More risk exists from people not reporting concerns about health professionals, than from making dubious complaints, new research shows

The Australian Health Practitioner Regulation Agency has commissioned new independent research to take the first look at vexatious complaints internationally.

The research found that while it’s difficult for health professionals to be on the receiving end of a complaint, the complaint is much more likely to vexing for the health worker, rather than vexatious.

AHPRA commissioned the research from the School of Population and Global Health, University of Melbourne to find out the extent of the problem of vexatious complaints and identify how they can be better prevented, identified and managed. AHPRA initiated the work in line with its commitment to the Senate Affairs Reference Committee inquiry into the medical complaints process in Australia.

The number of vexatious complaints dealt with in Australia and internationally is very small – less than 1%, the research found.

However, their impact is significant for all involved.

The research also confirmed that the risk of someone not reporting their concerns is greater than if the complaint turns out to be vexatious.

AHPRA’s CEO, Martin Fletcher, says it’s important to take an evidence-based, international perspective on vexatious complaints about health professionals.

“The Senate committee quite rightly asked the question – is this a big problem in Australia?” he says. “We also wanted to know the answer to this, given we get more than 10,000 complaints each year and the number keeps rising.

“We commissioned this research to find out: is there a potential for misuse of our complaints processes for health practitioners? Are vexatious complaints against health practitioners a big problem in Australia?”

He says that when a complaint is made about a health practitioner, it is not immediately obvious whether it is vexatious.

“And in the event that it is potentially vexatious, there may still be genuine risk to patients involved,” Mr Fletcher says.

“Our primary concern is to protect the public, so even if the intent behind a complaint is vexatious we have to make sure we manage any risk to patients.”

The University of Melbourne’s Associate Professor Marie Bismark says that being on the receiving end of a complaint is a distressing experience for any health practitioner, and regulators need to have good processes for dealing with unfounded complaints quickly and fairly.

“Our research found that the term ‘vexatious’ is often loosely used in debate to refer to complaints that may simply have been the result of a miscommunication or a misunderstanding,” she says.

“A truly vexatious complaint is a complaint that is groundless and made with the intent of causing distress or harm to the subject of the complaint.”

She says that while the issue of vexatious complaints is often discussed, there is actually very little hard evidence about how often they occur. The best available evidence suggests that truly vexatious complaints are very rare, and that under-reporting of well-founded concerns is likely a far greater problem.

“There is a common misconception that a complaint must have been vexatious if it resulted in no regulatory action,” A/Prof Bismark says.

“However, a decision by a National Board not to take regulatory action does not mean that the complaint was unfounded or made in bad faith. For example, a risk to the public may have been adequately addressed between the time the complaint was made and when the investigation concluded,” she says.

“This is not an issue that is unique to healthcare. Around the world, regulators from different sectors are occasionally faced with people who make repeated, unreasonable and fervent complaints or intentionally misuse complaints processes.

“Our research identified some helpful processes for identifying and responding to this type of complaint in a timely way. Efforts to better prevent and manage vexatious complaints must be carefully designed so they don’t discourage those with legitimate concerns from coming forward,” she says.

The report found that identifying vexatious complaints is inherently difficult, as classification relies on features which may be difficult to prove: complaint veracity and complainant intent.

The report found that some key principles for preventing, identifying and managing vexatious complaints include:

  • Clearly define the problem (what is and isn’t a vexatious complaint).
  • Quantify the incidence of vexatious complaints and their impacts.
  • Align management of vexatious complaints with overarching principles of fair, just, efficient and effective complaints-handling.
  • Adopt a proactive institutional approach which recognises that managing vexatious complaints is an inevitable part of complaints-handling work.
  • Recognise how various types of sub-optimal complaints differ, and carefully target interventions and approaches to each type.
  • Establish and enforce minimum standards for accepting complaints, and clear procedures for rejecting or aborting pursuit of complaints.
  • Use careful, repetitive and clear communication strategies to manage the expectations of all parties to complaints.
  • Employ complaints-handling staff with investigative skills, good judgement, and strong interpersonal communication.
  • Give staff specific training, informed by evidence and best practice, regarding identifying and managing sub-optimal and potentially vexatious complaints, and unreasonable complainant conduct.
  • Empower staff with appropriate flexibility, discretion and autonomy to exercise their judgement in identifying potentially vexatious complaints.
  • Combine staff-driven triage systems, based on experience and judgement, with rapid resolution powers, and mechanisms to divert vexatious complaints away from formal processes.

AHPRA says the report will be used to inform best practice for reducing, identifying, and managing vexatious complaints and helps to identify opportunities to work with others to help reduce their frequency and adverse consequences.

“Managing vexatious complaints is not a one agency problem and others have a significant part to play when they do occur,” says Mr Fletcher.

“As usual, prevention is better than cure. We are using the research findings to help improve our processes and protect the public.

“We are reassuring notifiers that we’re taking their concerns seriously and encouraging practitioners on the receiving end of a complaint to reflect on their practice, so they keep improving their care.”