Building workplace relationships in early learning

Bullying in the workplace is a serious work health and safety issue which affects all workplaces, including early learning centres.  Guild Insurance regularly manages workers compensation claims where there are allegations of staff members being bullied.   Bullying negatively impacts both employees as well as the business they work for; therefore, it’s something all businesses should be aware of and be consciously working towards eradicating

What is and isn’t bullying?

Bullying is repeated unreasonable behaviour directed towards workers.  Bullying can occur in many forms; it may be physical or psychological, it can be direct and obvious or indirect and subtle.  Examples of bullying are:

• Behaving aggressively
• Teasing or practical jokes
• Pressuring someone to behave inappropriately
• Excluding someone from work related activities or events
• Abusive or offensive comments
• Belittling or humiliating comments

Sometimes workers believe any behaviour or action in the workplace which makes them feel uncomfortable is bullying.  However, this isn’t the case.  Actions carried out by management, such as disciplinary action or feedback about poor performance, isn’t bullying when done reasonably.  Disagreements are also generally not bullying when they’re handled reasonably. There are other workplace behaviours, such as discrimination and sexual harassment, which while completely unacceptable, won’t necessarily be considered bullying depending on the circumstances.

Bullying doesn’t just occur in a face to face physical setting.  More and more cases are being reported of bullying occurring online using social media.  This online behaviour can be easier to hide and often won’t occur during work hours, yet the consequences for employees and employers are just as severe.

Consequences of workplace bullying

There can be many consequences, both for individuals and the workplace, when bullying is taking place.

Firstly, it is the responsibility of all employees to create and maintain a safe work environment.  If a workplace isn’t taking reasonable steps to prevent and manage bullying, this may be seen as a breach of WHS laws.

Bullying can lead to serious physical and psychological harm with people suffering from depression, stress, anxiety and emotional exhaustion.  It is well recognised that workers suffering from physical or psychological harm are more likely to take sick days and not be as productive as they would hope to be when at work.  Bullying can also lead to a level of staff resignations.

Preventing and dealing with bullying

There are numerous ways employees, employers and workplaces can reduce the likelihood of bullying occurring.  There are also many resources available to support this.

1. Workplace culture

To create and maintain a workplace where bullying doesn’t exist, it’s important to start by addressing the culture of that early learning centre.  Managers and senior staff need to be sure they’re leading by example in the behaviour they demonstrate and expect of their staff.  All staff should be expected to treat their colleagues fairly and with respect, and this behaviour must start with those most senior.

It is also vital that a culture is created where staff feel comfortable speaking up if there is something they’re unhappy about.  If a staff member feels they’re being bullied by a colleague, it’s ideal that they speak to their manager first before considering making a formal complaint against the centre.  Yet for this to happen, this openness and willingness to discuss concerns needs to be supported and encouraged.

A key step an early learning centre should take to prevent bullying occurring is to be sure no one thinks it won’t happen in their workplace.  Bullying behaviour unfortunately can occur in any workplace.  However, if a manager thinks their centre is immune, it’s possible they won’t put in place the necessary process to prevent this which could place them at greater risk.

2. Business policies

Early learning centres all have an extensive list of policies for their business.  There are many policies which are required from a regulatory perspective.  However, all centres should consider what other areas they should develop policies for beyond those required; bullying is an example of this.  A policy on workplace bullying should include information about what a staff member should do if they’re experiencing bullying and how the centre will respond to this.  Workplaces should also have a social media policy which sets out appropriate social media behaviour for both personal and professional use.

The benefit of having a policy, rather than just stating what’s required, is that it formally sets the standard that all staff are expected to abide by and can be continually referred to.  However, for policies to be effective they need to be known about and be accessible for all staff.  This means centres need a process for making sure staff are aware of the policies they need to adhere to.

3. Performance management processes

Performance management discussions can unfortunately lead to staff confusing feedback with bullying.  This confusion can often occur due to the way the performance appraisal is delivered.  It’s incredibly important that managers are undertaking their role in a reasonable manner so that it doesn’t cross that line and become bullying.  

Addressing poor performance shouldn’t be put off until an official staff feedback or review discussion.  Doing this means that a staff member’s poor performance will continue for some time without them being aware.  Receiving this unexpected feedback only at review time can be viewed as unfair and unreasonable by staff members.

When discussions are had regarding performance issues, staff should be encouraged to have a support person there with them.  This person can provide them with moral support during the meeting as well as afterwards.  A record of these discussions should be made so there is a history of what was said by all parties and what was agreed to.

The Fairwork Ombudsman provides resources to assist with managing underperforming staff members, this information can be found at www.fairwork.gov.au/how-we-will-help/templates-and-guides/best-practice-guides/managing-underperformance.

4. Additional resources

Preventing and managing bullying is not easy; therefore there are resources available to assist workplaces with this challenge.  For assistance with understanding what bullying is, how to prevent it and what both employees and employers should do if it does occur, refer to the follow sites:

www.fairwork.gov.au/employee-entitlements/bullying-and-harassment

www.fwc.gov.au/disputes-at-work/anti-bullying

www.safeworkaustralia.gov.au/bullying

Workplace bullying in early learning

It may surprise you to know that complaints about orthoses are a common source of podiatry claims to Guild Insurance. 

Common allegations include:

1. The orthoses caused the client to suffer a new injury, such as a hip or lower back problem.
2. The orthoses exacerbated the client’s existing or underlying condition.
3. The orthoses failed to resolve the client’s presenting problem.

Any claim against you, whether substantiated or not, can be distressing.  Your good reputation may be damaged leading to undue criticism from other healthcare providers and reduced client referrals.  Furthermore, complaints to agencies such as AHPRA may take many months to resolve resulting in a prolonged period of uncertainty.

Managing client expectations through effective communication is central to avoiding claims against you.  Key issues to discuss with clients include, but are not limited to:

• Discuss the range of options available to treat the individual’s condition. Take the time to discuss the pros and cons of each option, including costs and risks.Ensure the client understands the difference in expectations between pre-formed and custom-made orthoses.
• Make sure the client understands what outcomes he or she can realistically expect to achieve with the orthoses. Remember, what is obvious to you may be completely foreign to the client.However, don’t just ask them if they understand, as in many cases they’ll say yes even if they don’t.It’s better to ask the client to tell you what they’ve understood from the discussion.
• Where suitable, use visual aids such as diagrams and models to help explain the information.
• Allow clients adequate opportunity to ask questions and weigh-up their options, including the financial implications of their choice.Give them time to make their decision, they shouldn’t be expected to decide at the appointment where they were given the information.They may wish to think about it for a few days.
• Provide clear instructions about how the orthoses are to be used, including choice of footwear and any prescribed exercises or stretches.Carefully explain the implications of not following your instructions.
• Remember to discuss the expected life span of the orthoses and any instructions for ongoing care.
• Emphasise the importance of attending all follow-up appointments and contacting you immediately if they have any concerns.Remember to outline the early warning signs of any complications and urge the client to contact you as soon as any issues arise.
• Where possible, provide clients with written information for them to take away and read in their own time.Sometimes people are not able to absorb everything they’re told during an appointment.However, written information should only be used to re-enforce what was discussed, not as a replacement for the conversation.

Finally, remember to clearly document your discussion and the outcomes in the client’s clinical notes.  Good clinical notes are invaluable in the event of a complaint against you.

Orthoses - Managing Expectations

Incidents involving pharmacists selecting the wrong medication or the wrong strength are the most common dispensing errors reported to Guild Insurance.  Not surprisingly, a number of these errors involve look-alike, sound-alike medications. 

Despite awareness raising campaigns, errors still occur.  While a person could suffer harm if given any medication in error, the likelihood of serious clinical effects increases significantly when the medication involved has a narrow therapeutic index.  These errors can and do happen, even to experienced pharmacists who’ve never made a mistake before.  They can happen to you and they can be fatal to your customers.

Cases

A patient was admitted to hospital with unexplained abdominal bleeding.  On investigation he was found to have an abnormally high INR, even though he had never been prescribed anticoagulant therapy.   His elevated INR was eventually attributed to a dispensing error.  The pharmacist had inadvertently made a selection error and dispensed 5mg Coumadin instead of 5 mg Coversyl as prescribed.

Due to a pharmacist’s selection error, the cytotoxic medication Hydrea was dispensed instead of the prescribed antihypertensive Hydopa.  The young woman happened to be pregnant and claimed the error resulted in her suffering a miscarriage.

A customer successfully claimed for ‘loss of income’ when she was unable to work for an extended period after a dispensing error.  Although the customer had been prescribed Lamictal 25mg, the pharmacist inadvertently dispensed 200mg tablets.  The customer subsequently took the higher dose for a number of months and suffered liver damage.  While the pharmacist said she usually used ‘barcode scanning’, she failed to do so on this occasion.

Reduce the risk of dispensing errors

• Adhere to the PDL ‘Guide to good dispensing’ every time.Don’t be coerced into rushing or cutting corners.When errors occur, pharmacists often say “if only I’d taken the time to…”
• Display posters or reminders in the dispensary to promote compliance with dispensing procedures.
• Use barcode scanning every time.
• Make use of the safety features available in your dispensing software.Set up different alerts to remind people to perform certain tasks.Likewise, make use of advanced scanning features that automatically print a barcode on the dispensing label.
• Introduce measures to differentiate between look-alike or sound-alike medications:
  • Use separators, stickers or flags
  • Avoid positioning these medications in strict alphabetical order.For example, storing Coumadin under ‘W’ for Warfarin, limits the chance of inadvertently selecting Coumadin instead of Coversyl which has similar packaging.Consider storing other high-risk medications separately.
• Promote a culture where all staff are confident to point out risky practices when they occur.
• Seek help if you are feeling intimidated or uneasy about contacting the prescriber to clarify a script.
• Be careful with zeros and abbreviations.Transcription or interpretation errors involving a zero, decimal point or abbreviation are common causes of serious dispensing errors.For example, 6U of insulin could easily be interpreted as 60 units.
• Reducing distractions when a pharmacist is dispensing is everyone’s responsibility.Agree to strict rules for minimising interruptions and distractions in your pharmacy.
• Review the dispensary layout to ensure workflow supports each step of good dispensing.
• When handing medications to a customer, point out all warnings and directions on the label and packaging.This not only helps with counselling but serves as a final check against any dispensing error.

Pharmacy Dispensing Wrong Medication or Strength

Receiving a complaint is often an unexpected part of running any business, including a chiropractic practice.  No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are.  There can be a tendency to see a complaint as a personal criticism rather than constructive feedback.  However, there can be positive outcomes when the situation is managed appropriately. 

Why do people complain? 

There are many reasons why patients might complain about your practice and the treatment or service they’ve received.  Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise.  Understanding why people may complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.  The following are some of the reasons why people may feel the need to complain.

High expectations – consumer expectations are increasingly high when engaging professional services.  Your patients pay for your service and will most likely see you as a highly trained and qualified professional.  This view can influence their expectations about the service and outcomes they anticipate. 

Unrealistic expectations – it’s possible that patients may have unrealistic expectations about what they can reasonably expect from chiropractic treatment.  Their high expectations may at times surprise you.  It’s therefore important to remember that most patients will not have the clinical knowledge you do and what’s obvious or common sense to you may not be to them.  A practice must assist patients to be clear and fully informed about the treatment being provided and the outcomes they can realistically expect.  This requires ongoing discussions with patients and, where possible, written information to assist their understanding. 

To inform and be heard – patients may wish to make a complaint about an incident or poor outcome just so they are sure you and your staff are aware of what’s occurred and how they feel.  They may wish to complain simply to be listened to and acknowledged, especially if they have been adversely impacted.  Not all complaints will lead to a formal demand for compensation. 

Belief that someone is responsible – when something goes wrong we often try to determine who’s responsible.  Sometimes someone is obviously responsible, sometimes it’s hard to determine who’s responsible and other times there is no one person responsible but it’s just an unfortunate set of circumstances.  If a patient thought something had gone wrong and this led to them being harmed, it’s quite possible they may complain with the intention of holding someone responsible and possibly liable. 

The importance of managing complaints 

There may sometimes be a temptation to ignore a complaint and hope it’ll just go away.  Maybe the patient won’t follow up.  Maybe the incident won’t occur again.  This is a very short-sighted way to run any business as there are clear benefits when complaints are managed appropriately. 

• Patients will generally expect to see their complaint dealt with quickly and fairly.  When this doesn’t happen it’s possible that further complaints will follow and the issue or concern could become a much greater one.  Complaints may also escalate to AHPRA or another regulatory body. 
• Managing complaints should be seen as good ‘customer service’.  You rely on patients to keep your business afloat.  When patients are unhappy with a service they’ve received, they can talk with their feet by not returning to the practice.  Keeping patients happy and satisfied is more likely to see them continue to use your service and recommend your practice to others. 
• Complaints can provide a practice with an opportunity to review and improve their service.  Receiving a complaint may highlight an issue which the practice had not been aware of.  When investigating and dealing with the complaint, the practice may wish to consider a change in a procedure to avoid that issue arising again in the future. 

How to manage complaints

It’s advisable that every chiropractic practice has a complaints policy.  This means that the practice will have an agreed-to process which allows for all complaints to be dealt with in a fair and consistent manner.  It also means staff know what to do which is important as managing complaints can be challenging.

A key aspect in dealing with any complaint is listening to the person.  Where possible, make time to sit down in a quiet space and give them time to express their concerns.  Make the effort to hear what they have to say and take on board what they have told you.  You may not agree with all they are saying, however it helps if you can try to understand the situation from their perspective.  You may wish to ask them to document their concerns so you both have an accurate record of the matter.  Avoid being defensive or taking the complaint personally as this may inflame the situation.

With low level complaints you may be able to offer a solution there and then.  However, this won’t always be the case.  With more serious complaints you should provide the person with an assurance that you’ll investigate the matter and get back to them with a response at a later date.

Guild Insurance expects those insured with us not to admit liability (or name someone else as being at fault), or to offer any compensation without contacting us first.  However, this doesn’t prevent you from apologising or showing sympathy for any pain or inconvenience the person may be experiencing.  Contact Guild Insurance on 1800 810 213 as soon as you’ve received a complaint; don’t wait till it escalates to a claim for compensation.  We will provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation.  This support can be the difference between sorting a problem quickly and it escalating to a serious claim.  

Managing complaints in Chiropractic

Guild Insurance regularly analyses claims information to understand factors which may contribute to claims and complaints occurring.  This analysis has highlighted a trend where claims involve treatment by at least two dentists.   

Evaluating another dentist’s work

All dentists will at times treat a patient who’s had dental work carried out by another practitioner.  And you may have questions about that treatment, such as when:

• the work may not seem to be up to the standard expected of a dentist;
• the treatment selected may not appear the be the ideal or obvious choice given the clinical situation or
• it may seem as though the treatment provided has not led to the intended or expected outcome

Dentists must be very mindful of how they handle these situations and what they say to or in front of the patient.  It’s understandable that to provide treatment the dentist will want a complete understanding of prior treatment.  However, conversations about another practitioner’s treatment, if not conducted appropriately, may contribute to the patient lodging a complaint against that other dentist.

What can go wrong?

Not all situations where a dentist questions previous treatment will lead to issues arising.  However, the following case examples highlight how easily complaints can occur.

A patient had received many years of dental treatment from Dentist A.  Whilst happy with the treatment provided, the patient began seeing Dentist B when she moved to a new house.  During a consultation, Dentist B commented on the file fragments which had been left in her tooth, assuming she was aware.  When she appeared surprised, Dentist B explained that he had detected small fragments of a file which had been left in a tooth following RCT.  Dentist B was openly critical of Dentist A for what he described as ‘sloppy treatment’ and told the patient she should have been informed at the time when the file broke.

Whilst away for a weekend, a patient felt a tooth break whilst eating.  He decided to see a local dentist who was available to provide emergency treatment.  When he returned home he went to see his regular dentist to receive further treatment to that tooth.  His regular dentist was quite surprised with and critical of the treatment provided by the other dentist.  She informed the patient that due to the poor work she was going to have to replace what was done, therefore costing the patient more than he had anticipated.

Impact of comments made

Making negative comments about the work of another dentist can reflect poorly not just on that dentist but the dental profession.  If the entire situation surrounding treatment is not understood, the comments may be incorrect and presumptuous.  This can unfairly damage the reputation of a dentist as well as cause unnecessary frustration for the patient.

It’s therefore very important that when dentists find themselves in a situation where they have questions about the work of another dentist, this is handled appropriately.

Tips for managing these situations

• Don’t make off the cuff comments to a patient judging or criticising the treatment another dentist has provided.Making even what you see as a small or insignificant comment to a patient regarding the choice and quality of treatment provided by another practitioner could be enough to encourage that patient to make a complaint or a demand for compensation.
• If your patient has received treatment which doesn’t appear to have been the most preferred for their clinical situation, don’t assume this is an error on the part of another dentist.Sometimes patients choose a different course of treatment to that recommended by their dentist, often due to financial restraints.
• Avoid making assumptions.If you have concerns or questions about the treatment your patient has received from another dentist, consider seeking the patient’s permission to contact that dentist to find out more about the treatment provided and reasons behind their clinical decision making.It’s possible that the clinical situation you’re seeing is not the same as what the first dentist saw.
• When sending a patient back to their referring practitioner, provide a letter for that practitioner outlining your diagnosis, the treatment you provided and why that treatment option was selected.Don’t rely on the patient to convey this information.
• Documentation is vital.If your work is being questioned by a patient, another dentist or AHPRA, you’ll need your accurate clinical record to act as the explanation and evidence behind your clinical decision making.
• Patients can become frustrated with ongoing treatment costs.If replacement work is required, be very clear and upfront about the cost of this further treatment.
• Avoid offering free or discounted treatment when replacing work.This may further suggest that the initial treatment was ineffective and therefore a waste of money.Also, the patient may expect that discounted or free treatment will continue beyond what you had anticipated.Always contact your local ADA branch or Guild Insurance before offering any form of discounted treatment to a patient.
• And finally, always maintain a high level of professional behaviour, both when treating patients and anytime you’re communicating and interacting with them.This not only reflects well on you, it can also improve the public perception of dentistry as a profession.

Commenting on another dentist's work

Guild Insurance (Guild) undertakes regular reviews of the claims managed by them to understand trends and themes within those claims.  Recently Guild has identified an increase in the frequency and severity of fitness related claims being reported.  The nature of the incidents which lead to these claims suggest that some fitness professionals are not recognising the risks within their work, or they aren’t being proactive enough to properly manage those risks.

The following information will assist fitness professionals in understanding the risks they face in their day to day work and what they need to do to reduce the likelihood of these risks becoming a reality.

Don’t underestimate the importance of communication

Guild’s claims experience shows us that poor communication is a factor in almost all complaints from fitness clients.  In some cases, clients will allege the communication from the fitness professional was poor and this led to an incident, such as the explanation for how to perform an exercise was too brief and this resulted in the client injuring themselves.  In other cases, the client may not mention anything about communication when lodging their complaint, yet when the incident is investigated it’s found there has been a communication breakdown between the fitness professional and the client.  Fitness professionals need to focus not only on their technical knowledge but also their communication skills when communicating any information to clients. 

Don’t underestimate the risk of poor exercise selection and prescription

Exercise has the potential to provide a great deal of enjoyment whilst also providing health and fitness benefits.  However, Guild’s experience in managing fitness claims provides evidence that there are also significant risks attached to exercise; clients can suffer life changing injuries.  Yet this doesn’t mean we should stop exercising, it means we need to pay closer attention to the risks of exercise and put in place risk mitigation strategies to reduce the likelihood of these injuries occurring.  Hoping a client won’t be injured isn’t enough.  The risk of exercise needs to be understood and mitigated.

Work within your scope of practice

Fitness professionals need to be sure they understand, and work within, their scope of practice.  This means knowing what they’ve been trained to do and are competent in.  Giving advice outside this scope will potentially be creating a risk for the client which in turn becomes a risk for the professional.  Fitness professionals need to be sure that regardless of what information or program the client has requested, they only plan and deliver exercise programs within their scope.  If the client’s needs or requests are outside of this, the professional needs to seek assistance or refer the client to someone else.  Fitness professionals need to remember they’re responsible for all professional advice and guidance they provide, so they should never allow themselves to be coerced into doing something they know they shouldn’t.

Keep records of sessions

It’s important to keep a record of your sessions with clients.  This means maintaining an accurate and detailed history of what exercises your client has performed and the specifics of those exercises in terms of weight, height, sets, repetitions etc.  It also means you have details of how successfully the client performed those exercises and if there were any issues such as injuries.

Records of your sessions with clients serve two key purposes:

1. Continuity of service – this means you don’t have to rely on your memory to recall what took place in previous sessions, you have a documented history which will help guide you and your client in future sessions.
2. Defence of an allegation – if there is an allegation against you of wrongdoing, your records will assist in your defence as they provide evidence of what actually took place.

Balance encouragement and pushing too far

It’s quite common to hear clients allege their trainer pushed them too hard when they had told the trainer the exercise was beyond their capability and this led to them suffering an injury.  But where is the line between encouraging a client to challenge and improve their fitness and pushing too far that it becomes a risk?  Unfortunately, this line isn’t always obvious.  Therefore, fitness professionals need to be sure they’re tailoring all they do to each individual client and watch for signs that the client is struggling to a point of potential harm.

Balance creativity and risky

Like all good business people, fitness professionals are continually looking for new and different offerings for their clients and ways to set themselves apart from their competitors.  However, this ingenuity can create new risks for the business.  The risks of any new offerings need to be carefully considered before being put into place; think about what can go wrong before it does.  Guild has seen many claims where clients have been seriously injured undertaking an activity where it could be argued that the risks of the activity outweigh the likely benefits.

Be proactive with managing risks

Guild has seen numerous cases where the fitness professional has identified a potential risk or hazard, such as a pothole where clients are jogging, or weights being left on the floor rather than on racks, yet they’ve put in very little, if any, effort to manage that risk.  Warning clients to avoid a pothole whilst running is not proactively managing a risk.  Moving the clients away from the area where there is a pothole is going to be much more effective in preventing an injury.  When a risk assessment is done, and this leads to risks being identified, fitness professionals need to be sure they’re taking the necessary steps to reduce the likelihood of that risk eventuating.  Hoping it won’t happen isn’t enough.

And finally…

Don’t think it won’t happen to you.  No fitness professional is immune from the risks involved in training clients.  The more aware a professional is of what could possibly go wrong, the more equipped they are to prevent it.

Fitness professionals and their risks

Guild Insurance is a leading insurer of early learning centres in NSW. The responsible service of alcohol at meetings, fundraising events or social gatherings is something our clients frequently enquire about.

The following information highlights the risks faced by centre managers, committee members and staff when making decisions about the service of alcohol at events. However, if you are unsure about anything to do with the service of alcohol, you should seek legal advice.

Serving alcohol at events held by child care centres

• Guild recommends avoiding serving alcohol at events. If you do serve alcohol, you may be in breach of liquor licencing laws. Importantly, the centre and its committee members could be exposed to personal legal liability.
• The service of alcohol is highly regulated in NSW. To serve alcohol a current liquor licence is required and relevant people must complete an approved responsible service of alcohol (RSA) course.
• If you would like to hold an event that includes the service of alcohol, it is recommended you hold the function at licensed premises.

What if people bring their own alcohol to events?

Guild also recommends you prohibit committee members, parents or visitors from bringing any alcohol to events that have been organised by the centre.

While it might seem a safer option for people to bring along their own alcohol, it certainly does not remove the risk of legal liability attaching to the centre or members of the committee. If a committee member, volunteer or staff member was to be injured, or cause injury to someone else after consuming alcohol, a court may deem the staff and / or committee partly responsible. The court may also see the centre as encouraging a culture of drinking at such an event, or the centre and its committee not taking reasonable steps to avoid the incident giving rise to the injury. Therefore, Guild strongly recommends that you prohibit all alcohol consumption at any centre events, both in and out of business hours.

Early Learning Centres and Alcohol Consumption NSW

Managing Patient Expectations in Dentistry

Dispensing Errors Can Happen To Anyone

 

All early learning centres would be well aware of the expectation and legal requirement for them to provide a safe environment.  But what does this actually mean?  How can anyone be sure their business really is safe?  And what would it mean if your business wasn’t and an incident occurred?

Guild Insurance has been insuring early learning businesses for many years and this experience has provided us with a great understanding about the risks faced when an environment isn’t safe.  Unfortunately, this experience also tells us that despite best efforts, many early learning centres aren’t as safe as they could or should be.

What is a safe environment?

When many of us think about an early learning centre being safe, the first thought is often around the physical environment for children.  There are many obvious physical risks for children and Guild Insurance unfortunately sees numerous claims where children have been physically harmed.  But this is just one piece of the safety puzzle.

All businesses need to be free from dangers and hazards for all people who attend or use the business.  This means that early learning centres have an obligation to children, staff and anyone else who attends, such as parents.  And safety extends beyond physical.

Children need a centre where the likelihood of them being physically injured is low.  They also need to feel happy and nurtured.  They need to be able to learn and develop as they move through their childhood and develop social skills.  They need to feel respected as an individual whilst learning to respect and appreciate others as individuals too.  They need an environment where they can thrive as young people.

Staff also need an environment which is physically safe.  With the physical work required in early learning, injuries to staff are unfortunately not uncommon.  Staff also need a workplace which is supportive and enables them to perform their best.  They need opportunities to develop and grow as a professional and to feel that their contribution to the workplace is valued and appreciated.

It may come as a surprise to learn that visitors, such as parents, have been injured whilst at a centre. Therefore, a safe physical environment is important to them as well.  Parents will also want to be sure that the centre is a safe and secure environment for their child.  They need to feel confident that their child is going to be well cared for and educated.

What can go wrong?

To be able to create a safe environment, you need to start by understanding what can make it unsafe.  This means you need to identify the possible risks and think about what could go wrong before it does.  Below are examples of what can go wrong as seen in claims managed by Guild Insurance.

• The tip of a child’s finger was been amputated when it was caught in a closing door.
• A child fell awkwardly when going down a slide.When landing at the bottom of the slide he suffered a fractured arm.
• A child’s hand slipped whilst climbing a climbing frame.She fell forward and bumped her mouth on the frame, breaking a tooth.
• A parent tripped in a pot hole in the car park and fractured his ankle.
• A staff member injured her back whilst lifting a child and needed a month off work to recover.
• A staff member believed he was unfairly dismissed and therefore lodged a complaint with the Fair Work Commission.

Why do things go wrong?

When trying to understand why an incident has occurred, at Guild Insurance we focus on ‘contributing factors’.  This is because there’s rarely one main cause for an incident but more likely many factors which have contributed to it occurring.  Addressing these factors can assist in reducing the likelihood of incidents occurring.  Below is a list of the common contributing factors identified by Guild Insurance.

• Not knowing or following relevant laws and regulations.There are quite a few laws which relate to operating an early learning centre.It’s vital that all staff, not just owners and managers, know what’s required of them.Centres should have their own policies and procedures for staff to follow, however the law must be reflected in these.Staff should be very familiar with the Education and Care Services National Law and National Regulations.However, it doesn’t end there.Staff also need to be aware of their obligations regarding employment law, privacy and work health and safety, just to name a few.
• Play equipment and furniture.Many injuries occur when children fall off or trip over play equipment and furniture.Furniture can also create a risk for staff and others at the centre.Therefore, it’s important that staff think about the type of play equipment and furniture in the centre, the condition it’s in and where it’s placed.
• Not noticing a potential risk before an incident occurs.If play equipment or furniture looks unsafe, it probably is.By regularly inspecting your centre you’re likely to identify risks before there’s an incident.Don’t wait for a child to suffer an injury; make changes to reduce the risk before this happens.
• Reliance on other people.When there are numerous people working in a centre at any one time, it may be easy for staff to think that someone else, especially someone more senior, will notice and address risks.However, all staff have a responsibility to contribute to reducing risks within their workplace.Therefore, all staff should be encouraged to speak up if they notice something which could potentially create a risk.
• Other children, staff or parents. Other people can contribute to incidents occurring.Children have fallen off play equipment when numerous children are playing on it at the one time.Staff have accidentally lifted a child awkwardly and injured the child.Children have left a centre when a parent has accidentally left the door open.Always be mindful of those around you and the potential risks in each situation.

Unfortunately, all risks can never be eliminated from early learning centres.  And we can’t guarantee that the most effective risk efforts will mean an incident won’t occur.  However, there is a great deal which you and your staff can and must do to create a safe environment and reduce the likelihood of an incident in your centre.

Is your early learning centre a safe environment?

Imagine if…

You receive an angry email from the parent of one of your clients stating they aren’t happy that you declined to provide therapy to their child and they’re considering making a complaint alleging discrimination.  You know you weren’t the most suitably qualified speech pathologist to provide therapy to that child and did the right thing in referring to someone else.  Therefore, you immediately reply to the parent informing them of your version of events.  Some time after this you hear from the parent again claiming they have now lodged their discrimination complaint.

Guild Insurance’s Liabilities policies state that as soon you, as the policy holder, experience a claim made against you or an incident which could give rise to a claim, you are required to notify Guild.  However, Guild is aware that some clinicians respond to complaints on their own without first notifying Guild.  This can have a number of consequences for these clinicians as they’re not receiving the support or guidance their insurance policy may entitle them to.  It can also mean the policy holder is not adhering to the conditions of the insurance policy.

Possible scenarios

The following scenarios are some examples of when you should notify Guild Insurance:

• If a private health insurer, or other funding provider such as Medicare, has requested access to your clinical records as evidence of billing practices.
• If a client has complained directly to you or your practice with a formal demand for compensation or suggested they’ll make a notification to a regulatory body.
• If a solicitor or law firm representing a client has requested access to your clinical records or notified you of a complaint.
• Any other circumstance where you have an uneasy feeling about an incident or situation; when in doubt, notify!
  

When to notify Guild

Clinicians are sometimes unsure whether a matter is serious enough to warrant notifying their insurance company.  There are some occasions where notifying an insurance company is a must, such as when there is a request for client records from a solicitor or funding provider or when there is an allegation of the client suffering harm following therapy.  However, when a client complains directly to you, this is when you need to use your judgement.  If the client has simply informed you that they didn’t respond as hoped to therapy provided previously yet doesn’t seem annoyed or demanding, then this may be a matter which can be sorted by you alone.  Yet if you’re in doubt or concerned about the complaint or allegation from the client or their family, then you should notify Guild.

Will my premium go up if I notify Guild of a matter?

Guild’s premium pricing is influenced by a number of factors.  Notifying Guild of an incident is unlikely to be the cause of a premium increase the following year.  However, as detailed below, not notifying Guild may lead to further stress and complications.  Therefore, the cost of the premium should not be a factor in deciding whether or not to notify Guild.  

Consequences of not notifying Guild

Facing an allegation or investigation of any sort can be an extremely stressful situation for a clinician.  When a clinician handles a matter themselves without the support of Guild, that stress is compounded as the clinician will be dealing with a process they’re unfamiliar with. 

Guild has seen many cases where a clinician’s own response has either not provided the required information, or a response has been written in a way which is likely to inflame or escalate the situation.  This usually leads to further investigations being conducted and Guild being notified after the investigation has begun, inhibiting Guild’s support and influence.

When a clinician doesn’t notify Guild as soon as is reasonably possible of a claim made against them, they may be considered to not be complying with the conditions of the insurance policy.  This can lead to cover under the policy being cancelled or the claim not being paid.

It’s also important to understand that a clinician may leave themselves with out of pocket expenses by not notifying Guild at the beginning.  This may occur if they engage their own legal counsel not approved by Guild and at a rate Guild believes to be exorbitant or if they have offered to settle a matter without Guild’s consent.

The staff at Guild Insurance have a great deal of experience and expertise in managing allegations and investigations and are well aware of what is required when responding to them.  For this reason, it’s of benefit to everyone involved to notify Guild immediately and be sure the necessary support is provided and process is followed from the start.

How to contact Guild Insurance

To notify Guild of an incident, and therefore make a claim against your insurance policy, either call Guild on 1800 810 213 or go to guildinsurance.com.au/claims.

Notifying Guild of a claim - Speech Pathology

We hear it all the time – a disaster has ruined lives and businesses. 

Too often people unfortunately seek comfort in the belief that ‘it could never happen to me’. Yet claims reported to Guild Insurance tell us otherwise. They remind us that businesses suffer losses every day. 

Some business owners have unrealistic expectations about how they’ll cope if the unthinkable happens. Businesses are often surprised at just how much they’re impacted when a disaster occurs. This is why planning for a disaster is vital. Once something happens, the time to prepare has gone. All businesses need to be realistic about what can happen and be proactive in putting risk management strategies in place.

Matters to consider when preparing for a bushfire 

• Understand your risk of a bushfire based on location and current weather warnings 
•  Know the safest route out of your local area > Understand bushfire danger ratings and what they mean > Follow and adhere to bushfire warnings when issued
• Have a plan, and rehearse it, for what to do in the event there is a bushfire. This plan includes but isn’t limited to:
  • Being ready and willing to leave early before you see signs of fire, allowing for how fast fires can travel
  • An evacuation plan which needs to consider not only staff but any clients or other visitors who may be on the premises
  • An emergency items kit which is packed at all times and includes all emergency contact phone numbers, mobile phone chargers and a first aid kit 
  • Shelter options in the event you’re unable to leave
  • Be sure all staff are involved in preparing the business for a bushfire 
  • Understand what you’re insured for in the event of a fire; contact your insurer if this needs updating

Bush fire preparation resources 

Each state’s country or rural fire services have a range of resources to assist business and individuals prepare for and cope with a bushfire. To utilise these resources, visit rfs.nsw.gov.au to ensure you’re as prepared as you can be.

How to Lodge a claim

In the event you need to lodge a claim click here or call us at 1800 810 213 for assistance.

Download here
 

Imagine that you’ve closed your business at about 6pm on a Friday. Unbeknownst to you, later that evening water starts flowing from underneath one of the bathroom sinks. As no one is there to see or stop this, it continues with water inundating the entire building. By the time you’re aware of this on Monday morning, the building has suffered extensive damage to the floors and furniture. This damage, as well as mould starting to develop, means the business is forced to close for a week.

What is a flexi hose?

Many business and home owners will have little understanding of a serious risk lurking beneath their sinks. Flexible braided hoses, commonly called flexi hoses, are frequently found underneath bathroom or kitchen sinks right across Australia. A flexi hose is a flexible hose with braided or woven stainless steel which have overtime replaced standard copper pipes. They’ll usually be used to connect water to an appliance, such as a dishwasher, sink or toilet. The flexibility in them makes plumbing connections easier in a range of settings. However, it’s this flexibility that also creates a very real risk of water damaging your property and disrupting your business if the hose fails or bursts.

What could go wrong?

It’s quite simple really. When the stainless steel outer of a flexi hose fails by either corroding or fraying, this allows the inner tubes of the hose to expand to a point of bursting. And what could this mean for your property? The scenario at the beginning of this article highlights the damage which can occur and then the potential impact of this on the operations of the business.

What can you do about this?

Use a qualified plumber – There may be a temptation for some people to consider installing flexi hoses themselves, however the majority of issues with flexi hoses come about due to poor installation. Therefore, always use a qualified plumber to be sure flexi hoses are correctly installed.

Create a maintenance program – flexi hoses should be regularly checked for damage, approximately every 6 months. When undertaking these checks be on the look out for leaks, bulging pipes and fraying or rusting stainless steel. Your plumber may be able to assist you with this process.

Only use quality products – While all flexi hoses have a limited lifespan, some will last longer than others. Your qualified plumber should only be using products which adhere to the WaterMark Certification Scheme and carry the recognised WaterMark logo. While a high cost isn’t a guarantee of high quality, be mindful when trying to limit spending as sometimes cheap options will be of a lower quality.

Replacement program – quality flexi hoses are generally thought to have a lifespan of about 10 years, however this can vary and some have been known to burst within a few months of installation. It’s therefore recommended hoses are replaced approximately every 8 years, unless maintenance checks suggest it should happen sooner. If you’ve moved into a new premises and you aren’t sure of the age of the flexi hoses, consider replacing them all to be on the safe side. This may seem overly cautious, however the time and money spent doing this will be much less than dealing with water damage to your business.

Storage of chemicals nearby – it’s very common to store cleaning products in cupboards under sinks, which is where you’re also likely to find flexi hoses. It’s thought that the chemicals in these cleaning products may contribute to the corrosion of flexi hoses. Therefore, find another safe place to store these products away from your flexi hoses

Imagine that you’ve closed your centre at about 6pm on a Friday. Unbeknownst to you, later that evening water starts flowing from underneath one of the bathroom sinks. As no one is there to see or stop this, it continues with water inundating the entire building. By the time you’re aware of this on Monday morning, the building has suffered extensive water damage to the floors and furniture and mould has started to form.

What is a flexi hose?

Many business and home owners will have little understanding of a serious risk lurking beneath their sinks. Flexible braided hoses, commonly called flexi hoses, are frequently found underneath bathroom or kitchen sinks right across Australia. A flexi hose is a flexible hose with braided or woven stainless steel which have overtime replaced standard copper pipes. They’ll usually be used to connect water to an appliance, such as a dishwasher, sink or toilet. The flexibility in them makes plumbing connections easier in a range of settings. However, it’s this flexibility that also creates a very real risk of water damaging your property and disrupting your business if the hose fails or bursts.

What could go wrong?

It’s quite simple really. When the stainless steel outer of a flexi hose fails by either corroding or fraying, this allows the inner tubes of the hose to expand to a point of bursting.

How will this impact your centre?

Any building, both commercial and residential, faces the risk of a burst flexi hose. However early learning centres face a higher risk than many other buildings given their high number of toilets and basins, and therefore the high number of flexi hoses. The scenario at the beginning of this article highlights the damage which can occur with water potentially inundating the entire building before it is realised and stopped. However, the impact unfortunately doesn’t end there. Guild Insurance has seen many cases where extensive water damage has led to an early learning centre being closed for a period of time, possibly a week. This may be because of the time it takes for the floors to completely dry. Driers can be used to speed up this process, however these are quite noisy and it’s difficult to operate a centre while these are being used. There is also the issue of mould building up due to the water damage and this creating an unsafe space for both children and the staff. There is an unfortunate potential consequence of an early learning centre being unable to operate for a period of time. Several centres have experienced their children attending other centres during a closure and then not returning once the centre is up and running. While insurance can assist with the cost of repairs and lost revenue during a closure, it can’t assist with valued clients choosing to not return.

What can you do about this?

Use a qualified plumber – There may be a temptation for some people to consider installing flexi hoses themselves, however the majority of issues with flexi hoses come about due to poor installation. Therefore, always use a qualified plumber to be sure flexi hoses are correctly installed.

Create a maintenance program – flexi hoses should be regularly checked for damage, approximately every 6 months. When undertaking these checks be on the look out for leaks, bulging pipes and fraying or rusting stainless steel. Your plumber may be able to assist you with this process.

Only use quality products – While all flexi hoses have a limited lifespan, some will last longer than others. Your qualified plumber should only be using products which adhere to the WaterMark Certification Scheme and carry the recognised WaterMark logo. While a high cost isn’t a guarantee of high quality, be mindful when trying to limit spending as sometimes cheap options will be of a lower quality.

Replacement program – quality flexi hoses are generally thought to have a lifespan of about 10 years, however this can vary and some have been known to burst within a few months of installation. It’s therefore recommended hoses are replaced approximately every 8 years, unless maintenance checks suggest it should happen sooner. If you’ve moved into a new premises and you aren’t sure of the age of the flexi hoses, consider replacing them all to be on the safe side. This may seem overly cautious, however the time and money spent doing this will be much less than dealing with water damage to your business.

Storage of chemicals nearby – it’s very common to store cleaning products in cupboards under sinks, which is where you’re also likely to find flexi hoses. It’s thought that the chemicals in these cleaning products may contribute to the corrosion of flexi hoses. Therefore, find another safe place to store these products away from your flexi hoses

Receiving a complaint is often an unexpected part of running any business, including an exercise & sports science business.  No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are.  There can be a tendency to see a complaint as a personal criticism rather than constructive feedback.  However, there can be positive outcomes when the situation is managed appropriately. 

Why do people complain?

There are many reasons why clients might complain about your business and the service they’ve received.  Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise.  Understanding why people may complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.  The following are some of the reasons why people may feel the need to complain.

High expectations – consumer expectations are increasingly high when engaging professional services.  Your clients pay for your service and will most likely see you as a highly trained and qualified professional.  This view can influence their expectations about the service and outcomes they anticipate.

Unrealistic expectations – it’s possible that clients may have unrealistic expectations about what they can reasonably expect from treatment or a session with an exercise professional.  Their high expectations may at times surprise you.  It’s therefore important to remember that most clients will not have the level of knowledge you do and what’s obvious or common sense to you may not be to them.  A professional must assist clients to be clear and fully informed about the treatment or session being provided and the outcomes they can realistically expect.  This requires ongoing discussions with clients and, where possible, written information to assist their understanding.

To inform and be heard – clients may wish to make a complaint about an incident or poor outcome simply so they are sure you and your staff are aware of what has occurred and how they feel.  They may wish to complain simply to be listened to and acknowledged, especially if they have been adversely impacted.  Not all complaints will lead to a formal demand for compensation. 

Belief that someone is responsible – when something goes wrong we often try to determine who’s responsible.  Sometimes someone is obviously responsible, sometimes it’s hard to determine who’s responsible and other times there is no one person responsible but it’s just an unfortunate set of circumstances.  However, if a client thought something had gone wrong and this led to them being harmed, it’s quite possible they may complain with the intention of holding someone responsible and possibly liable. 

The importance of managing complaints

There may sometimes be a temptation to ignore a complaint and hope it’ll just go away.  Maybe the client won’t follow up.  Maybe the incident won’t occur again.  This is a very short-sighted way to run any business as there are clear benefits to appropriately managing complaints.

Clients will generally expect to see their complaint dealt with quickly and fairly.  When this doesn’t happen it’s possible that further complaints will follow and the issue or concern could become a much greater one.  Complaints may also escalate to complaints entities in your state or territory.

Managing complaints should be seen as good ‘customer service’.  You rely on clients to keep your business afloat.  When clients are unhappy with a service they’ve received, they can talk with their feet by not returning to the business.  Keeping clients happy and satisfied is more likely to see them continue to utilise your service and recommend your business to others. 

Complaints can provide a business with an opportunity to review and improve their service.  Receiving a complaint may highlight an issue which the business had not been aware of.  When investigating and dealing with the complaint, the business may wish to consider a change in a procedure to avoid that issue arising again in the future. 

How to manage complaints

It’s advisable that all businesses have a complaints policy.  This means that the business will have an agreed-to process which allows for all complaints to be managed in a fair and consistent manner.  It also means staff know what to do which is important as managing complaints can be challenging. 

A key aspect in dealing with any complaint is listening to the person.  Where possible, make time to sit down in a quiet space and give them time to express their concerns.  Make the effort to hear what they have to say and take on board what they have told you.  You may not agree with all they are saying, however it helps if you can try to understand the situation from their perspective.  You may wish to ask them to document their concerns so you both have an accurate record of the matter.  Avoid being defensive or taking the complaint personally as this may inflame the situation. 

With low level complaints you may be able to offer a solution there and then.  However, this won’t always be the case.  With more serious complaints you should provide the person with an assurance that you’ll investigate the matter and get back to them with a response at a later date. 

Guild Insurance expects those insured with us not to admit liability or name someone else as being at fault, or to offer any compensation without contacting us first.  However, this doesn’t prevent you from apologising or showing sympathy for any pain or inconvenience the person may be experiencing. 

Contact Guild Insurance on 1800 810 213 as soon as you’ve received a complaint; don’t wait till it escalates to a claim for compensation.  We will provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation.  Utilising this support can be the difference between sorting a problem quickly and it escalating to a serious claim.  

Download pdf here

Receiving a complaint is often an unexpected part of running any business, including a child care or early learning service.  No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are.  There can be a tendency to see a complaint as a personal criticism rather than constructive feedback.  However, there can be positive outcomes when the situation is managed appropriately. 

Why do people complain? 

There are many reasons why parents might complain about an early learning centre and the service they’ve received.  Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise.  Understanding why people may complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.  The following are some of the reasons why people may feel the need to complain. 

High expectations – consumer expectations are increasingly high when engaging professional services.  This is particularly for early learning services.  When a parent leaves their child with a service, they will have understandably high expectations regarding the level of care and supervision that will be provided to their child. 

Unrealistic expectations – it is also possible that at times parents may have slightly unrealistic expectations about what they can expect from an early learning service.  It’s therefore important that a service assists their parents to be clear and fully informed about the types of care and education they provide to children.  Having this information documented and readily available to parents, for example on your website or in brochures provided before children enrol, can be beneficial.  Encourage parents to ask questions so that expectations can be discussed and appropriately managed. 

Emotional motives – some parents may struggle with separation anxiety as much as their child.  Some may even feel a sense of guilt when leaving their child with an educator who is initially a stranger.  This level of emotion may contribute to the level of expectation they have regarding the quality of care provided. 

To inform and be heard – parents may wish to make a complaint about an incident simply so they are sure you and your staff are aware of what has occurred and how they feel.  They may complain so they’re listened to and acknowledged, especially if their child has been impacted.  Not all complaints will lead to a formal demand for compensation; sometimes people want to receive information about how the incident is being managed to ensure it doesn’t arise again. 

Belief that someone is responsible – when something goes wrong we often try to determine who’s responsible.  Sometimes someone is obviously responsible, sometimes it’s hard to determine who’s responsible and other times there is no one person responsible but it’s just an unfortunate set of circumstances.  However, if a parent thought something had gone wrong and this might have led to a poor outcome, such as an injury to their child, it’s quite possible they may complain with the intention of holding someone responsible and possibly liable. 

The importance of managing complaints 

There may sometimes be a temptation to ignore a complaint and hope it’ll just go away.  Maybe the parent won’t follow up.  Maybe the incident won’t occur again.  This is a very short-sighted way to run any business as there are clear benefits to appropriately managing complaints. 

Parents would understandably expect to see their complaint dealt with quickly and fairly.  When this doesn’t happen it’s possible that further complaints will follow, and the issue or concern could become a much greater one.  Complaints may also escalate to other people or organisations, such as your Regulatory Authority. 

Managing complaints should be seen as good ‘customer service’.  You rely on parents and families to keep your business afloat.  When customers are unhappy with a service they can talk with their feet by not returning to the service.  Keeping parents happy and satisfied is more likely to see them continue to use your service and recommend you to others. 

Complaints can provide an early learning service with an opportunity to review and improve their service.  Receiving a complaint may highlight an issue which the service had not been aware of.  When investigating and dealing with the complaint, the service may wish to consider a change in a procedure to avoid that issue arising again in the future. 

How to manage complaints 

It’s advisable that all early learning services have a complaints policy.  This means that the service will have an agreed-to process which allows for all complaints to be dealt with in a fair and consistent manner.  It also means staff know what to do which is important as managing complaints can be a challenging. 

A key aspect in dealing with any complaint is listening to the person.  Where possible, make time to sit down in a quiet space and give them time to express their concerns.  Make the effort to hear what they have to say and take on board what they have told you.  You may not agree with all they are saying, however it helps if you can try to understand the situation from their perspective.  You may wish to ask them to document their concerns so you both have an accurate record of the matter.  Avoid being defensive or taking the complaint personally as this may inflame the situation.

With low level complaints you may be able to offer a solution there and then.  However, this won’t always be the case.  With more serious complaints you should provide the person with an assurance that you’ll investigate the matter and get back to them with a response at a later date.

Guild Insurance expects those insured with us not to admit liability (or name someone else as being at fault), or to offer any compensation without contacting us first.  Contact Guild Insurance on 1800 810 213 as soon as you’ve received a complaint; don’t wait till it escalates to a claim for compensation.  We will provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation.  This support can be the difference between sorting a problem quickly and it escalating to a serious claim.

Download pdf here

Speech pathologists benefit from discussing risk and managing it proactively.  Maintaining health records is one of these important risk areas to be managed and understood. Guild Insurance’s experience in managing claims suggests many health practitioners would benefit from learning more about record keeping and what’s required.

Health records and insurance claims

Health records can impact insurance claims in two ways:

1. Poor records can contribute to a poor or unexpected outcome from therapy, due to lack of awareness and consideration of all factors impacting on that outcome, leading to the client complaining and possibly seeking some form of compensation.
2. Poor records may make a complaint, and therefore an insurance claim, difficult to defend due to the lack of evidence.

All speech pathologists want to achieve clinical outcomes to support client goals, as they understand that providing benefit from intervention to support the wellbeing of their clients is paramount.  By providing appropriate interventions, speech pathologists are also acting to avoid complaints which can be very challenging and confronting experiences and can lead to insurance claims.  Therefore, understanding what the standard is for health records and maintaining this standard really should be a focus. 

Why keep detailed clinical records?

1. Continuity of client care

The primary purpose of clinical records is to ensure the safety and continuity of client care. It’s not uncommon for speech pathologists to believe they can remember the details of client consultations.  However, Guild sees examples where clinicians haven’t remembered key aspects of prior therapy sessions which has led to poor outcomes for the client.  It’s therefore imperative to have all relevant information recorded, and readily available, to ensure certainty as to how and why you’ve provided therapy to the client in the past.

It’s also important to be sure you refer to the information within the client’s record.  Clients can suffer harm when recorded information is overlooked or forgotten about and therefore the therapy isn’t appropriate.

2. Regulatory requirement
Speech Pathology Australia’s (SPA) Code of Ethics assists and supports speech pathologists to maintain the high level of professional practice expected of them.  Members of SPA commit to upholding the Code of Ethics as part of their annual membership renewal.  As stated in the Code of Ethics, speech pathologists are required keep adequate records of the professional services they provide.

It’s the responsibility of all speech pathologists to make themselves aware of and adhere to Code of Ethics; not knowing is not an excuse for not complying.

3. Defence of a complaint
If there is any allegation of wrong doing made against a speech pathologist, their records are going to be incredibly important.  Those records provide evidence of what took place and why.  Without a good record, the clinician will be relying on their memory as a defence.  Information recorded at the time of the consultation is going to hold greater weight as a reliable defence than a clinician’s memory months after an event.  As the saying goes ‘Good records = good defence, poor records = poor defence and no records = no defence’.   

4. Funding audit
Funding providers, such as private health insurers, regularly conduct audits to be sure health practitioners are billing appropriately and members are claiming appropriately.  It’s not uncommon for a health practitioner to receive a request from a funding provider to validate a claim made by a health professional or a client.

This is another example of when a practitioner needs documented evidence of what they’ve done and why.  If the reasons behind treatment, and therefore billing, isn’t clear, funding providers can demand repayment.

What makes a good clinical record?

The key question many health practitioners ask when it comes to record keeping is ‘how much detail do I need to record?’.   When a speech pathologist is unsure if they have included enough detail, they should ask them self whether or not another clinician could read the record and understand the full picture of what took place and why, without the treating clinician or client filling in any gaps.  If the full story isn’t there, there isn’t enough detail.

Exactly what to include can vary according to the specifics of the client’s condition and therapy provided.  However, generally records should include, but aren’t limited to:

• Client identifying details and health history
• Client and emergency contact information
• Name and signature of the clinician as well as the date and location of the consultation
• Who, if anyone, attended the session with the client
• Reason for the client presentation
• The client's informed consent to the assessment and the details of that assessment
• Observations, clinical findings (even if there is no abnormal finding), and any working diagnoses
• Therapy goals, proposed plan of care, associated risks and alternatives (if any) discussed with the client.
• The client's informed consent to the agreed plan of care and fees
• All therapy provided and the client's response to the intervention
• Any advice, instructions or warnings given to the client and a plan for the next session
• Details of any further exchanges with the client, or their parent/carer, occurring via telephone, email etc
• Referrals to or correspondence with other health professionals or service providers
• Any other information you feel is relevant to that client’s care

In some cases, it’s worth noting what didn’t occur as well as what did.  For example, if a client has refused to consent to what would be considered the most ideal or obvious therapy option, the record should reflect that it was discussed and declined.  If it is simply left out of the record, it would appear that it wasn’t considered or discussed as an option.

It is acceptable to use abbreviations in clinical records, however they need to be understood by others who may access the record.  Therefore, if a speech pathologist uses an abbreviation not widely recognised within the profession, they should ensure there is easily accessible information in the record explaining what that abbreviation means.

Professional and objective

Health records need to always be professional and objective.  Comments about observations of the client or client’s family can be included, however this must be professional and only when this is relevant to the therapy being provided.  This may occur in situations where the client isn’t complying with instructions and this is detrimental to their outcomes.  However, it’s important to remember that health records can be accessed and read by a number of people, including the client, their family, your regulator and insurer, so always be mindful of the language used.  The language used should match the professional language a speech pathologist would use when speaking to the client during a consultation and remain within scope of practice for a speech pathologist.

Timing of entry in a client record

As mentioned above, information recorded at the time of the consultation is considered to be the most accurate.  However, it’s also recognised that completing the clinical record immediately after a consultation isn’t always practical and clinicians often add to the records some time after the consultation.  It is considered best practice to have the record of a consultation completed within 48 hours after the consultation or contact/event occurred as this allows for the most comprehensive and accurate description of what is being documented.

It’s recommended that managers and clinic owners allow their staff time in the day to complete their records.  This process shouldn’t be rushed as clinicians, especially those in the early stages of their careers, need time to process and record in detail all of what occurred in the therapy session.

Privacy and health records

All businesses have an obligation to keep confidential information they hold regarding their clients private.  This requirement is particularly important in healthcare given the sensitive nature of health information as well as personal and payment information also held by health organisations.

The Privacy Act (1988) regulates how health providers collect, store, use and disclose personal information.  The Act requires compliance with the 13 Australian Privacy Principles (https://www.oaic.gov.au/individuals/privacy-fact-sheets/general/privacy-fact-sheet-17-australian-privacy-principles). There may also be state or territory based legislation relevant to specific locations, which the speech pathologist should be aware of.

All health professionals have an obligation to store health records in a manner which protects the information from unauthorised access or disclosure.  There are various methods for the safe storage of health records and which method is used is up to each individual health professional or business.  The storage of records in both paper and electronic format is permitted and it’s important to remember that all records must adhere to privacy requirements, regardless of their format.  It’s recommended that health professionals who store their health records electronically seek assistance from technology experts to minimise their risks.

The Notifiable Data Breach (NDB) scheme commenced in February 2018.  This scheme requires all businesses covered by the Privacy Act to notify the Office of the Australian Information Commissioner (OAIC) and affected individuals (such as your clients) when a notifiable data breach has occurred.  A notifiable data beach is a breach, such as unauthorised access to records, which is considered likely to result in serious harm to individuals that information relates to.  Further information about this scheme can be found at www.oaic.gov.au/privacy-law/privacy-act/notifiable-data-breaches-scheme.   

Further information can be found on the Speech Pathology Australia website (www.speechpathologyaustralia.com.au) under Resources for Speech Pathologists, Professional Resources on a range of topics such as informed consent, Private Health Fund audits and privacy.

Download pdf here

Guild Insurance spends a great deal of time analysing claims and/or complaints relating to osteopathy treatment.  This involves complaints made directly to the osteopath or osteopathy practice as well as complaints to a regulatory body such as AHPRA.  This analysis helps Guild better understand a number of key details such as:

• what the complaint or allegation is about
• what the factors are which may not be mentioned in the complaint yet have contributed to the incident and therefore the complaint occurring
• what could have been done differently to possibly avoid the complaint from occurring

This information is then used to develop what Guild calls risk messages for osteopathy.  These are pieces of information which will guide the profession in relation to risk management tips and strategies to reduce the likelihood of complaints being received.  It’s important to understand that risk management can’t guarantee a poor outcome or complaint won’t ever occur.  However, by adhering to the following messages, osteopaths are taking positive steps to reduce the likelihood.

10 risk messages for osteopathy

1. Ensure you make communication a key feature of your work
Guild’s claims analysis suggests that poor communication is a feature in almost all treatment related complaints.  While patients rarely complain about poor communication, although this does happen, when an incident is investigated poor communication is quite often a factor.  Osteopaths must continually focus on their communication with patients, patient’s families where relevant, colleagues and other health professionals. Remember to explain what you do and why during your treatment. Good clinical skills alone aren’t enough to make someone a safe and effective osteopath.

2. Know and adhere to all AHPRA requirements

As a health professional registered with AHPRA, it’s every osteopath’s responsibility to make themselves aware of what’s required.  This means making the time to seek out and read the numerous codes and guidelines found on the AHPRA website (ahpra.gov.au).  Some of these documents detail what’s considered best practice.  However, some information actually refers to the law.  Not knowing this information is no excuse for not adhering to it.

3. Adhere to the advertising guidelines

AHPRA’s expectations regarding advertising are explained in the Guidelines for Advertising Regulated Health Services document which can be found on the AHPRA website.  There are numerous complaints continually being lodged with AHPRA alleging health professionals are breaching these guidelines.  Osteopaths need to be aware these guidelines specify what’s required under the National Law and non-compliance is a criminal offence for which hefty fines can be imposed.                                                                               

4. Ensure there has been an adequate assessment process prior to treatment

Assessing before treatment seems like an obvious suggestion.  However, it’s not uncommon to see claims where the assessment process hasn’t been thorough enough leading to treatment which is inappropriate or ineffective.  The assessment process should not be rushed.  Details of the assessment and findings are to be recorded in the clinical record and osteopaths must be sure they don’t make assumptions or fall into routines.  Remember, poor assessment usually leads to poorly selected treatment.

5. Manage patient expectations

It’s important that patients have realistic expectations regarding their likely treatment outcomes.   Unrealistic expectations are rarely met.  Unmet expectations will often lead to patients being dissatisfied with treatment and more likely to complain.  It’s the responsibility of the osteopath to be sure a patient’s expectations are realistic before treatment begins.  Osteopaths must remember that in most cases patients won’t have the clinical knowledge and understanding they have.  Osteopaths should never assume a patient understands their treatment or what is likely to happen post-treatment; they must have a conversation to ensure this understanding.

6. Be sure patients have given their informed consent to treatment

Patients must be given the opportunity to provide their informed consent to treatment before being treated.  Informed consent requires a conversation between the treating osteopath and patient about recommended and alternate treatment options as well as the benefits and risks for each of those options.  Informed consent should include informed financial consent which is a discussion about the expected costs of treatment.  Details about this consent discussion should be recorded in the clinical record.  Signing a generic form at reception prior to the first treatment is not informed consent.

7. Be mindful of treatment around sensitive areas

Guild Insurance sees numerous claims each year where a patient has accused an osteopath of touching them inappropriately during treatment.  In the majority of these cases, the treatment has been appropriate and justified.  However, the osteopath’s communication about the treatment has been lacking leaving the patient confused about where and how they’ve been treated and why.  Never make an assumption about a patient’s understanding or comfort level.  Be sure they understand the treatment and the reason for it before you proceed, particularly when treating around sensitive areas. It’s the osteopath’s responsibility to explain the treatment in simple, non-clinical language so the patient understands.  And be sure to always use appropriate coverings, such as towels, to ensure patient modesty is protected.

8. Refer to another practitioner when required

Osteopathy plays a key role in the Australian healthcare system; however it’s important to understand that other health professionals do too.  There will be occasions when a patient presents for treatment, yet the osteopath won’t be the most suitable person to provide that treatment.  Osteopaths must recognise those occasions and be sure they refer those patients to the appropriate professional.  Sometimes the most appropriate treatment an osteopath can provide is no treatment at all.

9. Don't allow yourself to be coerced into doing things against your better judgement
There will be occasions when an osteopath is being asked to do something they don’t believe is in the best interests of the patient.  At times they’ll find they’re actually being coerced or forced into something even when they’ve advised against it. This may be when a patient is asking for a particular type of treatment which the osteopath doesn’t believe is clinically justified.  Or when an osteopath has decided against treating a patient, yet the patient insists on some form of treatment.  Osteopaths need to be sure they aren’t convinced to do something they don’t believe is appropriate.  They must remember that they’re always responsible for their clinical decisions and they need to be sure they can justify those decisions. 

10. Maintain adequate clinical record
Clinical records are an osteopath’s history and evidence of what took place and they serve numerous purposes.  They assist with ongoing clinical care as no osteopath can remember how they’ve treated every patient in every consultation.  They also assist as evidence if an osteopath’s treatment is ever questioned by a patient, regulator, or private health insurer.  And finally, they’re necessary for meeting the expectations of the Osteopathy Board of Australia. 

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Receiving a complaint is often an unexpected part of running any business, including a fitness centre. No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are.  There can be a tendency to see a complaint as a personal criticism rather than constructive feedback.  However, there can be positive outcomes when the situation is managed appropriately.

Why do people complain?

There are many reasons why clients might complain about your centre and the service they’ve received.  Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise.  Understanding why people may complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.  The following are some of the reasons why people may feel the need to complain.

High expectations – consumer expectations are generally high when engaging professional services.  Your clients make a conscious decision to pay to use your centre and with this comes an expectation of a certain level of service.  Whilst in your centre it’s likely they’ll come into contact with a number of qualified fitness professionals whose services they may pay extra for.  All of this can influence their expectations. 

Impact of an incident – a very common reason for complaints to a fitness centre or fitness professional focuses on a client being injured whilst exercising.  Most people undertake a fitness program with the aim of getting fitter and healthier.  When a client is then injured their experience has been the opposite of what they hoped for.  These injuries can impact the client’s life significantly, if their ability to not only exercise, but to work and enjoy other aspects of their life has been affected.

To inform and be heard – clients may wish to make a complaint about an incident or poor service in your centre simply so they are sure you and your staff are aware of what has occurred and how they feel.  They may wish to complain simply to be listened to and acknowledged, especially if they have been adversely impacted.  Not all complaints will lead to a formal demand for compensation.

Belief that someone is responsible – when something goes wrong we often try to determine who’s responsible.  Sometimes someone is obviously responsible, sometimes it’s hard to determine who’s responsible and other times there is no one person responsible but it’s just an unfortunate set of circumstances.  However, if a client thought something had gone wrong and this led to them being harmed, it’s quite possible they may complain with the intention of holding someone responsible and possibly liable.

The importance of managing complaints

There may sometimes be a temptation to ignore a complaint and hope it’ll just go away.  Maybe the client won’t follow up.  Maybe the incident won’t occur again.  This is a very short-sighted way to run any business as there are clear benefits to appropriately managing complaints.

Clients will generally expect to see their complaint dealt with quickly and fairly.  When this doesn’t happen it’s possible that further complaints will follow and the issue or concern could become a much greater one. 

Managing complaints should be seen as good ‘customer service’.  You rely on clients to keep your business afloat.  When clients are unhappy with a service they’ve received, they can talk with their feet by not returning to the centre.  Keeping clients happy and satisfied is more likely to see them continue to use your centre and recommend your business to others.

Complaints can provide a business with an opportunity to review and improve their service.  Receiving a complaint may highlight an issue which the business had not been aware of.  When investigating and dealing with the complaint, the centre may wish to consider a change to avoid that issue arising again in the future.

How to manage complaints

It’s advisable that every fitness centre has a complaints policy.  This means that the centre will have an agreed-to process which allows for all complaints to be dealt with in a fair and consistent manner.  It also means staff know what to do which is important as managing complaints can be challenging.

A key aspect in dealing with any complaint is listening to the person.  Where possible, make time to sit down in a quiet space and give them time to express their concerns.  Make the effort to hear what they have to say and take on board what they have told you.  You may not agree with all they are saying, however it helps if you can try to understand the situation from their perspective.  You may wish to ask them to document their concerns so you both have an accurate record of the matter.  Avoid being defensive or taking the complaint personally as this may inflame the situation.

With low level complaints you may be able to offer a solution there and then.  However, this won’t always be the case.  With more serious complaints you should provide the person with an assurance that you’ll investigate the matter and get back to them with a response at a later date.

Guild Insurance expects those insured with us not to admit liability (or name someone else as being at fault), or to offer any compensation without contacting us first.  Contact Guild Insurance on 1800 810 213 as soon as you’ve received a complaint; don’t wait till it escalates to a claim for compensation.  We will provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation.  This support can be the difference between sorting a problem quickly and it escalating to a serious claim. 

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