Patients need an ombudsman

Hey there, time traveller!
This article was published 18/12/2014 (3979 days ago), so information in it may no longer be current.

The recent release of the inquest report on the tragic death of Brian Sinclair underscores the need for improving our current health-care system.

Mistakes, multiple referrals, delays, lack of co-ordination and communication breakdowns too often make the patient experience more risky, frustrating and emotionally draining than it should be. There is no perfect health-care system in any jurisdiction. The professionals who are in charge of Manitoba’s complex health-care system search constantly for ways to improve delivery of services across multiple domains. However, the system is under stress and there is no easy, simple solution. Appointing a patient ombudsman could address some of the concerns in Manitoba. A patient ombudsman would respond to complaints about hospitals, long-term care facilities and community care access centres. In addition to handling complaints, an ombudsman for the health-care system could be another catalyst for improvement.

Health ombudsmen exist already in Quebec and in a number of states in the U.S., in New Zealand and Britain. Ontario has just passed legislation that authorizes the creation of such an office.

The practical job of the ombudsman would be to receive and hopefully to resolve patient complaints about actions and inactions, involving such matters as unreasonable delays, administrative mistakes and poor interpersonal behaviour by health-care professionals and administrators. In addition, an ombudsman could help individuals to navigate in a complicated and often intimidating health-care system. The services of an ombudsman are free, and such offices can react quickly.

The process of handling complaints would be informal and non-legalistic and make non-binding recommendations. It would be less intimidating for patients than more formal complaint mechanisms used by existing health regulatory bodies for doctors, nurses and other health professionals.

As well, it is less adversarial than other complaints procedures, and the range of potential remedies for patients’ grievances is wider.

Adjudicating disputes and protecting patient rights would be the primary job, but the ombudsman’s reports and recommendations could also lead to policy and program changes. By communicating publicly about issues, the ombudsman would become an identifiable figure to whom Manitobans could turn when they feel poorly treated by a system that, because of its scale and complexity, can become dehumanizing. Reports from the ombudsmen and the publicity surrounding individual cases can serve a general educational purpose and can reinforce the espoused values of safe, quality and compassionate care.

At present, patients and their families can appeal to the authorities within the individual health-care institutions if they believe substandard or uncaring service is being provided. For example, all but one Winnipeg hospital maintains a “patient representative” (PR) position. However, such positions tend not to be very visible, operate on limited budgets and hours, and even though occupants are dedicated, they are seen to be employees of the institution who can only go so far in their advocacy on behalf of patients. We should be looking for ways to increase the profile and effectiveness of such offices. A health ombudsman would complement and reinforce the crucial roles of PRs.

Currently, Manitoba’s general ombudsman can investigate complaints within institutions that are part of the province’s five regional health authorities. However, most patients do not know the services of the general ombudsman are available and relatively few cases arise in the health fields. Moreover, the mandate of the existing ombudsman is wide (it includes access to information and privacy) and its budget and staff resources are limited, so backlogs of cases often develop.

Creating a separate ombudsman for health matters would not be costly, especially in the context of a $6-billion-plus health budget for the province. It could start off as a part-time position while gauging patient demand, and it could be housed within existing ombudsman services.

Translating patient rights from lofty rhetoric into practical terms is challenging. A patient ombudsman is not a panacea, but such an office could expeditiously investigate complaints and apply a flexible range of remedies to resolve them. Over time, it might promote quality improvements that in the long term might prevent tragedies.

Paul G. Thomas is professor emeritus in political studies at the University of Manitoba and the founding board chairman of the Manitoba Institute for Patient Safety.