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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When considering an insurance policy, it’s easy for many of us to think “it’ll never happen to me”.  However, the vast experience of Guild Insurance tells us ‘it’, being events that require insurance claims, unfortunately can happen to people like you. 

Guild Insurance is dedicated to providing risk management information to those insured with us to help reduce the likelihood of events occurring which will have a detrimental impact on their business and lead to an insurance claim.  However, we also know that not everything can be prevented.  Which is why business owners also need to consider what they can do to reduce the severity or impact on their business should an event occur.  And this is where asset registers become so important.

What is an asset register?

An asset register is simply a list of assets held by a business.  These can be created and stored in various ways, such as paper format or electronically, yet should always be stored safely and be easily accessible.

Why are they needed?

All businesses should hold an asset register as they serve a number of important purposes.

It’s estimated that well over half of Australian businesses are underinsured.  A detailed asset register will help a business understand the value of what they own and therefore the level of insurance required to be adequately protected.

An asset register also assists businesses when there is a need to lodge an insurance claim due to property loss or damage.  When there is an up to date asset register, this necessary information can be provided quickly to an insurance company which is likely to speed up the settlement process.  Making an insurance claim for property damage or loss can be quite a stressful process for any business.  An asset register can reduce some of this stress by making the process more straightforward.

When a business has multiple sites, keeping track of all assets is quite a challenge.  An asset register provides the business with a way to manage all assets, even when the assets aren’t physically in sight of those responsible.

What information should be included?

For an asset register to be of any benefit to a business, it’s important that the information is up to date and correct.  Businesses should have a process for how and when the register will be updated and by who.  This process should require adding a new asset as soon as it is purchased.  However, it would also be beneficial doing regular checks of the asset register to be sure nothing has been accidentally left off.

The asset register should include a list of all items which could be lost or damaged if there was an incident at the premises.  Don’t just focus on the costly items; damage to a lot of items which are of lesser value can still add up and you will want a record of these items.  The types of assets to be recorded may include:

• Furniture, both indoor and outdoor
• Computer and other office equipment
• Electrical items such as fridges and air conditioners

The information to record about each of these items may include:

• Description of the item
• Brand, make or model
• Serial number
• Purchase value
• Purchase date
• Location of the item
• Warranty information
• Invoices

Creating an asset register

As previously mentioned, asset registers are really just a list of items so the creation of them doesn’t need to be overly complex.  There are a number of template examples which can be found through internet searches. 

However, the challenging aspect of creating an asset register is being sure the information you have on there is detailed and correct.  It’s therefore recommended that businesses use their accountant to assist with this task.

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Maintaining appropriate and proper clinical records relies on speech pathologists integrating fundamental record keeping practices into their daily routines.  Using this checklist will help to evaluate your practice.  ‘No’ answers are opportunities for improvement.

Actions	Yes	No
I keep a separate record for each client.
I obtain and record informed consent for all services provided.
My entries are legible, accurate, and made in chronological order and clearly dated. Any corrections I make to records do not remove the original information.
I have signed my notes, and initialled any corrections or additions.
I record sufficient information to allow me or someone else to return to the records at any time and be able to understand what took place and why.
My entries are made at the time of the session, or as soon thereafter as practicable within 48 hours.
If I don’t have an opportunity to write my notes until the following day, I always enter the date I’m making the additional entry in the client’s record.
If documents are scanned to the record, such as external reports, the scanning is done to a sufficient quality that retains the legibility of the original document.
I have consistent processes for recording the details of any further interactions with clients that may occur via telephone, text message or other method.
I only use abbreviations that are widely recognised and accepted in speech pathology or I provide a list of abbreviations in the client’s file.
I don't make subjective or emotive comments; all information is professional. I know that clients have a right to access their records.
All client care and entries in the record are made with the SPA’s Code of Ethics in mind.
I keep an appropriate, consistent standard of clinical records for all clients, not just those with complex needs.
While I may ask a suitably qualified assistant to record some health information in the client’s record, I always review their entries. I know that I cannot delegate responsibility for the accuracy of health information recorded to another person.
The date of any funding claim matches the date of therapy in the clinical record.
The claim item number matches the therapy type and length detailed in the clinical record
The provider number recorded for a claim matches the provider number for the speech pathologist that provided the service according to the clinical record.
My records are stored securely and in a way that ensures they can be promptly retrieved
My records are collected, maintained, transferred and disposed of in accordance with privacy laws and state or territory laws.
I have developed a privacy policy that provides information to clients about the collection, access, disclosure and retention of their health records.
We have regular training for everyone at our practice about the appropriate collection, storage, access and disposal of records.

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An increasing number of dispensing errors involving the wrong frequency are reported to Guild Insurance.  Typically, these errors occur when a pharmacist directs a customer to take a medication more or less frequently than prescribed.  For example, the customer was prescribed a daily dose, but the pharmacist labelled the medication to be taken twice a day. 

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 have serious consequences for you and your customers.

Cases

A man was hospitalised with Amiodarone toxicity as the result of a dispensing error.  The pharmacist misinterpreted a hand-written script for Amiodarone 400mg BD and dispensed 400mg TDS instead.  While the pharmacist recognised that the script had been written in “an unusual and misleading way”, he failed to verify his interpretation with the prescriber or another pharmacist.

A young man’s claim for compensation was successful after he experienced significant side effects as a result of a dispensing error.  The pharmacist had inadvertently dispensed Prednisolone 25 mg TDS, rather than the prescribed frequency of Prednisolone 25mg for 3 days.

An elderly woman died from renal failure, allegedly resulting from a dispensing error.  While the woman had been prescribed Methotrexate 5mg weekly, the pharmacist’s labelling instructions were unclear, and she took a daily dose instead.

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.
• Take the time to look up the medication if you are unfamiliar with the dosage or frequency.
• Seek help if you are feeling intimidated or uneasy about contacting the prescriber to clarify a script.
• Reduce ambiguity when labelling medications prescribed as a weekly dose by providing very specific instructions. For example, consider replacing ‘Take one tablet daily on the same day every week’, with ‘Take one tablet every FRIDAY only’
• 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.
• Promote a culture where all staff are confident to point out risky practices when they occur.
• Reducing distractions when a pharmacist is dispensing is everyone’s responsibility. Agree to strict rules for minimising interruptions and distractions in your pharmacy.
• 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.

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A growing number of dispensing errors involving the medication wrong quantity are reported to Guild Insurance.   These errors occur when a pharmacist dispenses a quantity of medication that differs to the amount prescribed.  For example, the doctor prescribed ten (10) diazepam tablets, but the pharmacist dispensed fifty (50) in error. 

While over supply of a medication can cause serious clinical effects, under supply can be equally problematic.  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 have serious consequences for you and your customers.

Case

A woman was prescribed a two-week course of Ciprofloxacin 500mg to treat a chest infection.  However, the pharmacist only dispensed a one week supply by mistake.  The woman claimed she developed pneumonia as a result of the pharmacist’s error.  

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 ….”
• Seek help if you are feeling intimidated or uneasy about contacting the prescriber to clarify a script.
• 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.
• Be careful with zeros and abbreviations. Transcription or interpretation errors involving a zero, decimal point or abbreviation are common causes of serious dispensing errors.
• Consider placing flags or warnings in the dispensing basket when handling a script for an unusual quantity of medication.For example, a simple card stating ‘RISK WARNING – different quantity’ could reduce the chance of you automatically selecting a standard quantity.
• 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.
• Reducing distractions when a pharmacist is dispensing is everyone’s responsibility. Agree to strict rules for minimising interruptions and distractions in your pharmacy.
• Promote a culture where all staff are confident to point out risky practices when they occur.

Download pdf here

Social media is an ever increasing form of communication for many people in both their personal and professional lives.  It presents people with many benefits in allowing them to communicate a variety of messages to many people with great speed and efficiency.  However, those benefits need to be balanced with the many risks social media presents.

Social media is a very broad term which includes any websites and applications which allow users to interact with other people as well as create or share information (text, photos, videos etc.).

There are endless examples where people appear to have not stopped and thought before they’ve posted on social media.  Poorly considered social media posts can and do affect the personal and professional reputation and image of individuals as well as a businesses; even if the post isn’t directly related to a business.

The following tips will assist individuals and businesses manage their risks when using social media.

Have a business plan for how and why social media is to be used

When deciding whether or not to create a business social media presence, it’s very easy to think ‘if everyone else is doing it, so should I’.  However there needs to be greater thought put into this decision.  The decision to use social media should be well thought out and based on a company’s needs and business plans; the benefits and risks need to be considered.

Business social media should be based on business requirements, not personal views

Business owners and managers need to be sure that when they make a decision on whether to use social media for their business, this decision is based on the needs of the organisation, not the owner’s/manager’s personal views of social media.  For example, a person who chooses to not use Twitter for personal use may still decide it’s a great tool for them professionally.  Business decisions and personal decisions regarding social media use should be separated.

Create clear business guidelines and processes regarding who is able to post on social media and how this is to be done

Due to the risks associated with social media interactions, it’s very important that businesses have a clear process for who is responsible for posting on social media.  The person undertaking this role needs to understand when social media is an appropriate form of communication and what sort of messages are to be shared using social media.  This process should also provide guidance on how often social media is monitored and responded to and how to respond to negative comments.

Consider training for those staff responsible for social media

It’s often assumed that young people are well versed in social media use however this isn’t always the case.  Also, not all users of social media understand appropriate business use and its associated risks.  Therefore it’s worth considering training in social media communications and its risks for the responsible staff members. 

Understand the social media site you’re using

There’s a wide variety of social media sites available to businesses, all providing similar yet different benefits.  When a business is using any of these sites, it’s very important they understand the various functions within that site.  Not fully understanding how a site works is going to increase the risks of using it.

Consider what messages should be shared using social media

All businesses have various ways in which they communicate with their customers and clients.  Social media is generally designed for short sharp messages, yet not all information suits this style of communication.  When businesses are communicating with their customers, they need to carefully consider how that particular message should be shared.

Carefully consider the implications of engaging with clients on social media

Professionals and businesses should consider if social media is an appropriate forum for them to be communicating with clients, both through business or personal accounts.  Engagement through personal accounts can blur professional boundaries.  When using business accounts, some conversations may not suit social media, especially if the conversation appears in a public setting.  It’s important to consider what conversations are best had away from social media and when to take a discussion off line.

Understand that you can no longer separate personal and professional use

Unfortunately many people hold a view that what they write within a personal social media account in their own time will have no bearing or impact on them professionally.  However this is not the case.  Whether fair or not, professionals are always representing their profession and professional self; personal social media posts can be considered to be representing a professional view.  Therefore the professional impact needs to be considered before any personal post is made. 

Don’t believe that any post is ever private

Too often people post information on social media which they intended to remain private and not be seen widely.  However social media can never truly be private.  Many online groups claim to be private and state that members require approval.  However non-approved users don’t need to be particularly savvy to access these groups and then share or copy information being posted.  Professionals need to remember that if they don’t want their colleagues, clients or competitors seeing a social media post, it should never be posted on either personal or business accounts.

Never post in haste, all posts need to be carefully considered

As mentioned earlier, social media is designed for quick short messages to be shared widely.  This means social media can encourage messages to be shared with little thought or planning which on occasions leads to poorly worded messages which are easily misinterpreted.  It’s important to pause and think through a message before it’s shared.

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It isn’t uncommon for Guild Insurance to hear complaints from patients alleging they weren’t aware their general dentist wasn’t a specialist or that they weren’t given an option for a referral to a specialist prior to treatment commencing.  All patients have a right to be fully informed of the treatment they’re to receive and who will be performing this treatment.  This means general dentists need to be sure their patients understand they aren’t a specialist.  Following are some tips to assist with this.

• Don’t make assumptions about what patients will understand. Without specific dental training and knowledge, what is obvious or common sense to a dentist won’t be obvious or common sense to a patient. Dentists may at times actually be surprised at how little patients understand about dental treatment. Therefore, all conversations with patients need to be detailed, explicit and without assumptions.
• It’s easy to understand why some patients may make assumptions about dentists being specialists when they aren’t; someone who does orthodontics is probably an orthodontist and a person who does endodontics is probably an endodontist. General dentists who are performing work that can also be done by a specialist need to have clear and explicit conversations with patients, so they understand the dentist is a general dentist who is able to carry out those treatments.
• When a dentist explains to a patient that they’re a general dentist and not a specialist, this conversation should include information about the patient’s option to be referred to a specialist if they would prefer. The general dentist may believe that the treatment to be provided is well within their personal scope of practice based on their ability and experience, however patients still have a right to decide who they would like to be treated by. For them to make this informed decision, they need to be informed of the option to be referred to a specialist.
• Not only should a general dentist inform a patient of their right to be referred to a specialist, they also need be sure they’re aware when a clinical situation is beyond their personal scope of practice and a referral isn’t an option but a requirement. All dentists need to be clear on their personal scope of practice and therefore be able to recognise when a clinical situation is one where they should not be providing treatment. In these cases, it’s imperative they don’t provide treatment and instead provide the patient with information about where they can go for treatment.
• It’s not uncommon to hear of cases where a general dentist has recommended a referral and the patient has stated they would prefer to be treated by the general dentist they know and trust. While the desire to respect the patient’s wishes is understandable, a dentist’s duty of care to the patient is paramount. The dentist has a responsibility to not treat when providing treatment would not be in the best interests of the patient. Therefore, when the clinical situation is beyond a dentist’s personal scope of practice, they must refuse to treat that patient and not allow themselves to be convinced to provide treatment against their better judgement. Dentists will be held accountable for the treatment they provide; stating that the patient refused to be treated by someone else doesn’t justify treating when it isn’t appropriate.
• Communication with patients needs to be explicit and not implied or suggested. This means when a dentist explains to a patient that they’re a general dentist and not a specialist, they need to be very clear about the difference. This clear communication also applies to any advertising done by a general dentist. The Dental Board of Australia expects all dental advertising to be free from information which may be false, misleading or deceptive; therefore, advertising must in no way give the impression a dentist is a specialist when they aren’t. This means avoiding terms such as specialising or specialises if the dentist isn’t a specialist.

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Manual handling means to use force or physical exertion to move something, by means such as pushing, pulling, lifting, carrying.  Manual handling takes place continually in an early learning centre, such as when lifting or carrying children, furniture or other equipment.

Manual handling, when not performed appropriately, can unfortunately lead to serious and long-term injuries for employees.  These injuries impact both the employee as well as the early learning centre which employs them.  Therefore, it’s imperative that both employees and employers understand the risks of manual handling within their profession, and specifically their workplace, and understand how they can reduce those risks and lessen the likelihood of staff being injured.

Manual handling occurs in all workplaces and is one of the costliest and most common causes of injury. 

Manual handling statistics for 2012-2015 reveal that[1]:

• In 2014-15 over 43% of serious, work-related injuries were caused when handling or moving objects.
• 41% were from lifting, carrying, or putting down objects and 17% happened while handling objects.
• In the four-year period, more than 150,000 workers were injured, 7 died and more than 1400 were permanently disabled in NSW workplaces as a result of manual tasks.

Employer’s responsibility

All employers have a responsibility to create a safe workplace for their employees.  This safe workplace relates to manual handling risks as well as other potential risks, such as the employee’s emotional wellbeing.

To reduce the likelihood of manual handling injuries within an early learning centre, the employer must:

• Identify areas or tasks which may pose a manual handling injury risk
• Assess the likelihood of those injuries occurring and the possible consequences or impact should they occur
• Identify and put into place strategies to lessen the likelihood of those injuries occurring

Manual handling injuries

The following information provides a brief description of some common injuries experienced by employees in early learning centres due to manual handling.

• Back – bulging discs due to lifting heavy boxes off a shelf
• Neck/shoulders – a strained neck due to reaching for items while changing a child’s nappy
• Arms/wrists – elbow pain due to repetitive movement of furniture around the centre
• Hips, knees and ankles – knee ligament damage caused by lifting a child who has fallen over

Reducing the likelihood of injuries

The Hierarchy of Control is a well-recognised system for reducing exposure to risks and hazards.  The controls are presented in order of effectiveness for reducing the risk, with the most effective coming first. 

The hazard controls are:

Elimination: this means physically removing the hazard.  For example, making the manual task of opening a heavy gate automated by using a remote control.  However not all hazards can be eliminated as this would mean a business couldn’t operate, therefore other less effective controls are more appropriate for some hazards.

Substitution: this requires replacing something which is hazardous with something less hazardous.  For example, large boxes of stock might be replaced with smaller boxes, meaning staff only need to lift lighter boxes.

Engineering controls: this means creating a physical change to the workspace to remove people from the hazard.  For example, lowering the sides of  a cot so staff don’t have to lean down over the sides.

Administration: this requires changes to the way people work, such as by implementing new policies, undergoing additional training or placing warning notices around the workplace.

Personal protective equipment (PPE): this requires staff to don protective equipment, such as gloves when handling children’s food or changing nappies.

Task modification is another way the likelihood of injuries can be reduced.  This means changing the way certain tasks are performed so they’re performed in a safer manner.  Examples of this include:

Decrease the weight of object being handled – this might mean pulling furniture or equipment apart to transport it, or it might mean taking some objects out of a box before attempting to carry it.

Use two or more people to move heavy or large objects – staff need to be encouraged to seek assistance from colleagues and not try to do things alone when doing so will be dangerous.

Pushing rather than pulling or carrying – this creates less stress on the body and is therefore less likely to lead to an injury.

Reduce the frequency of manual handling – early learning educators can’t eliminate manual handling from their work, however doing all that is possible to reduce how often manual handling occurs is a positive step.

Raise work surfaces where possible – raising cot heights is a way to reduce the need for early learning educators to bend down too far when picking up children.

Alternate tasks – having staff carry out different tasks avoids too much repetition of the same task; repetition of manual handling tasks increase the risk of injuries.

In summary…

Don’t think serious injuries won’t happen in your workplace, Guild Insurance sees many examples where exactly that has occurred.  And these injuries can result in a long time off work and modified tasks once the employee has returned.  Therefore, all staff need to take seriously their role in following safe manual handling practices. 

Download pdf here

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Imagine if…

You receive an email from a parent stating that they’re holding you responsible for their child’s injury sustained while at your centre and are suggesting they’ll complain to your regulatory authority if you don’t pay the child’s medical bills.  As you’re sure you and your staff are not to blame and it was simply an accident, you reply to the parent informing them of your version of events.  Some time after you hear from your regulatory authority informing you they’ve received a complaint about your centre which they’ll need to investigate.

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 has noticed a worrying trend where policy holders are responding to complaints on their own without first notifying Guild.  This can have a number of consequences for these people 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:

• A parent has requested financial compensation due to their child suffering an injury
• Your regulatory body has informed you that they’ve received a complaint about your centre and will be investigating
• You have been contacted by the Fair Work Commission regarding a disgruntled former employee alleging they’ve been treated unfairly.
• Any other circumstance where you have an uneasy feeling about an incident or situation; when in doubt, notify!

When to notify Guild

Policy holders 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 responding to a regulatory body or when faced with a demand for compensation.  Also, if the incident requires you to notify your regulator, this is a matter which Guild should be made aware of.  However, there are occasions where you need to use your judgement.  If a parent has simply informed you that they’re unhappy with an aspect of your centre yet doesn’t seem overly annoyed or demanding, then this may be a matter which can be sorted by you alone.  Yet if you’re in doubt or unsure, then you should notify Guild. 

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

Notifying Guild of an incident is unlikely to be the cause of a premium increase the following year as Guild’s premium pricing is influenced by a number of factors.  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.  When an early learning staff member handles a matter themselves without the support of Guild, that stress is compounded as they’ll be dealing with a process they’re unfamiliar with. 

Guild has seen cases where an early learning employee’s own response has either not provided the required information, or a response has been worded 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 Guild isn’t notified as soon as is reasonably possible of a claim being made, the policy holder 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 policy holder 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.

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Imagine if…

You are advised by your State Veterinary Board that a client has complained about the treatment you provided, suggesting it was performed negligently.  As you’re sure your treatment was appropriate, you immediately reply to the Board informing them of your version of events.  Some time after you hear from the Board again stating that they still have questions about your treatment and will be investigating further.

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 has noticed a worrying trend where policy holders are responding to complaints on their own without first notifying Guild.  This can have a number of consequences for these people 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 your Veterinary Board has notified you of a complaint from a client or other person and the Board has asked you to reply with your version of events.
• If a pet insurer has requested access to your clinical records as evidence of treatment provided and billing practices.
• If a solicitor or law firm representing a client has requested access to your clinical records.
• If a client has complained directly to you or your clinic with a formal demand for compensation or suggested they’ll make a notification to the Board.
• Any other circumstance where you have an uneasy feeling about an incident or situation; when in doubt, notify! 

When to notify Guild

Policy holders 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 replying to a Veterinary Board following an allegation, when there is a request for clinical records from a solicitor or funding provider or when there is an allegation of an animal suffering harm following treatment.  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 their animal didn’t respond as hoped to treatment 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, then you should notify Guild.

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

Notifying Guild of an incident is unlikely to be the cause of a premium increase the following year as Guild’s premium pricing is influenced by a number of factors.  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 veterinarian.  When a veterinarian handles a matter themselves without the support of Guild, that stress is compounded as they’ll be dealing with a process they’re unfamiliar with. 

Guild has seen cases where a veterinarian’s own response has either not provided the required information, or a response has been worded 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 veterinarian 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 veterinarian 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.

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A number of errors where medications are dispensed to the wrong customer are reported to Guild Insurance every year.   Of note, many of these occurred when a pharmacist dispensed scripts for two or more members of the same family.  For example, the pharmacist labelled the medications intended for a woman, with her husband’s name.

Similar errors have also occurred when pharmacists dispensed medications via dose administration aids.  For example, Webster packs were prepared correctly, but the pharmacist then put the wrong person’s label on the pack.

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 have serious consequences for you and your customers.

Cases

A pharmacist was processing scripts for a customer and her husband.  The pharmacist inadvertently labelled Carvedilol 12.5mg with ‘Mr’ instead of ‘Mrs’.  As a result, the woman’s husband began taking the medication as directed.  He experienced hypotension and dizziness, causing him to fall and suffer a fractured scapula.

A number of customers were waiting for their scripts to be dispensed.  The pharmacist called out the customer’s name and a woman stepped forward and collected the script.  The customer left the pharmacy and commenced taking the medication as directed. Sometime later, the pharmacist realised that the wrong customer had taken the dispensed medication.  The customer had claimed someone else’s script for Karvea 300mg instead of the Chlorsig eye drops she had been prescribed.  Unfortunately, by the time the customer had been located she had taken the medication and suffered severe hypotension requiring hospitalisation.

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.
• Use alert tags or signs to help distinguish between people with the same or similar surname.
• Don’t process scripts for two or more customers at once. Many errors occur when the wrong person’s labels are affixed to a medication. Don’t rely on the customer to tell you that the label is incorrect.
• Ask the customer to identify themself before handing over the dispensed item. It is not uncommon for the wrong customer to step forward and claim a script. Nor is it uncommon for a customer to say “yes” to the wrong name!
• 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.
• Reducing distractions when a pharmacist is dispensing is everyone’s responsibility. Agree to strict rules for minimising interruptions and distractions in your pharmacy.
• Promote a culture where all staff are confident to point out risky practices when they occur.

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Osteopaths, like any health professionals, must take care to clearly and effectively communicate throughout the treatment process in order to avoid misunderstandings which may threaten the osteopath patient professional relationship.

An osteopath must ensure that a patient consents to each part of the treatment process, and it is important to be highly sensitive to signs that the patient is uncomfortable or has potentially withdrawn consent.

While an osteopath may be accustomed to treating patients who are in a state of undress, an individual patient may not be comfortable or understand why they are required to be in a state of undress in the presence of their health practitioner. Osteopaths have a professional responsibility to provide each patient with appropriate covering, and respond sensitively and respectfully to each patient’s needs.

Practitioners are reminded to keep discussions with patients professional at all times. Be wary about discussing personal matters. Casual comments about a patient, even where intended to make the patient feel at ease, may be misinterpreted. Conversation should be limited to topics that are appropriate in the clinical setting.

Case Scenario:

A female patient attended for the treatment of a left knee injury sustained from running. The practitioner requested the patient remove her jeans. The purpose was to allow the practitioner to examine how the patella tracked and also to assess how the tissues surrounding the patella were moving. Towels were available but not offered. The patient felt uncomfortable and could not recall the practitioner explaining why she needed to undress. The patient complained to the Australian Health Practitioner Regulation Agency (AHPRA).

The Likely Finding:

The request to remove clothing was clinically justified. The practitioner acted inappropriately by not offering some sort of covering. The practitioner also acted inappropriately by not clearly communicating the need for the patient to remove her jeans, before making the request. In all of the circumstances, the practitioner’s performance is likely to be regarded as below the standard reasonably expected of an osteopath of a similar level of training and experience.

Common Errors

Issue	Comment
The practitioner gives a special status to a patient	The giving of special status to a patient, even where there is a familial or friendly connection, is a warning sign of potentially crossing professional boundaries.
The practitioner does not ‘offer’ a towel or robe to a patient who is in a state of undress	Where a patient is asked to disrobe/partially disrobe, the practitioner should provide suitable covering during an examination. Clean gowns or towels should always be offered and freely available for all patients. It is important to actively offer towels or robes to a patient who is requested to undress. Where towels or robes are clearly available, the Board still requires the practitioner to actively ‘offer’ them to the patient, and a failure to do so may amount to unsatisfactory professional performance.
The practitioner requests the removal of clothing without explanation	Practitioners must communicate the clinical need for the patient to remove any part of their clothing. This requirement is clearly set out in the Osteopathy Guidelines – Sexual & Professional Boundaries.
The practitioner stays in the room while the patient dresses or undresses	Practitioners should not remain in the room while a patient undresses, even if the patient raises no objection and dismisses the need for the practitioner to step out of the room. A space must be provided for patients to undress in private, and there should be an increased degree of care and skill in communicating with patients when they are in a state of undress.

 

Effective communication is the key to avoiding any misunderstandings on the part of patients regarding the nature and need for all aspects of their clinical care.

This article was written by Principal, Kellie Dell’Oro and Graduate Lawyer, Marianna Kirchmann. Please contact Kellie Dell’Oro if you have any questions or would like further information.

Kellie Dell’Oro
Principal

T | +61 3 9810 6775

E | kdelloro@meridianlawyers.com.au 

Case studies from practices

• A client claimed her dog was harmed as a result of a medication error. She alleged the dog suffered ‘tick poisoning’ after the practice supplied an inadequate dose of ‘tick prevention medication’. The dose given was calculated on a lower weight range than the dog’s current weight.
• A client alleged his dog died from renal failure as a result of incorrect dosing with an anti-inflammatory agent. The wrong weight had been recorded in the animal’s record. Although the dog was a small breed, a weight of 28kg was recorded. The veterinarian then used that weight to calculate the dosage, without recognising that it was unlikely to be accurate for a dog of that size.
• Guild Insurance also receives a number of similar claims every year where the cause of the incident is difficult to identify. In some instances, the veterinarian simply made a prescribing error and recorded the wrong dose or medication. In others, doses were weaned or titrated incorrectly. That is, a dose was increased when it should have been decreased, or a medication was continued long after it should have been ceased. While many of these errors result in minimal or no harm to the animal, some have had serious consequences. Errors involving prednisolone, NSAIDs or insulin have allegedly caused renal and hepatic failure. Some animals have died.

Tips for practice improvement

• The cases above serve as a timely reminder about just how easily errors can occur. Fatigue, distraction, lack of decision support tools and poorly designed work areas are all recognised as common contributing factors. Therefore, take the time to evaluate your current prescribing and dispensing practices.
  • Are you really doing everything you can to reduce the risk of error? Is your clinical workflow conducive to safe practice?  That is, do poorly designed work areas make it difficult to access things like dosing charts, calculators or product information?
  • Is your prescribing system easy to use and supportive of safe practice?  Have you considered using software with inbuilt alerts to warn you of prescribing errors?
• Always verify an animal’s weight before prescribing or dispensing medication. Weigh the animal at the time and reconcile what’s documented in the record. That is, does the recorded weight seem reasonable for the size, breed and condition of the animal? If it’s not possible to weigh the animal at the time, clarify the recorded weight with the client and again consider what is reasonable for the breed.
• Instruct staff to be particularly careful to double check and dispense the correct size of any medication. For example, 20 mg and 50 mg tablets of some popular NSAIDs may look very similar, but dispensing the wrong ones may cause disastrous consequences.
• Consider the benefits of asking another member of the practice to double check your calculation or selection, particularly if you are working under pressure or fatigued.
• To reduce the chance of inadvertently selecting the wrong medication from the shelf, introduce measures to differentiate between medications that look or sound similar. Ideas include the use of separators and flags, along with avoiding the temptation to store stock in strict alphabetical order.
• Instruct staff to point out all directions on the label and packaging when handing medications to the client. This not only helps to educate them, but serves as a final check against any error.
• Ensure staff always take the time to explain to a client what is meant by using a medication ‘off label’. There have been cases where this has not been explained to the client and they have later complained when they have read the label and seen it is not recommended for their animal.
• Use ‘alerts’ to help distinguish between the records for different animals belonging to the same client. Errors can occur when information, such as weight or test results, are inadvertently entered in the wrong record.
• Promote a culture where all staff are confident to point out risky medication practices when they occur.
• Finally, don’t believe these scenarios couldn’t happen in your practice. While the financial impact can be costly, the impact on your reputation shouldn’t be underestimated. Increasingly, people are choosing not to return to a practice once an error has occurred, instead venting their dissatisfaction via social media and the like.

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