Employment related disputes are an increasing trend in child care and early learning claims reported to Guild Insurance.  These claims indicate that some employers may not be aware of their obligations and the laws governing them as an employer.  This can have serious consequences for their business as there are a number of legal avenues available to an employee if they feel they have been treated unfairly.

Case examples

• Following complaints about an employee’s unprofessional conduct towards children, the employer investigated the matter and subsequently decided to terminate the employee. The employee then lodged an unfair dismissal claim with Fair Work Australia.
• An employee lodged a complaint with Fair Work Australia claiming she was expected to attend meetings outside of work hours and was not paid for these. Her employer claimed attendance was optional and that’s why she was not paid.
• An employer did not pay the outstanding wages and leave entitlements to an employee following their resignation. The employer stated this was because of the unprofessional conduct and behaviour of the employee since leaving. A complaint was lodged with Fair Work Australia.
• An already employed staff member undertook a course of further study. During this period his salary was dropped to a trainee salary. The employee disputed this and claimed back pay.

How to avoid or manage these claims

It’s important for every employer to understand that there are laws which govern what they do as an employer.  There are laws surrounding salaries and awards, leave entitlements and terminating employment.  Employers can’t simply do as they please, no matter how their employee behaves.  They must follow the law.

The following two websites contain a great deal of easy to follow information to assist employers, and employees, understand their obligations.

• fairwork.gov.au
• fwc.gov.au

If you employ fewer than 15 people, you need to make yourself aware of the Small Business Fair Dismissal Code.  Details on this can be found at fairwork.gov.au/ending-employment/unfair-dismissal.

Whilst you aren’t expected to become an expert in employment law, it is worth becoming familiar with the 10 National Employment Standards.  Information on these can be found at fairwork.gov.au/employee-entitlements/national-employment-standards.

If you find yourself in a difficult situation regarding an employment matter and you hold a Guild Insurance Early Learning Business Insurance policy, you are entitled to two (2) hours of free legal advice under the policy.  This advice can assist you to deal with a matter correctly and fairly whilst it’s still in its early stage which may prevent the situation escalating into a more serious legal matter.

Final key tips

1. Keep records of all discussions had with staff regarding performance or warnings, even if meetings are informal. Complaints can arise many months after an event and you may not recall what was said or agreed to.
2. Follow correct procedural fairness when there is any sort of employment related investigation. Assistance with this can be found at fairwork.gov.au.
3. Don’t make decisions in the heat of the moment. Take time to think about a matter before acting.
4. Be aware of your obligations when making arrangements for staff who are returning to work following parental leave (fairwork.gov.au/leave/maternity-and-parental-leave) or having been injured (seek information from your state or territory workers’ compensation authority).
5. Seek legal advice before acting to be sure you comply with the law. As previously mentioned, legal advice is available under the Guild Insurance Early Learning Business Insurance policy.

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All employers, business owners, contractors and employees have an obligation to create and maintain a safe working environment.  And to do this we all need to think about what makes our workplace unique in terms of the risks and the strategies needed to keep it safe.

There are a few ways in which osteopathy clinics can pose risks to the personal safety of practitioners, other people who work there and patients.  One on one consultations mean that the osteopath is always alone with a patient.  Small practices can lead to osteopaths being the only worker present in a clinic.  And the varied hours of clinics will often see practitioners working late at night.

Below are some tips to help you create a safe workplace for everyone who comes into your practice.

• When booking in a new patient who you know nothing about, consider booking them in during a busy time of the day when there are other staff around, rather than when the osteopath will be in the practice alone.

• If you have a patient who for any reason raises some red flags in terms of the osteopath’s comfort levels, only allow them to book in when there are others in the practice.

• When an osteopath is practicing in the evening and is the only person working at that time, consider locking the front door to the practice.  If you do this, explain to any patients inside what you’re doing and why.  And consider your process for other patients who’ll be arriving.  Will you let them know the door will be locked and that they’re to wait outside till you’re ready for them?  Maybe you’ll only lock the door once the final patient for the day has arrived.

• Installing a buzzer on the front door notifies you when it’s been opened, thereby allowing you to be sure when people are entering your practice.

• Consider installing a reception area camera and post clear signage so anyone who enters understands they’re being filmed and will be identifiable.  Don’t use cameras in actual treatment rooms.

• Consider walking patients and colleagues to their cars when it’s late, however be sure to consider your own safety when doing this.  Provide clients with advice on safe places to park.

• Always lock your car doors as soon as you get in, and keep in mind criminals can approach from varying angles so they may be in your blind spot.

• Unfortunately, osteopaths sometimes will be faced with the challenging situation of a patient asking them out or suggesting a romantic relationship begin.  Often when this happens, the patient isn’t aware that relationships between practitioners and patients aren’t allowed.  Thinking about this situation before it occurs and having a plan for what to say and do can make it easier for the osteopath to deal with it immediately and professionally. If patients appear reluctant to accept your refusal, make sure they’re booked when others are on site, or with other practitioners in future.

• If the practice is in the home of the osteopath, have processes in place to separate the living space from the practice and therefore protect the privacy and safety of the practitioner and their family members, especially children.  And be aware, family members may also breach a patient’s privacy or modesty so ensure everyone in your household understands the rules.

• Keep records of any uncomfortable, challenging or threatening behaviours from patients, and be sure to save anything that’s received via text or email.  This information is to be recorded in the patient record.  The details on what occurred can be brief yet must be professional, keeping in mind records can be seen by others.

• Don’t contact patients via your personal email or mobile phone or provide these details to them. If you need to contact them while off-site, put your phone on “No Caller ID” so they don’t have access to your phone number.  If you leave a voicemail message, ask the patient to call the clinic phone, not your mobile.

• Have a practice policy that advises against practitioners connecting with patients on social media as these connections can contribute to the blurring of professional boundaries.  And be sure to understand the privacy settings of any social media platforms used.

• Discuss any challenging or awkward situations with your colleagues or other osteopaths and even other healthcare professionals.  This not only provides support when dealing with challenging situations, it also can provide additional tips for how to manage these situations.

• If you’d like some assistance to deal with a challenging patient who’s making you feel uncomfortable or threatened, contact Osteopathy Australia for advice and support.

It’s important to remember that work, health, and safety laws apply to everyone in the business, including contractors, not just the business owner. A safe work environment is in everyone’s best interest so open communication about any concerns is the best way to protect all staff members. 

Guild Insurance regularly manages claims where a patient has been treated by more than one practitioner. This has led Guild to explore how treatment by multiple practitioners may contribute to complaints by patients which can lead to an insurance claim.

Evaluating another practitioner’s work

It’s quite likely that many natural therapy practitioners will at times treat a patient who’s previously been treated by another natural therapy practitioner.  And in some of these cases the practitioner may have questions about that previous treatment, such as when:

• the treatment may not seem to be up to the appropriate standard,
• the treatment selected may not appear the be the most ideal or obvious choice, or
• it may seem as though the treatment provided has not led to the intended or expected outcome.

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

How can these complaints be avoided?

• Don’t make comments to a patient judging the treatment another practitioner has provided.  It’s possible that the clinical situation you’re seeing is not the same as what the first practitioner saw.  Also, if the patient has told you what their treatment consisted of, it’s possible they might be incorrect due to their lack of clinical knowledge.  Making even what you see as a small or insignificant comment to a patient regarding the choice and quality of treatment provided by another practitioner could be enough to encourage that patient to make a complaint.

• If you’re seeing a patient for the first time, be careful to not fall into the trap of simply relying on the patient telling you what their previous treatment entailed or just relying on previous patient records.  You need to have a thorough understanding of the patient’s condition; only then can you decide what therapy will be most appropriate.

• If you’ve taken over the treatment of a patient from another practitioner whose health records are insufficient, you may need to spend some time doing further assessment before continuing with their ‘usual’ treatment. It’s advisable to engage the patient in a positive conversation on why you’re doing that, to manage their expectations.

• Managing patient expectations from the outset is vital.  Make patients aware of what to expect from their treatment; they won’t want surprises.  The more they understand about their treatment and likely outcomes, the less likely they are to be dissatisfied and look elsewhere for treatment.

• Building relationships with patients is an important element in running a successful practice.  Get to know your patients and give them a reason to trust you and come back to you. 

• Patients can become frustrated with ongoing costs of treatment, especially if they aren’t seeing the benefit they’d expected.  Always be open and upfront about the cost of treatment.  And where possible, let them know how many treatment sessions you anticipate they’ll require to achieve the anticipated outcome. 

• Documentation is vital! The key to dealing with a dissatisfied patient who’s considering making a claim or complaint against you is your accurate health records.  If your work is being questioned by a patient, or another practitioner, you’ll need a record of the facts behind your decision making.

• Avoid offering refunds or free treatments in the event of a poor or unexpected outcome.  This may be seen by the patient as an admission of responsibility or liability and they may expect that discounted or free treatments will continue.  Always contact Guild Insurance on 1800 810 213 before offering any form of compensation to a patient.

And finally, maintain a high level of professional and appropriate behaviour at all times, both when treating patients and anytime you’re communicating and interacting with them.  This not only reflects well on you, it can also improve the public perception of natural therapy as a profession. 

Download PDF here.

Many dentists would have experienced situations where a patient has attended for an appointment and informed their dentist how they want to be treated.  These patients present a number of potential risks for the treating dentist.  Below is information dentists should consider when in this situation.

Patient expectations – when a patient has formed their own opinion about the treatment they require, they have possibly also formed an expectation regarding the outcome of that treatment.  It’s possible that this expectation isn’t realistic and may not be able to be met.  With all treatment provided, the dentist needs to have a conversation with the patient prior to treatment beginning to be sure their expectations regarding outcomes are realistic.

Clinical assessment – regardless of what a patient thinks they know about their condition or what treatment they’ve requested, it’s always the responsibility of the dentist to conduct a thorough clinical assessment to form their diagnosis.  This information is vital so the dentist can provide the patient with treatment which is clinically required and appropriate for their situation.  A request from a patient does not justify rushing this important process or making assumptions.

Informed consent – treatment requests from a paitent should not be considered informed consent for that treatment.  Informed consent requires the patient be informed, by the treating dentist, of their treatment options, the intended or expected treatment outcomes and the risks of treatment.  It should not be assumed that a patient who has requested treatment has this required information; there should always be a discussion to be sure the patient is fully informed.

Considering the patient’s wishes – when a patient presents with a request for particular treatment, the dentist may feel they’re in a challenging position from a communication and patient relationship perspective.  There may be cases where what the patient is asking for is completely inappropriate or not possible.  Yet if the patient feels their request has been simply ignored, they may not be happy with the level of service from the dentist.  The dentist therefore needs to be mindful how they approach the conversation about other treatment options and the reasons for these.

Clinically justified treatment – all dentists are responsible for any treatment they provide, and they need to be sure it is clinically justified based on that patient’s individual clinical situation; requests from patients don’t lessen this requirement.  If treatment provided is found to be inappropriate or harmful, stating that the patient requested it would not be considered a reasonable defence. 

Communication – all of the above information requires effective communication from the dentist.  It’s important that all health professionals never underestimate how important communication is to help patients understand their treatment options. And it’s also worth keeping in mind that patients don’t just complain about poor clinical outcomes, many also complain about how they’ve been communicated with or made to feel.  It’s therefore imperative that the conversation between the dentist and patient is had in a respectful way so the patient feels they’ve been listened to, even if the treatment they’ve requested is not what will be provided.

Download the pdf here.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice.  Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

There are an increasing number of dental services available which are direct to the consumer, meaning the consumer hasn’t consulted directly with a registered dental practitioner.  While the convenience of these services is obvious, they aren’t without risk for both the consumer and any registered dental practitioner involved.

These direct services are available for several dental treatment areas such as orthodontic aligners, splints and sleep appliances.  These services can be initiated by the consumer creating their own impression using materials and information provided to them.  In other cases, the patient may have a digital scan carried out by the service provider at a designated location (shopfront or pharmacy), often by someone who is not a registered dental practitioner.  Following this, a treatment plan is developed and the device(s) required will then be provided to the patient for use.  Some of these services also offer mechanisms for remote supervision of treatment progress by a dental professional.

One of the concerns with this type of treatment model is that other dental issues, not directly related to the appliance, may not be detected due to the patient not being regularly assessed and treated in-person by an appropriately registered dental practitioner.  There are also concerns about how patient suitability (or standard of care case selection) is determined.  While some companies providing these services do have a process of assessing the suitability of the appliance for each patient, this is often done by the patient completing an online assessment form themselves; therefore, there is no assessment for suitability by a registered dental practitioner.

There may be occasions where a dentist, who isn’t involved in this treatment model, has a patient ask them about their views on it or asks them for support in completing forms required to purchase one of these devices.  Dentists should be aware that if they provide clinical advice, they are involved in the treatment.  It’s therefore recommended that dentists contact their ADA Peer Advisor (NSW/ACT) or Community Relations Officer (Victoria, South Australia and Tasmania) if they find themselves in this situation so they can obtain advice on how to best manage this situation.

Dentists who choose to participate in these treatment models need to understand and appreciate their level of responsibility and possible liability.  Regardless of whether or not a dentist has seen or consulted with the patient themselves directly, involvement in design of such appliances or other aspects of their provision and use may be deemed by regulatory bodies to be provision of a dental service.  Registered practitioners, when providing a dental service, must ensure their professional obligations are always being met. 

If a consumer is dissatisfied with the outcomes of their treatment and they’re aware of a registered dental practitioner who was involved in their treatment in some capacity, they have the same rights as other patients to formally complain to regulatory authorities or make civil claims about the treatment provided by this practitioner.  To defend against allegations of wrong-doing, this practitioner would need to show that:

• the treatment and/or advice they provided was to the professional standard expected;
• they are appropriately qualified and experienced to be providing that treatment and/or advice;
• the treatment and/or advice was clinically justified;
• the patient was aware of the risks, expected outcomes and limitations of the treatment; and
• detailed clinical records have been maintained, showing exactly what was done and why.

It is therefore strongly recommended that any registered dental practitioner choosing to become involved in any capacity in providing treatment through this direct model considers the risks involved and be certain these risks will be appropriately managed.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them. 

Every year at Guild Insurance, the veterinary liability claims reported to us are analysed to ensure we fully understand what clients are complaining about, what’s going wrong and what can be done to address this. 

The information below provides a summary of what’s been learnt from this process.  Unfortunately, the best risk management practices can’t guarantee a complaint won’t occur, that’s why you need insurance.  However, being aware of common complaints, and how to reduce the likelihood of them, is something all vets should be aware of.

Why clients complain

Treatment has been unsuccessful – this is when the treatment hasn’t gone to plan, and the outcome isn’t as intended.  This is most commonly seen following de-sexing procedures.  Clients are often not only unhappy about a poor outcome but can also be motivated to complain due to a sense their time and money has been wasted.

Treatment was inappropriate – this means it’s alleged there’s been a poor outcome because the treatment shouldn’t have been provided. This may be because the treatment selected was an incorrect choice or that the vet should have referred to someone else to provide treatment.

Diagnosis issue – a client might complain if they believe the diagnosis, and therefore the treatment which followed, was incorrect.  Or they might think it took too long to form the correct diagnosis.  Generally in these cases the client’s unhappy with the time and money spent during the diagnosis phase and the potential harm to their animal during this period.

Medication error – common medication errors include the animal receiving an incorrect dose, the animal receiving the incorrect medication, or the medication being administered incorrectly. Generally medication errors are due to human error where the vet has made a simple, but at times serious, mistake.

New injury – this is when the animal has suffered an injury during treatment.  Common examples of this include an organ being damaged during surgery or an animal (horse or cattle) suffering a rectal tear during an examination.

Tips for reducing complaints

Communication – don’t underestimate the importance of communication with clients and colleagues; our claims tell us that breakdowns in communication contribute to complaints.

Manage expectations – if clients have unrealistic expectations, those expectations most likely won’t be met, and the client won’t be satisfied.  An important part of communication is ensuring clients understand what the likely and realistic outcomes of treatment will be.

Informed consent – another key part of communication is ensuring clients understand treatment options, treatment outcomes and potential risks so they can give their informed consent to treatment.  Clients should also be made aware of the anticipated cost of treatment so they can give their informed financial consent.

Clinical decision-making – it’s important to not rush the assessment, diagnosis and treatment selection process.  When the necessary time and care isn’t taken, assumptions and mistakes can be made.

Record keeping – keeping detailed records of all aspects of treatment, as well as any communication with the client, assists with the continuity of care of the animal over time. Detailed records will also assist in the defence of an allegation of wrongdoing.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791. This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

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You said what? Appropriate conversations in chiropractic

Complaints of wrongdoing against chiropractors isn’t always about the treatment provided or the clinical outcome.  Guild Insurance sees numerous cases annually which relate to the professional behaviour and conduct of a chiropractor.  This sort of complaint may initially seem less serious than those relating to poor clinical outcomes, however, having your professional conduct questioned and issues raised about inappropriate behaviour towards patients can be incredibly distressing. 

Some of these professional conduct complaints relate to conversations, both during and outside of the consultation.  Once investigated, it’s usually found that the chiropractor in no way intended to breach any professional boundaries or make the patient feel uncomfortable.  However this is what’s occurred.  The information below has been created to assist chiropractors understand what they should be doing and saying differently to avoid facing a complaint similar to the following examples.

Examples of inappropriate conversations

• A patient complained alleging the chiropractor made them feel uncomfortable by asking questions about being a single parent.The chiropractor claimed it was only done to understand more about the patient’s lifestyle, however the patient felt judged by the chiropractor.
• A patient complained of feeling uncomfortable as the chiropractor lowered the patient’s pants during treatment without consent.Following investigation, it was found the treatment provided and lowering the patient’s pants was, in this instance, clinically justified.However, distracted by a chat they were having about weekend activities, the chiropractor forgot to continually talk to the patient about treatment and didn’t seek the patient’s informed consent before moving clothing.
• A patient complained about questions the chiropractor asked about dating.The chiropractor claimed the conversation was just intended as a friendly chat, however the patient felt the chiropractor was trying to initiate an intimate relationship.

Tips about professional conversations

• Don’t become too friendly with your patients.While it’s clinically beneficial to build a rapport with patients, a professional boundary needs to be maintained.And this boundary means there are conversations you would have with a friend or family member which you shouldn’t have with a patient.Conversations should be had in a professional manner so avoid becoming too casual, relaxed or jokey when talking to patients.Often comments made in light humour, or to build rapport, can lead to difficult situations and potentially embarrassing accusations or reputation damaging conditions on your registration.What may be funny to you may not be to someone else.The relationship with a patient should always remain a professional one; keeping in mind the patient is paying for a healthcare consultation not a social chit-chat.

• Limit non-professional or non-treatment related conversations. These types of conversations can easily complicate and confuse a professional situation.When a practitioner asks personal questions of their patient, this is most likely intended to just be a friendly chat.However patients often report being confused and uncomfortable and don’t understand why they’re being asked questions not related to treatment.While some conversations may be fine, such as asking how a person’s weekend was, things can easily change when more questions are asked, such as about the partner they spent the weekend with.
• Explain to patients why questions are being asked. If you do need to ask some personal or lifestyle questions to assist with history taking or to better understand an injury or pain, be careful to explain why you’re asking.
• Don’t forget to keep talking about treatment.When non-treatment related discussions are had, this detracts from time which should be spent discussing treatment.The discussion about treatment shouldn’t just be had at the beginning of the consultation, it’s an ongoing conversation throughout.Not only can chats about something other than treatment make a patient feel uncomfortable, it may also mean the patient isn’t fully informed about their treatment.
• Consider the situation of the patient during a conversation.During treatment, patients are often sitting or lying in positions which may make them feel vulnerable or exposed.Personal conversations had during this time are likely to compound the uncomfortable feeling.Keep in mind a patient could easily misinterpret the intentions behind your questions or conversation if they’re already feeling uneasy.
• Consider the method of communication. SMS, email and other forms of electronic communication encourage brief messages and don’t often adequately convey the full intent or tone of the message.Therefore, if communicating in this way, practitioners need to be mindful that patients may easily misinterpret the message and make assumptions.Also, don’t forget that electronic communication, as with all communication with a patient, needs to form part of the clinical record for that patient.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice.  Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

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Receiving a complaint is an unexpected part of running any 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 patients might complain about the service they’ve received. Sometimes a complaint will almost be expected following an incident; sometimes it’ll take you by complete surprise. Understanding why people might complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.

The following are some of the reasons why people may feel the need to complain.

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

Unrealistic expectations – it’s possible that patients may have unrealistic expectations about what they can reasonably expect from the service you provide. Their high expectations may at times surprise you. It’s therefore important to remember that most patients will not have the clinical knowledge you do and what’s obvious or common sense to you may not be to them. A sonographer must assist patients to be clear and fully informed about the service being provided and the outcomes they can realistically expect.

To inform and be heard – patients may wish to make a complaint about an incident or poor outcome so they’re sure someone’s aware of what’s occurred and how they feel. They may wish to complain just to be listened to and acknowledged, especially if they’ve 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’s no one person responsible but just an unfortunate set of circumstances. However, if a patient thought something had gone wrong and this led to them being harmed, it’s quite possible they may complain with the intention of holding someone responsible and possibly liable.

The importance of managing complaints

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

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

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 procedure to avoid that issue arising again in the future.

How to manage complaints

It’s advisable that every business has a complaints policy. This means that the business will have an agreed-to process for dealing with a complaint 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 quite 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’ve told you. You may not agree with all they’re 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 to not 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’ll 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.

Managing complaints in sonography

Examples of inappropriate conversations

Operating a business during the COVID-19 pandemic has presented many challenges. Unfortunately, many businesses closed for a period of time while others worked on reduced hours. And for others, staying open meant finding new ways of doing so, such as by providing virtual services. As the world starts to consider how to move out of pandemic restrictions, it’s important for all business owners to carefully consider the approach they’ll take and the associated risks. The fallout of COVID-19 is likely to be with us for some time, so we all need to be careful to not become complacent and make changes too quickly.

Government requirements

Firstly, all business owners need to be sure they’re keeping up to date with and adhering to government requirements and regulations. This can at times be challenging as the federal government is making recommendations, yet all state and territory governments are moving at different paces in terms of lifting restrictions. All business owners need to take responsibility for being sure they understand what they can and can’t yet do regarding their operations. Information about this can be found on the following websites:

Australian Federal Government - www.australia.gov.au 

ACT - www.covid19.act.gov.au

New South Wales - www.nsw.gov.au/covid-19

Northern Territory - www.coronavirus.nt.gov.au

Queensland - www.covid19.qld.gov.au

South Australia - www.covid-19.sa.gov.au

Tasmania - www.coronavirus.tas.gov.au

Victoria - www.vic.gov.au/coronavirus-covid-19-restrictions-victoria

Western Australia - www.wa.gov.au/government/covid-19-coronavirus

Business owners may also wish to seek guidance and clarification from their professional association.

Gradual changes

While it’s understandable that business owners want to get back to how things were pre-pandemic, it’s advisable that changes aren’t made too quickly. Rushing could see changes being made which aren’t allowed or aren’t safe if they haven’t been carefully considered. It could also result in staff not understanding the changes and not adhering to them as they should. It’s important to remember we may not continue transitioning out of restrictions. Unfortunately restrictions could at any time be wound back which is another reason why a planned and measured approach is ideal.

All changes should be communicated to clients. This means they’ll feel reassured and trust that your business is continuing to operate safely. It also helps your clients understand what you expect from them to maintain this safety. This communication can be done in a variety of ways, such as by simply posting notices around the premises or sending email updates.

What works for you?

Not all businesses and business owners are the same and therefore how they provide services during the period of restrictions and how they transition out of these will, and should, differ. You should consider the following when planning to transition out of restrictions:

> Is the current way of working successful? If the changes you’ve made to the business during the restriction period have worked well for you, you may feel less urgency than others to move away from these.t of

> Does the service you provide require contact with others? The services provided by some professionals requires them to come into close contact with their clients, whereas other services can be offered from more of a distance. When thinking about making changes to your services, you need to carefully consider how close this will require you to be to your clients and if this is something you think you can do safely.

> Are your clients high risk in relation to COVID-19? If your clients are at an increased risk, possibly due to their age or health condition, this should be seriously considered when assessing how the business provides its services.

> Are you, or someone you live with, high risk? It’s not just the health of your clients you need to consider when making decisions about how to run your business. You also need to consider your health and that of those you live with. Remember, this is a highly contagious virus which can have devastating consequences; please don’t risk your or another person’s health.

Insurance cover

All business owners and professionals need to be sure they have insurance to cover them for what they do. During the period of restrictions, when some professionals changed the way they were working this led to changes in their insurance cover. Therefore, as you come out of restrictions and again change the way you provide services, you need to be sure your insurance covers those services as well as the hours you’ll be operating and the estimated income.

Trust your instinct

There are unfortunately cases of clients pleading with business owners to open when they aren’t ready and even when in breach of government restrictions. This puts unfair pressure on business owners to do the wrong thing to keep their clients happy. Of course one of the core functions of running a business is to keep clients happy and satisfied, after all they keep you in business. However this can’t be done when it’s potentially detrimental to the health of you or others. When making changes to come out of restrictions, ensure these are planned, well thought through and explained to your clients. If they do try to convince you otherwise, reiterate your reasons to them and don’t allow yourself to be convinced to do something you know isn’t appropriate.

In summary…

As more and more businesses are coming out of their restrictions and returning to their usual services, it can be very tempting to follow suit. However, please be sure no changes are made without careful consideration and planning, as the risks are too great.

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It might be surprising to know that telehealth has been occurring for about 100 years now; there’s evidence of radios being used in the 1920s to provide clinical advice to people in remote locations. The way telehealth is conducted or provided has changed greatly over the years as the technology which supports it has changed and developed.

What is telehealth

Telehealth is providing health services remotely with the use of technology. There are many forms of technology which assist this such as phone calls, teleconference calls and sharing of images and videos.

There are many reasons why telehealth is used, however, they primarily boil down to the patient and practitioner not able to physically be in the same place. This may be because of geographical remoteness. Age or disability can prevent patients from travelling to their practitioner. And now social distancing requirements to reduce the spread of COVID-19 is making face to face appointments difficult and potentially unsafe. Therefore, telehealth is very beneficial, however it isn’t without risk. And these risks need to be considered and managed before this service is offered.

Is it right for you?

All business owners want to stay ahead of their competitors and provide the best service possible to their clients. However, this can mean at times business owners leap into something new too quickly without proper consideration and assessment.

Telehealth isn’t ideal for all health practitioners. Before you start offering telehealth services, do some research that will help you assess if it’s right for your business, your patients and the services you provide. Consider the pros and cons; think about how it’ll benefit your business but also consider the risks and challenges it’ll create.

You should consider developing an implementation plan to assist you in working through a range of factors to consider, such as:

• Which services will suit telehealth, which won’t?
• Who’ll assist with providing and supporting the technology required?
• How will this new process be communicated with patients?
• How will patients be assisted if they have difficulty with the technology, or simply
  don’t want to use it?
• Will the process be phased in gradually?
• How will it be evaluated?

Invest to do it well

The old saying ‘if something’s worth doing it’s worth doing well’ really does apply to implementing telehealth practices. When technology works well, it’s fantastic, when it doesn’t, it can cause a huge amount of frustration and time wasting. It’s therefore important that health practices don’t rush into implementing telehealth practices. It’s worth taking the time to ensure the tools and technology used are suitable for that individual practice. It’s also recommended that time is spent training all staff to be sure they understand how to use the new technology and what’s required of them with this change. Investing both time and money at the beginning will benefit the practice, practitioners and patients in the long term.

Some things stay the same

Much of what you already do, and what you’re required to do, as a health practitioner won’t change when using telehealth.

• Communication – communication is always incredibly important for all health practitioners. However, it needs additional focus when consulting via telehealth. Practitioners may find they need to spend longer having conversations and should consider what questions they’ll ask the patient to be sure information has been understood.

• Record keeping – you need to keep detailed and accurate records of all consultations and communications with patients, and this includes when using telehealth. It’s not just about actual consultations, even details about phone conversations with patients need to be recorded. If a consultation takes place via telehealth, make a note of this in the clinical record including the type of technology needed.

• Informed consent – you need to ensure patients give their informed consent prior to treatment. Providing signed informed consent is a bit harder when consultations take place remotely, yet this can still be done in some cases. However verbal consent is sufficient. But remember, informed consent can only be given when the patient has been informed about the treatment, so sending a form to be signed to a patient before there has been any discussion or consultation isn’t appropriate. Also, verbal informed consent must be noted in the clinical record.

• Privacy – you have a professional obligation to maintain the privacy and confidentiality of your patients. Therefore, when conducting a telehealth consultation, be sure it’s done in a private setting where no one in the background can hear or see what’s happening. Many forms of online communication, such as teleconferences, have a recording function. Consultations shouldn’t be recorded simply because they can. They should only be recorded if there’s a clear and specific reason for it and if the patient has given their consent.

• Duty of care – health practitioners have a duty of care to all patients they treat. If a patient is being treated using telehealth and has never met the practitioner prior to this, this doesn’t change anything in terms of the practitioner’s duty of care to that patient.

• Clinical decision making – Incorrect diagnosis is one of the greatest risks with telehealth, yet telehealth is no excuse for mistakes being made. If you don’t have the information needed to make a diagnosis or provide/recommend treatment, you must to find a way to get this additional information. Practitioners may want to consider if their assessment processes alter when using telehealth. Practitioners should also be sure they don’t allow the patient, or the treatment circumstances, convince them to provide treatment or advice that goes against their better judgement.

• Practice within scope – when consulting using telehealth, the need to keep within your recognised scope of practice, and refer when the situation is outside of this, is no different.

• Funding schemes – some funding schemes, such as private health insurers and Medicare, provide cover for telehealth, for some forms of treatment. As the treating practitioner, it’s your responsibility to be sure you’re meeting the requirements of the various funding providers and don’t claim for items which aren’t permitted.

• Regulatory requirements – in addition to the above, any other requirements set by regulatory bodies need to be adhered to. This includes keeping on top of government advice and restrictions relating to COVID-19

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The Coronavirus pandemic has challenged us all personally and professionally, as we live through never before seen challenges. Many professionals and businesses alike are struggling with the ever-changing landscape as they navigate business continuity in a way which is safe for them, their staff and their customers and also complies with changing government restrictions and requirements.

You don’t have to be powerless through this uncertainty, and the key to continue to thrive as we move into the new normal is robust communication with your customers. Clear, concise and relevant  communication with your customers is vital in the coming weeks and months to ensure continued engagement.

As Guild Insurance works across multiple industries, our experience of working with thousands of professionals and their customers puts us in the unique position to understand what customers need from you. We have compiled some information to assist you in developing email communication with your customers.

Please note that this information is generic and should be used as a guide. All businesses are unique and how they’re responding to COVID-19 is also unique. Therefore, you need to create your communication to suit your individual circumstances.

Start your email with an introduction to the situation

E.g. We face challenging times ahead as we navigate through a continually changing
environment caused by the impact of the Coronavirus pandemic. Here at (business
name),we are focused on staying healthy and continue to review our health and safety
processes, so we can keep our doors open to our customers when they need us. A key part of this is to ensure we change our operational practices to maintain compliance
with evolving government recommendations and restrictions and reduce the risks to our
staff and visiting customers. We’re therefore contacting you keep you informed of what
we are doing here at (business name).

Now inform your clients of what you’re doing to avoid the spread of infection in your business

E.g. At (business name), the health of our clients and staff is our number one priority.
Therefore, on top of our usual cleaning and hygiene processes, we’re implemented the
following steps.

• All clients will be asked to wash their hands when they enter the premises
• Hand sanitiser is readily available, and we insist all staff and visitors use it regularly
• We’re asking all clients to wait outside the building, where there is space to maintain
  the recommended distance, rather than in our waiting room which doesn’t allow for
  social distancing. We’ll call you when you should come in for your appointment.
• We are regularly cleaning and sanitising all high touch areas such as doorknobs and counters.
• We will no longer accept cash and will only accept card payments.

Let your clients know if anything about the service you usually provide has changed

• Is there a service no longer available, have modifications been made, is there something new you’re now doing?
• Are you offering services remotely?
• Have opening and closing hours changed?
• Will your usual cancellation policy alter to encourage people to not attend if unwell
• Will you be offering any financial assistance or support to customers who may be experiencing financial hardship?
• Will you offer refunds if people have paid upfront and are no longer able to participate/attend?

E.g. Our usual cancellation policy requires 24 hours’ notice or a late cancellation/no show fee of $40 is charged. However, we are currently waiving this notification period until further notice. This fee will not be charged provided you call us to let us know you can’t attend. Therefore, if you feel that on the day of your appointment you have flu like
symptoms and shouldn’t attend our practice, please give us a call and don’t come in.

Finish with a reminder asking people to not attend your business if they have any concerns about displaying COVID-19 symptoms

E.g. We understand everyone wants to get on with life and do the things they are used
to doing. However, for the time being it may not be possible, and we must do what we can to flatten the curve. At (business name) we’re committed to doing our part to minimise the spread of COVID-19. Therefore, if you are experiencing any flu like symptoms, please consider others and stay home, do not visit our practice. We’re keen to see you again soon, however only when you’re feeling well

As we all do our best to minimise the spread of COVID-19, one of the tragic outcomes is that many businesses need to close their doors for a period of time. This is never a decision made lightly as the ramifications are enormous. There are many factors to consider when doing this, such as how staff will be looked after during this time, if services can be provided online and how to communicate the closure with clients.

Another important consideration should be the protection of the property from which you operate your business. Sadly, vacant buildings can lead to an increase in thefts and burglaries as a lot of crime is opportunistic. Thieves will know that many businesses have closed only temporarily and therefore the buildings may not be empty, there may still be items worth stealing inside.

The following are some tips to consider if you are temporarily closing the physical premises of your business:

• While you want to inform your clients about the change to the business, placing a sign on the front of the building may not be the most ideal way, especially if this will be easily visible for those walking past. If you do want to place information on the building about a
  closure, don’t indicate this is potentially long term or indefinite, simply provide details for clients to contact you.

• Redirect mail to a home or post-office box and place a ‘no junk mail’ sign on the building’s letterbox. A messy overflowing letterbox is a sure sign no one has been frequenting the premises.

• Use a timer to have the lights turn on and off at certain periods of the day, creating a look of someone being in.

• Electronic Security Alarms should be kept operational where fitted.

• Consider which appliances can be turned off as many appliances continue to use power even when they aren’t being used. Items to consider turning off include hot water tanks, televisions, microwaves and computers. However, be sure to think about what you’re turning off before you quickly switch off all power; for example, fridges and freezers, unless empty, should be kept on.

• It’s important to conduct regular external inspections of your property to check the condition, ensuring that it’s safe and there are no signs of attempted entry or vandalism. Where possible, visit your property fortnightly, however, be sure you’re complying with government COVID-19 restrictions when doing this. Maintain the external appearance by removing any rubbish and mail and keep lawns and gardens trimmed.

• Clear out your gutters. A build-up of leaves and other debris creates a fire hazard as well as a risk of an overflow of water entering the roof space during a storm.

• If you have a good relationship with your neighbours, let them know about your closure and be sure they have your contact details. That way if anything goes wrong or they notice anything suspicious, they can let you know.

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Dentists need to acknowledge that adverse outcomes are an unfortunate, yet very real, aspect of dentistry. Whilst dentists may do all they can to avoid these outcomes, they won’t ever be completely eliminated from dentistry, or any other area of healthcare.  Therefore it’s vital that all dentists have considered how they’ll manage an adverse outcome should the situation arise.

What to do following an adverse outcome

One of the first steps a dentist must take when there’s been an adverse outcome is to discuss this with the patient. It’s acknowledged this is a very challenging thing to do, however it isn’t optional.  The Dental Board of Australia’s Code of Conduct states that ‘When adverse events occur, practitioners have a responsibility to be open and honest in communication with a patient’.  It’s well recognised that patients appreciate a healthcare professional being upfront and honest with them in informing them of what has occurred and what this means for the patient.

Many practitioners are hesitant to say sorry when informing a patient of an adverse outcome. There is often a concern that this may mean they’ve admitted guilt and are then more likely to be held accountable.  However, Australian legislation makes it clear that an apology is not an admission of liability.  It’s best to avoid statements such as “I’m sorry I’ve done this to you” as this may be seen as an admission.  An apology needs to be carefully worded and can be as simple as “I’m sorry this has occurred”.

When having this conversation with patients, it’s important to give them opportunities to ask questions. It needs to be a balanced two way conversation, not just information given by the dentist.  This will ensure the patient has a greater understanding of what’s occurred and what the implications are for them.  It also assists the patient in feeling part of the treatment process and decision making moving forward.

It’s common to hear patients state that they want to know what the practitioner and practice is going to do to avoid a similar situation occurring again to either themselves or other patients. This means you need to explain to the patient what you’ll do to understand why the adverse outcome occurred and what measures you’ll put in place to reduce the likelihood of it happening again.

Why are these conversations difficult?

It isn’t uncommon for a practitioner to find it difficult to have this open and honest conversation with a patient following an adverse outcome. This isn’t surprising given many people find it challenging to initiate hard conversations.

In many cases the patient will know there has been a poor outcome as it will be obvious to them. In these cases there is no avoiding the conversation as the patient will probably confront the dentist.  However there will be occasions where the patient isn’t aware, such as when a file has fractured during RCT.  There may sometimes be a temptation for a dentist to not inform patients of these cases, possibly thinking they don’t need to know.  However, this is not an acceptable way to practice.  Patients have a right to be informed about their health outcomes and dentists have an obligation to keep them informed.

There are a number of reasons why a dentist may find these conversations challenging, such as:

• Dentists may be concerned that informing patients of what went wrong and why may increase the likelihood of a formal complaint and demand for compensation.
• The outcome may be a surprise to the dentist, leaving the dentist thinking “I never thought this would happen to me”. If the dentist is struggling to understand what went wrong and why, explaining it to the patient is going to be difficult.
• A dentist may be concerned they’re admitting to professional incompetence.
• A dentist may be worried the conversation will lead to professional or financial repercussions for the dentist or practice.

Benefits of a well handled adverse outcome

There are obvious benefits for both dentists and patients when a poor outcome is well managed.

When a patient has lodged a formal complaint about a health experience, it’s quite common for them to state that they’ve done so as a means for obtaining information and or an apology regarding what occurred and why. It seems that when a situation is not well explained to the patient, they may feel the need to take the matter further, such as a formal complaint, to get the information they need.  It also seems that a patient may lodge a complaint when they feel their concerns have been dismissed and they haven’t received an appropriate acknowledgement or apology.

This is evidence of two things:

• Patients don’t necessarily complain for financial or malicious means. It’s easy to assume that patients complain because they want to receive financial compensation or because they want there to be repercussions for the practitioner who has harmed them. Whilst these may be influential factors in some cases, they aren’t in all situations. There are situations where a patient complains simply to receive further information.
• An open and honest conversation may prevent some complaints from occurring.       If the patient feels the dentist has been up front with what’s occurred, has provided a commitment to rectify the situation and has provided information about how the situation will be prevented in future, many patients may not feel a need to formally complain. They may also be more likely to continue treatment with that dentist as the relationship and trust still exists.

In summary…

Dentists need to remember that they have an obligation as a registered health professional to provide their patients with honest information following an adverse outcome. However, being obliged to do this shouldn’t be the only reason it’s done.

It’s well recognised that patients expect and appreciate this honest conversation. And having this conversation can go a long way towards the patient deciding whether or not to lodge a formal complaint and whether to continue being treated by that dentist.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them. This article contains information of a general nature only, and is not intended to constitute the provision of advice.