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Blog Archive

 

Last July, Patient Ombudsman’s blog highlighted the issue of temporary closures in hospital emergency departments. One year later, and this issue continues to be a concern for communities needing access to emergency services and a challenge for hospitals dealing with staffing issues.

In December 2023, the Auditor General of Ontario‘s audit on emergency departments reported there had been more than 200 temporary emergency department closures between July 2022 and June 2023.  And in January 2024, the Rural Ontario Municipal Association released a report that looked at challenges accessing health care in rural Ontario that noted 867 temporary emergency department closures between January and November 2023 (inclusive), as per a study by the Northern Ontario School of Medicine.

In June 2024 alone, our office noted media reports of temporary closures for emergency departments at Almonte General Hospital, the Chesley site of South Grey Bruce Health Centre, Listowel Wingham Hospital Alliance and St. Marys Memorial Hospital, as well as a temporary closure of the obstetrics unit at Collingwood General and Marine Hospital due to staffing shortages.

As seen in our most recent annual report, Patient Ombudsman received more than 350 complaints in 2022/23 about experiences in emergency departments, a 17% increase over the previous year. These complaints focused on concerns about delays, the quality of assessments, diagnostics and treatment, poor communication and a lack of sensitivity and caring. Our current data shows that almost one in five complaints to our office about public hospitals in 2023/24 were about experiences in emergency departments.

Last year, our blog focused on what patients and hospitals can do to lessen the chances of a negative experience and focused largely on communication: sharing information about expected wait times and alternatives for non-urgent needs; communicating with courtesy and respect; and ensuring patients know who to speak to about concerns or worsening symptoms. The guidance we provided in last year’s blog as well as in several past annual reports focuses on ensuring patients are treated fairly when faced with long wait times and other challenges in emergency departments.

We continue to support the need for good communication; at the same time, Patient Ombudsman is concerned about the ongoing issue of closed or reduced hours/services at Ontario hospitals, which limits patients’ access to care when they need it most and can potentially lead to safety risks.

Access to care is essential and the significant, ongoing issues that we see both in the complaints to our office about emergency departments and in media reports of reduced services are ones we will continue to monitor and report on in the months ahead.

Every year, Patient Ombudsman receives more than 5,000 complaints from patients, long-term care residents and caregivers about their health care experiences. Our team of Early Resolution Specialists work with both the complainants and the health sector organizations to find fair resolution to these concerns. But sometimes, complaints are not quite ready for our involvement.   Patient Ombudsman is an office of last resort. This means that if you want to make a complaint about a negative experience, you first need to try to address the issue directly with the health sector organization before Patient Ombudsman can review the complaint. If the organization is not able to address your complaint or you’re not satisfied with how it responded, then Patient Ombudsman can help.

Why is ‘last resort’ important? We believe that resolutions are best achieved as close as possible to the point of care and that the best resolutions happen when patients, residents and caregivers deal directly with the organization they have a relationship with. Not only does this give the organization a fair chance to resolve the issue itself, but also helps maintain the relationship between you and your care provider or the health organization. Who do I talk to? If you have a concern about a health care experience, your first step is to contact the health care organization directly. But knowing where to take your complaint can be confusing. The person responsible for managing complaints may differ from organization to organization:

  • In a hospital, you would contact the patient relations or patient experience department. The contact information for these departments is usually available on the hospital’s website.

  • In a long-term care home, a staff person is designated to respond to concerns. This may be an administrator, a director of care, manager or ‘resident experience’ staff. Ask the home who you should speak to about your concerns.  

  • For home care services, you should contact your care coordinator. Home and Community Care Support Services organizations has patient relations information listed on their website as well.

  • For community surgical and diagnostic centres, a staff person is designated to respond to concerns. This may be an office manager or a quality advisor. If the centre does not have information about their complaint process clearly marked on their website or in the centre, ask who you should speak to about your concerns.

If you have tried to resolve your concern with the health organization and are not satisfied with its response, contact Patient Ombudsman. We’re here to help!

What do we mean when we say we want high-quality health care?

Many health care organizations agree that when measuring quality, health care needs to be safe, effective, patient-centered, efficient, timely and equitable. These six domains are an important framework to evaluate quality, but they’re not the only measure.

There are times when someone receives the care they need but still has a negative experience. As an ombuds, our office uses a fairness lens in our review of the processes, decisions and behaviours that contributed to a negative health care experience.

Unique Perspective

As one of the only ombuds offices in Canada dedicated to health care, Patient Ombudsman has a unique role in Ontario’s health care system. Unlike other ombuds offices, which may have oversight over a variety of government services and may be addressing complaints about things as varied as housing and education in addition to health, Patient Ombudsman is focused on health care alone. We are also the only organization in Ontario that resolves and investigates complaints about care and health care experiences from patients, residents and caregivers across different sectors of the health care system.

This unique perspective allows us to have a bigger picture on what patients, residents and caregivers are experiencing. We can share what we’re hearing and make recommendations to help improve experiences for everyone.

Quality Improvement

Complaints provide a unique perspective from which to learn and share to improve the quality of the health care experiences for everyone. When working to resolve a complaint, we listen to what happened, who was involved, and ask what would make it right. We also reach out to the health sector organization involved and ask for its perspective so that our decisions and recommendations are fair and unbiased.

Using a fairness framework, we often ask if patients, residents and caregivers had an opportunity to ask questions and did they receive information in a clear and timely way? How were decisions made and how were those decisions communicated? This kind of framework doesn’t focus solely on whether a person received the care they were supposed to, but whether they received the care in a fair and equitable way.

Resolving a complaint may have the health sector organization updating a policy or procedure to better reflect what should happen in similar situations or putting a whole new process in place to address the problem. These kinds of changes go beyond the individual complaint and result in widespread change across the organization, benefiting future patients, residents and caregivers.

This emphasis on improving experiences across the health care system is at the heart of our newly released 2024-2027 strategic plan, which shares the aims and objectives of our work over the next three years. We want to use this plan as a tool to engage with and inform the people we serve and with whom we work. Our strategic plan outlines how we see ourselves evolving as an organization and the commitments we’re making to improve the quality of our services while advancing our goals of better health care experiences for patients, residents, and caregivers across Ontario.

Read our 2024-2027 strategic plan to learn more about how Better Experiences results in Better Health Care.

Most of the complaints that Patient Ombudsman receives are resolved through the work of our Early Resolution Specialists – the frontline staff who work closely with both the person making the complaint and the health organization to find a fair resolution. There are times, however, when Patient Ombudsman may decide its appropriate to launch an investigation. There are typically two kinds of investigations that Patient Ombudsman carries out: an investigation based on a complaint or an own motion investigation. A complaint-based investigation may happen when an early resolution to a complaint cannot be achieved or if there are disputes about the facts. An own motion investigation is typically about a systemic issue or a matter of high public interest that comes to Patient Ombudsman’s attention. This kind of investigation can be initiated without a complaint. What to expect when an investigation is launched? When Patient Ombudsman launches an investigation, everyone involved is notified and receives information about what to expect throughout the investigation process. An investigator will reach out to the complainant (if there is one) and to the health organization to collect relevant information. This may include speaking with people within the organization who have information related to the investigation. It is important to note that officers, directors, employees, shareholders, and other members of the health organization are required to cooperate with the investigation and provide information and documents relevant to the investigation. Investigations are carried out in private, which means that during our investigations, we only provide specific details needed to collect evidence. We also expect that those we speak to or collect information from keep their involvement confidential. We might take steps to shield the identity of witnesses and maintain the anonymity of whistleblowers in some cases. After gathering information and conducting interviews, investigators will draft a report of their findings and make recommendations. This report is sent to the health organization or other parties who may have potentially adverse findings, and they will be given an opportunity to respond to the findings. After the report is finalized, Patient Ombudsman follows up with the health organization on how it is addressing the formal recommendations. A summary of the report findings, including full recommendations, is made available to the public on our website.   In 2023, Patient Ombudsman published three investigation summaries that touched on issues related to billing for uninsured services, chronic care co-payment, and reprisal and access to care. Investigations are an important part of our work and the resulting recommendations are intended to push for systemic change and improvement in our health system.

As the year draws to a close, we’re taking time to reflect on the changes we’ve seen in complaints over the last year. Sharing data and stories from the complaints we received and resolved between April 2022 and March 2023, our latest annual report shines a light on health care experiences and the growing number of Ontarians who have nowhere to turn with their health care concerns.

Last year, our office received a record high number of complaints at more than 4,300 complaints – 50% of which were related to hospitals, 7% related to long-term care homes and 6% related to home care. Quality of care remains at the top the list for both hospitals and long-term care homes with staffing/resources at the top for home care.

What stands out in our 2022/23 complaints data is the number of complaints about organizations and services outside of our jurisdiction: 37% non-jurisdictional complaints is almost double the number of non-jurisdictional complaints we received in 2021/22. Most of these complaints were related to primary care such as family doctors and walk-in clinics.

When we receive a complaint that is not within our authority to help resolve, we try to connect people to someone who can help. Last year, we provided more than 2,600 referrals to other complaint organisations and services.

System navigation is a big part of our work and emphasizes the importance of having appropriate oversight bodies for all areas of our health care system.

The growing number of complaints isn’t a concern. In fact, it’s a sign of a healthy system. When people make complaints, it shows they are comfortable talking about what isn’t working and gives health organizations a second chance to make things right and hopefully ensure it doesn’t happen to anyone else.

We look forward to continuing to work with patients, residents, caregivers and health care organisations in 2024 to help make Ontario’s health system fairer and more responsive for everyone.

For most people, summer means sunshine, mosquitoes, and hot weather. It can also mean a busy time for hospitals and emergency departments, with vacationers increasing populations in small, rural communities. This, coupled with the well-known staffing issues, creates challenges for many health care organizations, sometimes resulting in the need to reduce the operating hours of emergency departments.

Given these pressures, it’s not surprising that complaints about emergency departments are a growing concern. In 2021/22, we received more than 300 complaints about experiences in emergency departments – approximately 14% of all hospital complaints that year. We also noted a 43% increase in the number of patients and caregivers who reported that they were treated with a lack of sensitivity, caring, courtesy or respect at hospitals, particularly in emergency departments.

What can patients and health organizations do to lessen the chance of a negative experience?

A visit to the emergency department can be a stressful time for patients, who may not be feeling well enough to ask questions or get the information they need. For those who can, here are some steps patients can take to help ease miscommunication and stress in the emergency department:

  • At check-in, ask how long the expected wait time is and who you should speak to if you have questions, or your situation gets worse while you wait.

  • Let the appropriate staff know if your symptoms are worsening.

  • When discharged, ask for the instructions about your care in writing, and what you should do if your condition worsens after you are discharged from hospital.

Our 2021/22 annual report sets out recommendations to hospitals to help address some of these concerns, including:

  • Providing as much information as possible about expected wait times.

  • Letting patients know what to do if they have urgent questions or their condition changes while they are waiting.

  • Having information available about alternatives to emergency department care for non-urgent needs.

  • Explaining the hospital’s policy about the ability for a family member or caregiver to enter and remain in the emergency department with vulnerable patients and ensuring family members know who to contact if they are not permitted to stay.

  • Listening to patients and family members with a caring and courteous manner.

As an office of last resort, Patient Ombudsman reviews complaints after the organization involved has had a chance to respond to a patient’s concerns. If you’ve had a negative experience in hospital, contact the hospital’s patient relations department to work through the hospital’s complaints process. If you are not satisfied with the hospital’s response, or if the matter places you or other patients at risk, contact Patient Ombudsman.

We recognize that hospitals and other health organizations are working to provide excellent care in the face of significant pressures. Ensuring clear communication with patients and caregivers, especially around wait times and service delivery, can go a long way to address some of these challenges.

June is National Indigenous History Month, a time to recognize the history, heritage and rich contributions of First Nations, Inuit, Métis and Urban Indigenous peoples across Canada.

As Patient Ombudsman, our role is to champion fairness in health care. And yet, we are keenly aware of anti-Indigenous racism in the health care sector. Between 2019-21, our office received 27 complaints from 25 individuals reporting discrimination or lack of culturally sensitive care for Indigenous patients in hospitals, long-term care homes, and home and community care. The complaints covered a wide range of issues, including use of racial slurs and general lack of sensitivity or compassionate care. Several noted that incorrect assumptions were made about alcohol or drug use in evaluating their physical/medical concerns. Other complainants noted that the health care organization did not provide or refused to permit culturally appropriate care, such as not allowing smudging or healing circles, or that the health care organization was not open to engaging family members or Elders in care planning.

These complaints are disturbing, and we recognize that they are just a small fraction of what Indigenous patients are experiencing. We know we’re not hearing from many patients and caregivers across Ontario. Last year, the Wabano Centre released a report that highlights personal stories from more than 200 individuals across Ontario’s Champlain region who experienced Indigenous-specific racism while accessing health care. These individuals not only shared their own experiences, but 40% also reported having witnessed racism and discrimination against others.

Patient Ombudsman recognizes the need for us as an organization to better support Indigenous patients and caregivers as they navigate the health care system, and we share the concerns about negative experiences. We are working to build our own capacity and continue to support our staff in building cultural competence. We have a dedicated Early Resolution Specialist - Indigenous Experiences staff member to support complaint resolutions for Indigenous patients and caregivers and assist with community outreach to help us ensure we are a welcoming space to receive concerns.

These are just the first steps. There is always more for us to learn and ways for us to improve our practices. We welcome opportunities to hear from Indigenous patients, caregivers and communities about how we can better support people’s needs.

Our Early Resolution Specialist – Indigenous Experiences can be reached at indigenous.experiences@patientombudsman.ca

As shown in our annual report, we receive thousands of calls or emails from residents, patients and caregivers every year who want to know how to make a complaint and resolve their concerns about health care experiences. We know it can sometimes be confusing to know who to complaint to or even how to complain. If you’ve had a negative health care experience, we’ll work with you to help you understand Patient Ombudsman’s complaint process and how we might be able to help. Here's what happens when we get a call or email: We make sure you’ve come to the right place. If your complaint is about an experience in a hospital, long-term care home, or home and community care services, we’ll double check that the organization is within our jurisdiction. Patient Ombudsman is not able to review complaints about walk-in clinics, doctor’s offices, or retirement homes. In addition, if your complaint is about a clinical decision made by a regulated health professional, such as a doctor or nurse, we’ll direct you to the organization that can help. For example, health care providers are overseen by their professional regulatory colleges. Next, we’ll confirm that you’ve first tried to resolve the issue with the health care organization directly. For a complaint about a hospital, this means contacting the patient relations department. Patient Ombudsman can only review complaints after the organization involved has had a chance to resolve your concern. If their response or resolution was not satisfying, that’s where we can step in. We gather information. Once we’ve determined we’re the right place for your complaint, we’ll start to gather information. We may ask you to submit your complaint in writing so that it can be assigned to an Early Resolution Specialist, and we may ask for you to provide consent so that we can contact the health organization for more information. We want to understand the situation from all perspectives to determine what is fair. We listen. You can help by telling us what happened, who was involved, and what would put things right. Next, we’ll reach out to the health care organization to hear its perspective and to gather additional information. We work with all parties when trying to resolve complaints. We try to facilitate a fair resolution. Once we’ve reviewed the complaint and all the relevant information, we’ll work with both sides to see if a resolution is possible. We apply fairness principles to determine whether the health care organization acted fairly. Sometimes, we may need to escalate the complaint to our investigations team. Every complaint is different, and every resolution can be too. Maybe you're looking for an apology, or you want to make sure that what happened to you doesn’t happen to anyone else. It takes courage to bring forward concerns about a negative health care experience, and these complaints give us the opportunity to improve Ontario’s heath care system for everyone. Once we feel the issue has been addressed to our satisfaction, we’ll let everyone involved know and close the file. If you have a concern about your or a loved one’s experience in a hospital, long-term care home or with home and community care, contact us! We provide service in English and French, as well as other languages upon request. Accommodations are available as needed.

Fairness by Design and Long-term Care Placement

This past fall, the More Beds, Better Care Act, 2022 came into effect.

For hospital patients who have been deemed “alternate level of care” and are waiting for long-term care placement, the act allows placement coordinators to carry out certain steps of the long-term placement process without patients’ consent. For example, it allows placement coordinators to select long-term care homes and share the patient’s application and health information with the homes.

While the act helps move patients who no longer need hospital care into long-term care homes, freeing up much-needed hospital beds, it also makes some significant changes to the long-term care placement process.

It’s important to recognize that moving from home or hospital into a long-term care home is a significant transition for many seniors and their families.

Patient Ombudsman sees many complaints related to hospital discharge and care transitions, with patients and caregivers frequently reporting concerns about poor communication, inconsistent information, and pressure to rush important decisions. Several of our past annual reports have highlighted these kinds of complaints to try to shine a light on the hospital discharge process and the importance of clear communication during the long-term care placement process. Both stories show how important it is to ensure the long-term care placement process is fair and includes patients and caregivers. One way health care organizations can better ensure decisions around long-term care placement are made in a fair manner is to incorporate fairness into their processes and review their decision-making through a fairness lens. The concept of using fairness standards when creating policies and reviewing your decisions at the outset is “fairness by design.” Patient Ombudsman has developed a resource to help hospitals and Home and Community Care Support Service organizations evaluate the fairness of how they implement their long-term care placement processes. In addition to the main resource, we have also developed a one-page checklist that highlights the main questions to keep top of mind. By keeping the patient’s needs in mind, health care organizations can help make the long-term care placement process as smooth as possible.

What is the Patient Ombudsman?

What happens when you or someone you love has a bad experience in a hospital, long-term care home, or with home care?

We’re often at our most vulnerable when we’re seeking health care, and a negative experience can leave you feeling frustrated or hopeless, especially if you’ve complained and feel like nothing improved.

If you’ve tried resolving your concern with the health organization directly and feel you aren’t getting anywhere, we can help.

 

We’re here to help

Patient Ombudsman is an independent, impartial office established by the provincial government to receive, respond to and help resolve complaints from patients or caregivers about their care experiences with public hospitals, long-term care homes, and home and community care.

Patient Ombudsman is not a patient advocacy organization. We work with both sides – patients/caregivers and health care organizations – to find a fair resolution.

 

What do we mean by fair?

Before coming to Patient Ombudsman, you need to try to have your complaint addressed by the organization that you were dealing with. If you aren’t satisfied with the outcome, that’s where we come in. When we’re working to resolve a complaint, we use a set of principles that look at what was decided, how was it decided, and how people were treated. We often ask questions about how the health organisation came to its decision, and whether policies and procedures were properly followed.

 

How can we help?

Every complaint is different, and so are the possible resolutions.

A resolution could be an apology from the health organization, it could be a commitment to change a policy or process, or it could be fixing an issue to make sure it doesn’t happen to anyone else.

If your complaint is about treatment decisions made by a health care provider (such as a nurse or doctor), or about an organization that is outside of our jurisdiction (such as a retirement home or walk-in clinic) we can help direct you to the right organization that deals with those concerns.

In certain situations, Patient Ombudsman can also carry out investigations and make recommendations to health sector organizations based on the findings of the investigation.

Together, we can help make change in our health care system to ensure others have more positive health care experiences.

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