Evaluation of the new complaints system within the health services. Interim report (2018:26)

On 1 January 2018, new regulations entered into force with the aim of contributing to a more effective complaints system within the health services. The Swedish Agency for Public Management (Statskontoret) has been commissioned by the Government to monitor and evaluate this system. This is the first interim report. The commission will receive its final assessment by 1 December 2019 at the latest.

The new complaints system will, among other things, contribute to a more rapid response to patient complaints and to strengthening patient safety. The Patient Advisory Committees, together with the care providers, will represent the first line in the complaints system. Within the new complaints system, the Health and Social Care Inspectorate (IVO) has limited responsibility for handling complaints. IVO will instead develop its riskbased supervision so as to carry out supervision where the need is greatest.

Implementation has generally gone well

Statskontoret finds that the relevant actors in general have implemented the new complaints system in an effective way. Many care providers, especially county councils, have changed their procedures for receiving and handling patient complaints. Most Patient Advisory Councils have reinforced the staff and indicate that they are well equipped for their mission. IVO has developed its assessment process based on the new regulations.

It is too early to say how the new system will perform in terms of number of complaints. So far, the clearest consequence is that the number of complaints being received by IVO has decreased. There is variation in the developments for care providers and Patient Advisory Councils. It is also unclear what costs will be incurred by the different actors.

However, Statskontoret nonetheless finds that the cooperation between IVO and the Patient Advisory Councils has not developed in accordance with the objectives of the reform. The majority of the Patient Advisory Councils want to cooperate to a greater extent and indicate a desire to obtain more feedback on the complaints information that the councils submit to IVO.

Statskontoret also notes that the information on the complaints system provided to patients and relatives has thus far not been sufficient. Access to information from care providers varies, and the information is perceived as unclear on the IVO and 1177 Vårdguiden websites.

Too early to assess the effects of the reform

It is still too early to assess the effects on patient safety that the new complaints system will yield. Most care providers state that the new regulations have not affected their conditions for preventing care-related injuries. Statskontoret will return to the effects of the reform on patient safety in the final report.

Several positive results so far

One outcome of the reform is that patients and relatives receive responses to their complaints more quickly than before. Most care providers answer complaints from patients within an average of four weeks. Another positive change is that IVO's investigations of complaints under the new regulations have thus far in 2018 taken a shorter amount of time on average compared to previously.

In addition, Statskontoret finds that the measures implemented by IVO so far have provided better conditions for the agency to conduct more riskbased and patient-centred supervision. However, we also note that IVO has not yet transferred any resources from handling patient complaints to the self-initiated supervision. It is reasonable that IVO should be able to transfer extensive resources already during 2019. This is a prerequisite for strengthening supervision and thus contributing to increased patient safety.

Challenges to achieving the goals of the reform in the future

There are several challenges for the relevant actors with regard to achieving the goals of the reform. In particular, the county councils emphasise that the primary obstacles to preventing care-related injuries at an early stage are the high staff turnover and a lack of procedural knowledge by the health services staff. Half of the county councils that have answered our survey state that a lack of resources to handle complaints represents an obstacle.

Another challenge is to handle complaints in a uniform manner throughout the country. Statskontoret finds that complaints that are not investigated by IVO are handled differently by different county councils. Most common is that the cases are handled by the unit providing the care. In one of the county councils, however, the complaint is sent to the Patient Advisory Council before the care provider takes any action. Statskontoret finds that different practices in the county councils can lead to the handling of complaints being unclear for patients.

Statskontoret already noted in 2015 that IVO's IT support needs to be developed in order to fully support the activities. Although work in this regard is taking place within IVO, the agency still needs to develop its IT support. Statskontoret is of the opinion that effective IT support is an important prerequisite for handling the cases effectively and for systematically utilising information from the Patient Advisory Councils.

Statskontoret's recommendations

In this interim report, Statskontoret provides the following recommendations:

Statskontoret recommends that IVO develops a model for how the Patient Advisory Councils' analyses will serve as a basis for supervision. IVO and the Patient Advisory Councils need to develop close cooperation in order for the complaints system as a whole to function as intended.
Statskontoret recommends that IVO, the care providers and the Patient Advisory Councils, together with the National Board of Health and Welfare, evaluate whether the information on the complaints system currently found on different websites is consistent and sufficiently clear for the patient.
Statskontoret recommends that IVO establishes a timetable for when the agency can transfer resources to the self-initiated supervision, and clearly state what measures the agency needs to implement in order to keep to the schedule.
Statskontoret recommends that IVO, together with the Patient Advisory Councils, evaluates the order in which complaints transferred from IVO are handled by the Patient Advisory Council before being submitted to the care provider for action.
Statskontoret recommends that IVO establishes a timetable for when IT support adapted to the operational needs can be in place.

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