A patient charter of rights: how to avoid a toothless tiger and achieve system improvement

• Published in: Canadian Medical Association journal (CMAJ) 2012-10, Vol.184 (14), p.1583-1587
• Main Authors: Flood, Colleen M, May, Kathryn
• Format: Article
• Language: English
• Subjects: Analysis; Canada; Care and treatment; Complaints; Evaluation; Health care delivery; Humans; Litigation; Methods; Patient Advocacy; Patient Rights - legislation & jurisprudence; Patient safety; Patients; Patients rights; Physician patient relationships
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.111050

To explore the potential for a patient charter (sometimes also referred to as a patient bill of rights) to be a galvanizing force for sys tem im - provement, we collected literature on governmentenacted patient charters across 39 jurisdictions (Appendix 1, available at www .cmaj .ca /lookup /suppl /doi :10 .1503 /cmaj .111050 /- /DC1). We con - ducted a keyword search of PubMed, Google Scholar, Westlaw Canada and Quicklaw, using search terms such as "bill of patient rights," "charter of patient rights," "ombudsman" and "complaints commissioner," focusing primarily on publications within the past 15 years. We searched for publications detailing the contents of patient charters in various jurisdictions, in addition to publications assessing the outcomes of the implementation of such charters. We also looked directly at pa - tient's rights legislation from different jurisdictions. Our focus was on national or provincial/ state-level patient charters, as opposed to more local initiatives at the regional or hospital level. Many Canadian hospitals have voluntarily put in place mechanisms for resolving patient complaints. For example, Toronto East General Hospital has a code of patient rights and responsibilities, which includes common patient rights such as access to information about one's care, in - volve ment in decisions about one's care and main tenance of the confidentiality of one's health records.24 However, patients may question the independence of these internal processes given the institution's interest in protecting its own reputation and its close relationship with medical staff. Consequently, it is important that patients have recourse to an adjudicative body they perceive as impartial if they are unhappy with how their concerns or complaints have been handled at a local level. Accordingly, most countries with patient charters have established independent patient ombudsmen or commissioners to resolve complaints using a variety of informal and formal mechanisms. For example, in New Zealand, the health and disability commissioner uses various methods of dispute resolution (advocacy, mediation, etc.), with a focus on promoting resolution directly between providers and patients. A key ingredient to the success of a patient charter is a well-resourced and responsive ombudsman; lack of sufficient resources and training among ombudsmen has been one of the most common concerns across jurisdictions.16 In New Zealand, health care institutions and professiona