Everyone is a patient or potential patient. Patients have the right to safe and quality healthcare of an appropriate standard that encompasses the traditional duty of care – reasonable care and skill, with patient safety (the minimisation of harm) and co-ordination of care.
Healthcare today is more complex and is provided by teams led by doctors or dentists and which comprise other professionals such as nurses, pharmacists, therapists, etc.
The World Health Organization pointed out in 2014 that globally, many patients experience neglectful, abusive and disrespectful treatment, which violates their human rights and their rights to care.
Such treatment infringes on the trust between patients and healthcare providers and may deter patients from accessing healthcare services. This leads to negative impacts on patients’ health and well-being, and on the healthcare delivery system.
Disrespectful care may be institutionalised, unchallenged or unrectified.
The dimensions of respect in healthcare include freedom from harm and mistreatment; preservation of patients’ dignity; maintenance of confidentiality; provision of information and informed consent; engagement with effective communication; respecting patients’ choices; provision of efficient and effective care; continuity of care; availability of competent healthcare professionals; and access to family support.
A patient’s navigation through the healthcare delivery system is potentially fraught with challenges, especially when hospitalised. This is worse when patients or their caregivers have a grievance.
Grievances can result from any stage in the patient’s journey through the healthcare delivery system. This is usually more likely to occur if there is an adverse event, such as when the patient is harmed.
Grievance procedures are rarely designed in a manner that is simple, accessible and expeditious from the patient’s perspective. Patients may require support in navigating these procedures, particularly if an adverse event has occurred.
The common reasons for grievances are failings in clinical care and treatment and unprofessional staff attitudes.
A poor explanation or an incomplete response are the common reasons for dissatisfaction with the way patients’ grievances had been handled in the first instance.
Poor grievance handling can render a difficult situation worse for patients and their caregivers.
Poorly handled grievances can escalate, creating unnecessary demands on human, facilities and services’ resources.
The Private Healthcare Facilities and Services Act requires all private healthcare facilities to have a grievance mechanism in place. The Health Ministry has a mechanism to address patients’ grievances, which include inquiries.
However, as the participants in the Ministry’s inquiries are its employees, patients and/or their caregivers’ perceptions of conflict of interests are not uncommon.
There is no national data on grievances addressed by public and private healthcare facilities. Neither is there data on medical errors, which are a major cause of mortality and morbidity in developed countries.
All that is available are adverse incident reports from about 75% of Health Ministry hospitals. The paucity of such data hampers the formulation and implementation of specific policies and strategies to minimise harm and improve the quality of healthcare to patients; and to monitor change.
Patients and/or their caregivers have complained to regulators such as the Health Ministry, Malaysian Medical Council, Malaysian Dental Council; filed police reports; taken the matter to the courts; and even the media.
A common refrain is that they would not have acted as such had an explanation been provided and that they did not want another patient to suffer from their adverse event.
These actions by patients and/or their caregivers reflect their dissatisfaction with the current grievance mechanisms in the public and private healthcare facilities.
Ombudsman was originally a Swedish term that meant “grievance person”. It was first used in 1809 when the Swedish Parliament established the office of Justitieombudsman, who was given the task of looking after citizens’ interests in their dealings with the government.
The system was taken up by other countries in the 20th century, so much so that there are currently ombudsmen in about 150 countries, according to the International Ombudsman Institute (IOI),
Every Ombudsman system has two basic functions – investigation and resolution of grievances suffered by individuals; and improvement of public services through learning from the investigations undertaken, implementation of its recommendations, and monitoring to ensure the desired outcomes are attained.
The values of the various Health Ombudsman systems include the following:
• The health and safety of patients are of paramount importance.
• The Ombudsman’ actions are independent, impartial and in the public interest.
• Open and honest communication and sharing of information assists improvement in healthcare delivery.
• Transparency and accountability are the basis of grievance procedures.
• Fair and equitable treatment for patients and healthcare providers.
The roles of the various Health Ombudsman systems include the protection of the health and safety of the public; promotion of high standards of healthcare delivery by healthcare facilities and services; promotion of professional, safe and competent practices by healthcare professionals; and maintenance of public confidence in the management of healthcare grievances, safety and quality in the delivery of healthcare services.
The Health Ombudsman systems function by receiving and investigating complaints about healthcare facilities, services and professionals; deciding the action to be taken, and in certain instances, taking immediate actions to protect the safety of the public; monitoring the performance of regulators of healthcare professionals; providing information about minimising and resolving healthcare grievances; and reporting on the performance of its functions to the public and Parliament in many countries.
Malaysia aspires to be a developed country. With the current global focus on patients’ rights and the country’s agenda for improvements in healthcare delivery, it is timely for the establishment of a Health Ombudsman system which shall safeguard patients’ needs, interests and legal rights; evaluate the cost effectiveness of healthcare services; as well as improve the safety and quality of healthcare facilities and services.