Patient safety charter: symbolic or meaningful?

The Kinew government’s throne speech contained a number of important commitments to further improve the safety, quality, and timeliness of health-care services delivered through an expensive, sprawling, complicated system involving multiple interdependent domains and levels.

Always under stress, currently the system operates under the severe strain of inadequate or maldistributed resources, including money, personnel and equipment.

For individuals and their families finding their way in the complex system too often leads to anxiety, frustration and anger. Lack of timely access to appropriate services can involve great stress, lead to worse health problems, and cause patients to incur private costs to obtain treatments. Human errors, system breakdowns and adverse events causing harm to patients are bound to happen.

The focus here is on the throne speech promise “to improve safety for patients and staff with a patient safety charter enshrining into law your right to good health care.” A bill to establish a charter has not yet been released so we are left to speculate on how far it might go in proclaiming and protecting patients rights.

The word charter might suggest the creation of a legal right for patients to receive timely access to health care, together with the right to safe, quality care when they interact with the multiple institutions and wide variety of personnel serving in them. The further implication might be that patients could take health authorities and the government to court for any failure to meet the high level standards set forth in a charter.

To the best of my knowledge, no jurisdiction has established such far-reaching guarantees. Creating patient rights enforceable through the courts would potentially and inappropriately take certain decisions on health-care spending out of the hands of elected and accountable politicians in the cabinet and the legislature and transfer them to judges.

Alternatively, a charter could represent simply an aspirational statement of what patients should expect and to which all health institutions and their personnel would commit to achieve. Critics might dismiss such a statement as a symbolic gesture which does little to enhance access or to protect patients in their encounters with the health system. They might point to the existing array of mechanisms meant to promote and protect patient rights.

Most health-care institutions, like hospitals and long-term care facilities, already have adopted “bills of patient rights.” Most such institutions have “safe to ask” or “speak up” campaigns meant to encourage patients to raise their concerns. There are also “patient relations” offices and internal processes intended to mediate disagreements between patients and the institution.

In terms of clinical practice, The Regulated Health Professions Act sets forth rules and processes for the regulation, complaints and discipline of health professionals in over 20 professional domains. There is also the Manitoba Apology Act which allows health professionals to apologize for adverse events without creating legal liability and an apology is not admissible in court.

Finally, Manitoba’s independent office of the ombudsman can investigate complaints within institutions that are part of the province’s five regional health authorities. There are limits to the authority of the ombudsman, most notably the fact that she can only recommend, not order, health authorities or the government to act in certain ways. Also, her authority does not cover private institutions which play a growing role in the delivery of health services. The budget of her office is stretched, outreach activity is limited, most patients do not know of her services, and not surprisingly, few cases arise in the health-care fields.

To make any future charter meaningful, I recommend that Manitoba follow the Quebec model by creating a specialized ombudsman for the health sector. The Quebec Health Ombudsman oversees a complaint process that entitles persons to make complaints about health services they require, have received, or ought to have received. Unlike Manitoba, Quebec’s ombudsman handles complaints involving private institutions.

The complaint procedure involves two stages. Each health institution must appoint a complaints commissioner to whom complaints are initially submitted. If concerns cannot be resolved at the local level, complainants can appeal to the ombudsman which is empowered “by any appropriate means” to ensure that users are respected, that their rights are enforced, and that institutions uphold and apply the complaint process. The ombudsman can also intervene whenever there are reasonable grounds to believe that a person or a group has been or may likely be wronged by an act or omission. On average, it handles more than 1,000 complaints annually. It issues both an annual and special reports based on its findings.

Quebec’s ombudsman puts a human face on the health-care system by having an identifiable public figure whom patients can approach with problems. Its services are free and it can react more expeditiously than other complaint mechanisms. Because it does not make binding decisions, it relies mainly on mediation and persuasion, making the complaint process less legalistic and adversarial. Its reports put pressure on authorities to respond, have educational value, and reinforce in the cultures of health-care institutions the espoused values of safe, quality, and compassionate care.

To ensure that a future charter of patient safety is more than symbolic window dressing, Manitoba should create a separate health ombudsman.

Paul G. Thomas is professor emeritus at the University of Manitoba and served from 2004-2008 as the founding board chair of the Manitoba Institute for Patient Safety.