Of the 441 concerns lodged in the region in 2011/2012, 23 per cent were of the type Access to Service. The percentage increased from 12 per cent in the previous reporting year. A further breakdown of this specific type of concern, shows that Waiting Time for Bookings/Appointments and Assessment accounted for 39 per cent. These concerns were related to Acute Care-Medical and Emergency Services. Limited Availability also accounted for 19 per cent of the reported concerns in this area. Some of these relate to clients waiting for Long Term Care beds. Also of note was the Waiting Time for Surgery made up for only four per cent of all Access concerns.
The numbers show the Region has more concerns than others in the province.
"In 2011-12 SHR again reported the highest number of concerns at 441 in comparison to similar sized regions. SHR had the third highest number of concerns behind Regina and Saskatoon. As the 2011-2012 Annual Provincial Summary did not report regional-specific non-jurisdictional data, we are unable to share any comparative analysis," detailed the report.
The Client Representative/Quality of Care Coordinator (QCC) initiative dates back to 1995 when Saskatchewan Health funded each health region to create a Client Representative/QCC position. Every regional health authority has a Client Representative/QCC in place, as does the Saskatchewan Cancer Agency.
The role of the position includes;
To assist individuals/families with questions or concerns about health services in their region;
They are responsible to work with management and staff to resolve concerns that are brought to their attention and to jointly identify opportunities for system improvement;
To ensure individuals are informed about their rights and options;
To recommend changes and improvements to enhance the quality of health services delivered in the region based on their findings and trends of concerns raised.
"Concerns may be initiated by or on behalf of anyone who receives health care services in the region/service area. If clients so choose, concerns may be brought forward anonymously. The Client Representative/QCC is in the best position to work with clients and family members on a local level to address their care concerns," detailed the report.
"After recording the concern information, the Client Representative/QCC is responsible for investigating the concern. The depth and breadth of an investigation varies from case to case and is dependent upon the individual circumstances. The Client Representative/QCC is also encouraged to advise all clients or family members of their additional rights (e.g., contacting legal counsel; referral to regulatory body) depending on the type of concern."
The average days to resolve or close a concern increased slightly during the 2011/2012 year. The average number of days to resolve all concerns was 21 days (increased of four days). The majority of concerns were resolved in less than 30 days with the average being six days. Some concerns required 80 days before they were considered as resolved. This result in an increased of 15 days to resolve some concerns from the previous year (65 days).
