Evaluation of the new complaints system within the health service Final report (2019:18)

Since 1 January 2018, new regulations are in place that are intended to contribute to a more effective complaints system within the health service. The Swedish Agency for Public Management (Statskontoret) has been commissioned by the Government to follow up on and evaluate the new system. This is Statskontoret's final report.

Using the new complaints system, the Riksdag and the Government want to reinforce the patients' standing and develop the systematic patient safety management. In the new system, the patients are primarily intended to contact the care provider to lodge a complaint. The Health and Social Care Inspectorate (IVO) is only to investigate the most serious complaints. IVO shall instead develop its self-initiated supervision.

The complaints management is more efficient, but the reform has yet to contribute to increased patient safety

Statskontoret assesses the reform to have created conditions for patients to have shorter waiting periods in having complaints answered, since the care providers can respond to complaints faster than IVO. The care providers have also developed working methods to receive and manage complaints, often at lower levels of the organisation, closer to the patient. This has provided them with better opportunities to implement measures to prevent shortcomings and care-related injuries.

However, Statskontoret notes that the new complaints system has yet to yield the expected effects for patients and patient safety in all respects. Patients still find it difficult to navigate the complaints system, and few are happy with the responses from care providers. In addition, the complaints system is not yet contributing to any great extent to increased patient safety. The reason is that the lessons learned from the complaints often stop at lower levels of the care operations, and that there is no possibility to compile, analyse and learn from the complaints at the higher levels of the care provider organisations and at the national level.

Nor has Statskontoret found any evidence to suggest that the number of complaints to care providers has increased. This is a fundamental condition for the system to work, as it is based on care providers receiving information about shortcomings in the health service via patient complaints.

The reform has provided IVO with the conditions required to increase its self-initiated supervision

Statskontoret notes that IVO has begun transferring resources from the complaints management to its self-initiated supervision, and that it conducts more cases of self-initiated supervision in 2019 than previously. However, the work only began recently and the allocation of resources between the two areas is not yet stable because, for example, it is influenced by how many complaints IVO will receive in the future.

Statskontoret's recommendations

The Government should monitor how the number of complaints evolves and attempt to increase awareness about the complaints management of private care providers.
The Government should continue to finance the efforts of Sweden's local authorities in developing 1177 Vårdguiden to allow patients to lodge complaints via the online service.
IVO should continue the work with transferring resources to the self-initiated supervision. IVO also needs to ensure that the management of complaints by private individuals is consistent and legally secure, and continue developing its collaboration with the patient advisory committees.
The local authorities should ensure that all patient advisory committees have sufficient funding to fulfil their assignment. Many already do, but not all.
The care providers should use complaints as a basis for their systematic patient safety management. Care providers should also strengthen the knowledge and attitude regarding complaints so that they are not seen as something negative, but rather as a tool to improve the operations.

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