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LC: Motion debate on "Mechanism for handling complaints concerning medical incidents"

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Following is the speech by the Secretary for Health and Welfare, Dr E K Yeoh, in the motion debate on "Mechanism for handling complaints concerning medical incidents" in the Legislative Council today (May 9):

Madam President,

Recently, there are a lot of discussions among the public on the credibility and transparency of the complaint system for health care services; and suggestions on various improvement measures. I would like to thank Hon Andrew CHENG for moving this motion and members' views, so that the public can have a better understanding on the root of the problem, and at the same time, the Government can gather different views on the issue.

It seems that today discussions focused mainly on the complaints system of the Medical Council and its improvement measures. However, I think it may be more appropriate to first consider the patient's complaint system as a whole. After that, I will respond to questions related to the composition and complaints system of the Medical Council and clarify the standpoint of the Government.

Just now, members have discussed on the role, functions and credibility of a patient complaints systems. In order to properly define the role and function of a complaint system, we must first understand what constitutes a complaint. A complaint occurs when there is grievance resulting from a discrepancy, which is perceived as unreasonable, between the expectation of the patient and the service received or outcome of treatment. Such grievance may be related to the quality of professional care, administrative procedures or attitude. And the discrepancy may be the result of, among other things, poor quality of service, miscommunications or undue expectation from the patients. Sometimes, it could also arise from grieve in reaction to the loss of a loved one or to loss of health arising from their own illness.

Moreover, patients will translate the discrepancy into a complaint only when they believe that their concerns will be taken seriously, investigated, a clear explanation given and appropriate follow up actions or improvement measures carried out by the system or organization dealing with the complaints. Besides, patients must know and perceive that making complaint is a basic customer right before they will do so. We should also note that there may a very different psychology underlying each complaint and objectives to be achieved by the complainant. While some complainants merely want to air their dissatisfaction and to look for an explanation or apology, others wish to see prompt action to improve service quality or think they deserve a compensation.

Therefore, based on the above understandings on complaints, an effective complaint system should act in the public interest to investigate, analyze and identify the cause or causes of each complaint. The system must be accessible and user-friendly so that aggrieved patients will not be debarred from making complaints. It must be fair, objective and transparent in order to gain the confidence of both the patient and health care workers. Moreover, the complaint system can act as a bridge and mediator between the complainant and the complained in case there is a breakdown in communication.

Apart from that, any complaints system should provide opportunities for self-examination and improvement. We should look at complaints positively and treat every complaint as a chance for improvement.

As mentioned in the consultation document on health care reform, we are very concerned about the problems of the existing complaints system and have proposed improvement measures targeting at the problems identified. We have examined the existing complaints system. There are quite a number of channels for grievances to be addressed to, including the complaints mechanism of individual providers, the professional regulatory bodies, the Ombudsman, the Legislative Council and the court of law.

These different complaints channels have different functions and role in handle grievances or complaints of different nature. For instance, the complaints mechanism of service providers handle complaints in relation to a customer perspective, but also include professional practice and compensation; the professional regulatory bodies are responsible for cases related to professional misconduct or negligence; the Ombudsman would investigate complaints related to mal-administration in public services; and the Court of Law may need to consider damages and compensations.

We need to examine how these systems relate to each other and how they function in order to guide future improvement. Improvement measures should be targeted at adding functions that may be inadequate and enhancing functions that are not effectively carried out. We have identified the following main problems of the existing systems:

i. though complaints channels are available, they are regarded as complex and the interface between the various channels is confusing. Owing to the lack of understanding of the system, complaints are often directed to an inappropriate channel and the objectives of complainants are not fulfilled.

ii. the credibility of the complaints systems particularly for complaints against the practice of doctors had been questioned;

iii. The complaint process is not user-friendly nor transparent.

On the proposal of an independent complaints office, I think we will have to be clear on how independent the system should be; how should the scope of the function and power be defined; and what should be its relationship with the existing complaints systems. Having an additional independent complaint system will not only duplicate the functions of the existing systems but will also add confusion to the already complex system and create even greater problem of the interface between various complaints channels.

In view of the problems of the existing complaints system, we, in our consultation document on health care reform, have made proposals on the reform measures. We proposed to set up a Complaints Office within the Department of Health to handle complaints related to patient care. Such arrangement has several advantages:

i. The Complaints Office will rectify one deficiency of the existing system. It can assist the complainants by clarifying the nature of complaints and the objective of the complainants. Acting as a guide to the complaints systems, it can steer the complainants to the appropriate complaints channel. Besides, it can also help by providing advice and explaining the content of the complaints.

ii. The Office will open up an opportunity for communication between the complainants and the complained through mediation at an early stage. This will help to reduce conflicts and avoid further deterioration in the relationship between patients and the health care workers.

iii. In addition, the Office will be able to provide a one-stop service to the complainant. It could conduct investigations into complaints, assist complainants to obtain expert advice, brief complainants on the facts of the case as known and try to mediate between the complainant and the complained.

Now, I would like to respond to members' proposals on the reform on the composition, operation and complaints handling procedures of the Medical Council. Let us first revisit the objective and advantages of a professional regulatory body.

The primary purpose of the professional regulatory body is to protect the public from incompetent practice, to maintain public confidence in the profession and to maintain the integrity of the profession. A well-designed professional regulatory system, which is effectively executed, offers the best protection of professional standards, to patients and the community. As complaints may reflect the practice of health care professional is not up to standard, one of the main objectives of an effective complaints system is to monitor quality of service provided and rectify any deficiency identified.

Medicine is a discipline with a specialized body of knowledge, therefore, medical and health professionals are in an appropriate position to appraise and pass judgment on the practice and conduct of their peers. As with many other places, professionals in Hong Kong are empowered through legislation for self-regulation. It is recognized that such system is effective and efficient when it acts in the best interest of the patients and society. However, we must not forget that one pre-requisite is it has to have the confidence of the public and the profession. Thus, it is essential for the system to be fair, objective and transparent in order to ensure public confidence on the system.

In recent years, it has been observed that the public started to question the credibility of the complaints system of the Medical Council. Besides, the complaints handling procedure is not user-friendly and non-transparent. The Medical Council has to evolve and develop in order to meet the changing public expectation and societal needs. As the reform of the Medical Council would have direct influence on public interest, the Government has the responsibility to review the existing law and procedures in order to ensure it is in line with the public expectations and that the public interests is being protected.

I am in agreement that we need to review structure, function of the Medical Council and its complaints handling procedures in order to improve its credibility and transparency. In view of the issues and public discussions, I have initiated a review of the structure, function and operation of the Medical Council in association with the Council. The Medical Council is empowered by law to investigate, prosecute, inquire, deliver verdict and award discipline for complaints received. Since the evidence and information collected during investigation would have direct influence on the adjudication, people may question the fairness and independency of the final adjudication if investigation and adjudication are not separated.

Besides, the majority members of the Medical Council are doctors. This will lead to a perception that decisions and judgments made in the complaints handling process are dominated by doctors and views of lay members are not adequately reflected.

We have initiated a dialogue with the Medical Council and I am encouraged that the council is in agreement for a need to review and propose on improvement measures related to its structure, function and complaints system. In the House Committee meeting of this Council held on 27 April this year, members have decided to set up a working group under the Panel on Health Services, inviting representatives from the Government and relevant health professionals to discuss on the reform measures to improve the credibility of the existing patient complaint system and requirement to amend the existing law. I look forward to the commencement of work of the working group. I believe, through the coordinated work of various parties, a consensus on the reform proposal for the improvement of the patient complaint system can be reached.

Thank you, President.

End/Wednesday, May 9, 2001

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