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What happens when you make a complaint

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Receiving your complaint

We will start reviewing your complaint straight away. We will contact you if we require further information.

If there is nothing we can do to assist you, we will explain why. We will also tell you what other options you might have.

We keep records of all complaints to help us identify systemic issues and patterns of behaviour.

If we take your complaint further, we will tell you what we have decided to do with it.

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What we can do about your complaint

If we take your complaint further, we may:

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Assessment

When we are assessing a complaint, we seek more information to help us understand the issues in your complaint. This often means requesting medical records and a response from the health service provider, if we don't already have one.

Most assessments last for 30 days. After 30 days, we can request a 30-day extension from the Health Ombudsman or make a new decision from the list above.

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Refer to another state or federal organisation

Some complaints can be legally and more effectively handled by someone else. For example, a hospital, the Australian Health Practitioner Regulation Agency (Ahpra), the police, or the Crime and Corruption Commission.

If we refer your complaint we will tell you who we have referred it to.

We will forward information that we have collected about your complaint to that place.

In Queensland, the OHO works with Ahpra to oversee and regulate the practise of registered health practitioners. Complaints about registered health practitioners are mostly referred to Ahpra, or to the specific national registration board for that practitioner type, for example, medical, nursing and midwifery, or physiotherapy.

The most serious complaints are managed by us, and are not referred to Ahpra. This usually means complaints involving allegations of professional misconduct, or behaviour that would result in suspension or cancellation of the practitioner's registration.

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Local resolution

Local resolution is a process where we work with you and the health service provider, in an informal way, to resolve your complaint as quickly as possible.

Often complaints are a result of poor communication or a misunderstanding. By simply discussing your concerns with the health service provider, we may be able to resolve your complaint quickly and easily.

We will only recommend local resolution if you and the provider agree, and we believe your complaint can be resolved quickly. Serious complaints, such as those involving professional misconduct, are not suitable for local resolution.

Most local resolutions are completed within 30 days. After this, we can request a 30-day extension from the Health Ombudsman.

The process

If you and the provider agree, we will put you in touch with one another so you can communicate openly and directly about your respective concerns.

The complaint is resolved

Your complaint will be resolved if you and the health service provider agree on any of the options listed below.

  • Explanation: You can request a detailed explanation to help you understand what happened and why. This can often resolve a dispute.
  • Changes in practice, policy or procedure: During local resolution, you and the provider may agree on ways to improve their health service. This can prevent the same thing happening to someone else, as well as improve healthcare quality.
  • Apology: Local resolution can encourage a provider to acknowledge deficiencies in their practice and apologise to you for any harm caused. Apologies and acknowledgements cannot be used in court or other proceedings.
  • No further action: You and the provider agree that nothing further can be done.

We close the complaint once a resolution is reached.

The complaint is not resolved

If you and the health service provider do not agree, the complaint is not resolved. If so, we will talk with you and the provider to find out why and decide what further action is required. Our decision may be to:

We will advise you and the provider of our decision and explain to you the relevant process and what you will need to do.

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Conciliation

Conciliation is a confidential and free complaint resolution service. It is an effective way to resolve complaints, particularly those that require detailed explanations.

Anything said or information given during conciliation (other than something that reveals a public interest matter) cannot be used as evidence in a court, tribunal or by a disciplinary body.

The process

After assessing your complaint we may decide conciliation is suitable. We will then contact both you and the provider to confirm your participation.

You do not have to agree to participate, and you and the provider can withdraw from the process at any time.

You will be guided through the process by our independent and impartial conciliators. They help progress conciliation, but don’t take sides or make judgements. Our conciliators cannot force agreement or award compensation.

While our approach may vary depending on the case, your conciliator will work with you and the provider to develop a conciliation plan. You can choose to conciliate in various ways, through face-to-face meetings (held in convenient, private locations), teleconference, letters, emails or faxes. You can choose to have a lawyer present, but you don’t need to have legal representation.

During conciliation both you and the provider can speak openly and directly to each other about your complaint.

If you and the health service provider agree to participate in conciliation, you must both do so in good faith. This can mean:

  • agreeing to meet reasonable timeframes
  • agreeing on the issues to be conciliated
  • attending meetings
  • following negotiation procedures agreed by both parties
  • disclosing relevant information.

Public interest

We are obliged to consider and investigate public interest matters that arise during conciliation. We will tell you if a matter of public interest is identified before or during conciliation. We are able to use otherwise confidential and privileged information given during the conciliation to determine appropriate action on public interest issues and refer to other agencies where necessary.

The complaint is resolved

Your complaint will be resolved if you and the health service provider agree on any of the options listed below.

    • Explanation: You can request a detailed explanation to help you understand what happened and why. This can often resolve a dispute.
    • Changes in practice, policy or procedure: During conciliation, you and the provider may agree on ways to improve their health service. This can prevent the same thing happening to someone else, as well as improve healthcare quality.
    • Apology: Conciliation can encourage a provider to acknowledge deficiencies in their practice and apologise to you for any harm caused. Apologies and acknowledgements cannot be used in court or other proceedings.
    • Compensation: In conciliation, you can discuss compensation, a refund or fee waivers. Compensation is limited to out-of-pocket expenses and/or corrective treatment costs. Both parties must agree on the compensation, refunds or fee waiver. Your conciliator cannot decide or award compensation.
    • No further action: You and the provider agree that nothing further can be done.

We will give you and the provider a results report on the outcome of the conciliation.

The complaint is not resolved

If you and the health service provider do not agree, your complaint is not resolved. If so, your conciliator may recommend that we:

If your complaint is not resolved after conciliation, you still have the right to take legal action, but there are strict timeframes. You may need legal advice.

We may also end the conciliation process early if:

  • it appears that no agreement can be reached between the parties
  • the complaint involves a matter of public interest, such as a health practitioner whose health, conduct or performance must be addressed.

Conciliation fact sheets

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Immediate action

The Health Ombudsman can impose restrictions and bans on individual health service providers who are a risk to public health and safety or for reasons of public interest.

Read more about the Health Ombudsman's immediate action powers here.

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Investigation

We conduct formal investigations for the most serious complaints. This is where an individual health practitioner poses a serious risk to other people, or there may be evidence of the practitioner's professional misconduct.

We may also conduct an investigation into a health facility or service to determine if there are systemic issues affecting the provision or quality of health services.

An investigation involves a much more detailed examination of the matter. During an investigation we can:

  • collect relevant information, including documents and equipment
  • interview anyone we believe has information.

We will let you and the health service provider know if we decide to start an investigation.

We abide by procedural fairness ensuring all parties are given fair opportunity to comment and provide information.

Read more about investigations here.

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Potential legal or disciplinary action (referral to Director of Proceedings)

The Director of Proceedings is an independent position that has the power to determine if a matter is appropriate for referral to the Queensland Civil and Administrative Tribunal (QCAT).

In deciding whether a matter should be referred to QCAT, the Director of Proceedings takes into account factors such as:

  • How serious was the threat to public health and safety?
  • To what extent did the registered health practitioner breach any codes, standards or guidelines?
  • Has the registered health practitioner shown remorse or insight?
  • How likely is it that the Health Ombudsman would win the case?

If the Director of Proceedings refers the matter to QCAT, the Director of Proceedings prosecutes the matter on behalf of the Health Ombudsman.

If the Director of Proceedings decides not to refer to QCAT, the matter is referred back to the Health Ombudsman with a recommendation to:

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No further action

If there is nothing further we can do to assist you, we will advise you and close your complaint.

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