Our assessment process

Early Resolution

Some complaints can be resolved quickly and informally by speaking with both parties over the phone to clarify the problem and work out a way to resolve the issue.

If the complaint is too complex to resolve informally, we may write to you and take the complaint through our formal process.

Formal Assessment

You may have received a letter from us advising that your complaint will be assessed through a formal process.

To assess a complaint we will gather relevant information. This process may involve:

• sending a copy of the complaint to the health service provider requesting a response to the issues raised
• obtaining a copy of the medical records which relate to the complaint
• seeking information from previous or subsequent health care providers
• seeking clinical advice in relation to the complaint
• sending the complainant a copy of the response for comment
• exploring available resolution options relevant to the complaint.

Following this process the complaint may be dismissed, referred to a relevant registration board, assessed for conciliation or for further investigation.  In some instances, more than one option may be chosen.  Each party will be advised about the assessment decision.

If no resolution is reached using this approach, we may not be able to assist the complainant any further.

Referral to a relevant health registration board

If the complaint is about a registered health practitioner, we will contact the Australian Health Practitioner Regulation Agency (Ahpra) (external link) This is because the relevant health registration board will deal with matters relating to the performance, health and conduct of a registered health practitioner.

A decision will be made as to whether the relevant board or our office will manage all or part of the complaint.

Find out more about how the Health Complaints Commissioner interacts with Ahpra and the National Boards.

Conciliation

Conciliation enables all parties to meet and have a full and frank discussion in a privileged and confidential process.  More detailed explanations may be provided or compensation may be discussed.  Conciliation allows parties to resolve the complaint in a collaborative way.

If parties are seeking compensation, this process may be an alternative to litigation.

Investigation

An Investigation is a detailed examination of the complaint, and is usually reserved for highly complex matters where complaints give rise to systemic or public interest issues.

An investigation report will be prepared and published on our website.

Dismissal

The complaint may be dismissed if a reasonable explanation has been provided for the concerns raised in the complaint, and there would be no benefit in continuing the complaint process.