(According to article 13. Legislation quality, complaints and disputes in health care (Wkkgz)).
Chapter 1. General Terms
Article 1. Definitions
For applying this procedure we define:
A. Healthcare provider: the independent care institution PoliDirect;
B. Director: the medical director/owner of PoliDirect;
C. Patient: the individual with a request for healthcare and/or the individual receiving healthcare by the healthcare provider;
D. Representative: the individual or individuals acting legally on behalf of or with the patient towards the healthcare provider regarding fulfilment of duties regarding the patient;
E. Healthcare professional: an individual providing healthcare professionally;
F. Emplyee: everyone who is associated with the healthcare provider through an employment contract, including the doctors that have a partnership agreement with the healthcare provider;
G. Complaint: an expression of discontent filed with the complaints professional about acting or failure towards a client/patient regarding the provision of healthcare;
H. Complainant: the patient, his representative or next of kin filing the complaint;
I. Defendant: the individual whose decision or actions the complaint relates to;
J. Superior: individual directing or coaching the healthcare professional or employee;
K. Complaints professional: the individual in the organisation of the healthcare provider charged with external impartial receival, mediation and settlement of complaints and support for and advising of patients in these matters;
L. Ruling: a written message, supported by reasons, by the healthcare provider that outlines the assessment of the investigation of the complaint, the steps that the healthcare provider will take based on the complaint and the term within which these steps will be taken;
M. Claim: a complaint whereby the complainant is asking for financial compensation or indemnification;
N. Term: the legally stipulated period of six weeks, to be extended once with a period of four weeks, in which the healthcare provider is expected to formulate a ruling about the complaint. It is possible to deviate from the term in agreement with complainant;
O. Dispute: a complaint which, after following the procedure, has not been resolved to the complainant’s satisfaction;
P. Law: Legislation regarding quality, complaints and disputes (Wkkgz);
Q. Healthcare: as defined by this law: medical-specialistic healthcare, treatment and support as offered by the healthcare provider.
Chapter 2. Message of discontent/complaint
Article 2. Whom can a patient turn to when he/she is discontent?
A patient can discuss his/her discontent with:
1. The health care professional or employee concerned or the person responsible for the cause of the complainant’s discontent;
2. The superior of the person concerned’s actions;
3. The complaints officer.
Article 3. The healthcare professional/employee and his/her superior
1. A healthcare professional/employee or his/her superior will give the discontented person the opportunity to discuss the cause of his/her discontent on short notice. The healthcare professional/employee involves third parties if this is contributory for resolving the cause of the discontent and if the patient does not object to this.
2. Healthcare professionals/employees will point out the complaints procedure to the discontented patients.
3. Healthcare professionals/employees will discuss the cause for discontent of patients, anonymously or with permission of the patient, in their team with the objective to take away the cause of the discontent and increase the quality of the healthcare.
4. When a patient voices his/her discontent about a healthcare professional/employee to his/her superior, the superior will allow the patient to do so. The healthcare professional/employee concerned will attend this discussion, unless the superior or the patient prefers not. The healthcare professional/employee concerned will be informed by his/her superior about the discontent. Paragraph 2 and 3 of this article are applicable regarding the discussion about discontent with a superior.
5. If the discontent can not be resolved to the complainant’s satisfaction, the healthcare professional/employee or, in case a situation as stated in paragraph 4 applies, the superior will point out to the complainant the possibility to file a complaint with the complaints officer.
Article 4. The complaints officer
- The complaints officer is by law, by professional standards and by his/her job description, independent and impartial. The healthcare provider does not interfere with the way the complaints officer conducts his/her business in a specific case.
- The complaints officer has at least the following assignments:
1. He/she informs patients, employees and third parties about the complaint procedure;
2. He/she advises the individuals contemplating to file a complaint and helps with the wording if required;
3. He/she supprts the complainant and the person or department the complaint relates to by resolving the complaint (through mediation);
4. He/she informs the complainant if required about the way the health care provider will formulate their ruling and helps to bring it to the arbitration body’s attention if so required;
5. He/she informs the director about the procedure as soon as possible, but not later than 5 week days after the moment the complainant, in consult with the complaints officer, has chosen the procedure (article 6 paragraph 2 sub c or d);
- The complaints officer focusses on reaching a sustainable solution of the complaint and restoring the relationship between the person appealing to him/her and the person whom the complaint relates to.
- The director allows the complaints officer to use the clinic’s/healthcare provider’s facilities needed to execute his/her assignment.
- The complaints officer:
1. Registers the complaints filed, the work resulted from the complaint and the results;
2. Reports regularly in writing to the management responsible and the director about his/her work and observations based on this registration;
3. Notifies structural deficiencies in the health care and will make recommendations based on his/her observations.
4. Takes care of the process of the complaint procedure, ensuring that the security and the registration of the files protects the privacy of the complainant, the defendant and possible third parties, and unauthorised people cannot have access;
- The complaints officer can go directly to the director if he/she feels hindered in carrying out his/her work according to this article or feels disadvantaged doing his/her job. The director will investigate and, if necessary, take steps to ensure that the complaints officer can fulfill his/her duties according to this article and does not get disadvantaged when carrying out his/her work.
- In case the actions by the director as described in paragraph 6 do not lead to removing the hinderance and/or the complaints officer cannot be expected to go to the director under the circumstances, the complaints officer can go to the board of the healthcare provider.
Chapter 3. Complaints procedure
Article 5. Filing a complaint
- The complainant should first file a complaint with the management of the location where the complaint applies. The following applies:
1. A complaint should preferably be filed in writing or electronically;
2. If suitable, the complaint can be make verbally or by telephone; the healthcare provider should register it (electronically);
3. The healthcare provider will make a model complaint form available;
- The complaint can only be filed by:
1. a patient or on behalf of the patient, with his/her permission;
2. The representative of the patient;
3. The next of kin, as defined by law;
- The complainant can be represented by somebody appointed or authorised by him/her to file the complaint (and during the rest of the procedure);
- An individual who believes he/she is wrongly not recognised as representing the patient can file a complaint about this.
- In case it is impossible to assess a complaint over time, the healthcare provider or the individual whose ruling has been requested about the complaint will notify the complainant about this, supported by reasons.
Article 6. Filing a complaint, information and choice of complaint procedure
- After a complaint has been filed as mentioned in article 5, the complainant will receive a confirmation thereof within 5 week days. The health care provider will discuss the complaint with the complainant and informs him/her of the possibilities in the complaint handling procedure. If required more written information can be provided. If the complainant has indicated that he/she does not want contact by telephone regarding the complaint, he/she will be advised of the choices in complaint procedures in writing. If this is not possible, or no reaction has been received to this, the health care provider will choose the most apt procedure based on the nature of the complaint and other circumstances.
- The complainant chooses the procedure after being informed by and in consult with the health care provider. A complaint can be handled as follows:
a. Request for registration: if the complainant does not want the health care provider’s ruling, but does desire to signal or make note of the discontent, the complaint will be registered and analysed according to article 16;
b. Request for (practical) resolve/mediation: the health care provider will take the complaint under advisement;
c. Request for ruling: the board investigates the complaint and will give ruling, if necessary after advice from the complaints officer;
d. Request for financial compensation: The complaint will be processed by the director or by the liability insurance company;
- Depending on the nature of the complaint, a combination of procedures a to d is possible. This will be in consult with the complainant and the health care professionals/employees concerned.
- When the complainant is of the opinion that the complaint has been resoved to satisfaction, the health care provider will complete the complaint and register it according to article 6 paragraph 2 under a.
- If the possibility of paragraph 2 does ot lead to a satisfactory outcome for the complainant, he/she may decide to go to the independent complaints officer (article 7).
Article 7. Procedure by the complaints officer
- If the processing of the complaints, as mentioned in article 6 has not been thorough enough in the eyes of the complainant, he/she may go to the complaints officer.
- The complaints officer:
1. Can agree with the complainant that the complaints officer will first explore the possibilities to resolve the complaint (for instance through mediation) with the complainant and the health care professional/employee or the department the complaint relates to.
2. Will always confirm the agreement with the complainant about the procedure within 4 weeks.
- When the complainant is of the opinion that the complaint has been resolved to his/her satisfaction, the complaints officer will complete and register it according to article 6 paragraph 2 under a.
- If the possibility of paragraph 2 will not lead to a ruling that satisfies the complainant, he/she can still decide to ask for a ruling (see article 6, paragraph 2 sub c), whereby the legal period starts from the moment of receival of the written request by the complainant for a formal ruling from the health care provider.
Article 8. Ruling director
- The complainant receives, as soon as possible, but ultimately within 6 weeks after the complaint has been filed, a written message from the health care provider containing the ruling based on the investigation, the reasons why, which decisions the health care provider has taken about and regarding the complaint and the term in which the steps decided on will be completed;
- If the director foresees that more than 6 weeks will be required to come to assessment of the complaint, he will advise the complainant and the individual concerned about this in writing or by email before the end of the term. The director will also indicate the new term in which there will be a ruling. This term shall be no longer than 10 weeks from the day the procedure has been chosen as mentioned in article 6 paragraph 2 sub c and/or d;
- If the director comes to the conclusion that the complaint can not be assessed within the extended term, he will notify the complainant and the individual concerned in writing or by email. The director will explain why the complaint cannot be assessed within the time of the term, and also the term within which ruling can be expected. The director will request the complainant to advise within 2 weeks if he/she will wait for the ruling and not take the complaint to the Arbitration Committee. If the complainant is not prepared to do so and prefers to file the complaint with the Arbitration Committee, the complaint procedure will be terminated.
- The director will mention in the ruling that the complainant, when not satisfied about the resolution of the complaint procedure, has the possibility to take the complaint to the Arbitration Committee for ruling. The board will advise the time frame in which complainant can do this, and the address and website of the Arbitratoipn Committee.
Article 9. Processing the claim
- If a complaint will be processed as a claim as stated in article 6, the process will be transferred (partly or wholly) to the director of the health care provider.
- The complainant will receive within 5 week days after receiving the complaint an acknowledgement of the process by the director, mentioning, amongst others, a contact person and contact details for the complainant.
- The director or the health care provider’s liability insurance company will rule about the claim within 6 weeks after the acknowledgement. This term can be extended by 4 weeks or deviated from, both in consult with the complainant, if the nature of the claim requires this.
- The process of the claim will be according to the Code of Conduct for Transparency of Medical Incidents; better processing Medical Liability (GOMA, 2012), except for the therein mentioned term of 3 months.
- The terms included in article 8 of the procedure concerned are also applicable to the process for request for financial settlement (article 6 paragraph 2 sub d).
Article 10. Processing a complaint that concerns more than one healthcare provider
- A combined processing of a complaint can happen when a complaint concerns the healthcare provided by more than one healthcare provider in mutual cooperation, and the complainant mentions that he/she filed the complaint also with other healthcare providers. If the complainant values the combined processing of the different healthcare providers, where he filed the complaint, the healthcare provider / complaints officer will contact the other healthcare providers.
- The healthcare provider / complaints officer (on behalf of the health care provider) will agree with the other healthcare providers about the processing of the complaint resulting in a collective ruling of the shared complaint procedure or a coordinated ruling by the individual healthcare providers, and who will provide the coordination.
Article 11. Consecutive complaint procedures
If the complainant has gone through one of the procedures as mentioned in article 7 paragraph 2, and decides to go for a follow-up procedure, the healthcare provider will ask the patient’s permission to use the details needed to process the complaint in the follow-up procedure.
Article 12. Not processing, cancellation and termination of the procedure by the complaints officer
- If a complaint can in all fairness not be investigated (thoroughly) within a certain timeframe or due to other circumstances, the healthcare provider / complaints officer may decide not to process the complaint. The complainant will be informed in writing, including the reasons for this decision.
- Processing a complaint stops when the complainant withdraws the complaint. The complainant can withdraw the complaint by notifying in writing or electronically that he/she refrains from further processing of the complaint by the healthcare provider. The cancellation will be confirmed in writing/electronically to the complainant.
- If the complaint is withdrawn verbally, the cancellation will be confirmed in writing to the complainant, mentioning the date of the phone conversation and possibly the reason for the cancellation.
- The healthcare provider can terminate the procedure of the complaint in case of compelling reasons. A compelling reason could be an aggressive attitude by the complainant towards the employees or other misdemeanor, making further processing of the complaint by the healthcare provider impossible, in all fairness. The complainant and the defendantwill be informed in writing about the termination of the complaints procedure and the reason for that.
Article 13. Arbitration Committee Independent clinics
- There is a dispute if a complaint has not been resolved to the satisfaction of the complainant after following this procedure and the complainant does not accept the ruling. The complainant can take the dispute to the Arbitration Committee for Independent clinics.
- The Arbitration Committee is authorised to give a binding legal advice including assigning compensation for damage suffered.
- The complainant can take a dispute to the Arbitration Committee without asking for ruling by the healthcare provider if he/she in all fairness cannot be expected under the circumstances to file his/her complaint regarding the behaviour of the healthcare provider in the contect of health care provision with the healthcare provider (article 21 paragraph sub c of the law).
- A dispute can also be taken to the Arbitration Committee by an individual, who is wrongly not recognised as representative by the healthcare provider, if the message as stated in article 8, paragraph 1, does not meet his/her complaint to satisfaction.
- A dispute should be brought to the Aritration Committee’s attention within a year after the date of the ruling by the healthcare provider as stated in article 8.
Article 14. Registration
- If the complaint is registered according to article 6 paragraph 2 sub a, it will be recorded in the designated database. This database is analysed on a regular basis in order to design steps for improvement of the healthcare quality.
- The database meets the current laws and regulations in this field, like the Law for protection of personal data.
Article 15. Filing and retention period complaint file
Chapter 4. Other provisions
Article 16. Other possibilities to complain and report
This procedure does not impact the possibilities to file or report complaints with other (external) institutions like the Inspection for Health care, the board of Magistrates or the civil or criminal court judge.
Article 17. Costs
- No costs will be charged to the complainant or defendant if the complaints can be processed based on this procedure.
- Costs incurred for external help or support on the complainant’s or defendant’s initiative, and/or the costs for the representatives for either complainant or defendant will be for their own account.
18. Annual report
The healthcare provider issues an anonymised report regarding the processed complaints and the rulings thereof every year. This report also mentions the steps taken to improve the quality of the health care, which resulted from the individual complaints or analyses of the complaints.
Article 19. Disclosure complaints procedure
The director ensures that this procedure is brought to the attention of the patients and their representatives. The procedure can be found on the public pages of the website of the health care provider and a copy will be provided to patients and their representatives if required.
Article 20. Evaluation
The director evaluates this complaint procedure within two years after introduction and as often as desired by the director thereafter.
Article 21. Establishment and amendment of the procedure
This procedure is established and can de amended by the director.
Article 22. Enforcement
The Inspection for the Health care is charged with the supervision of the enforcement of what has been identified in articles 2 to 11 and 13 to 23, or in a note or command as stated in article 27 or article 28 in the law. The Inspection report this to our Department of Public health, Wellbeing and Sport.
Article 23. Date of introduction and title of the act
- This procedure comes into force on January 1, 2017.
- This procedure will be cited as: Complaints procedure patients PoliDirect.