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annual report 2009-10

About this reportThis report is designed to be an easy to read record of our

achievements against the objectives and strategies of our

strategic plan. It also sets out our fi nancial position for the

2009-10 year.

Our ‘Preventing harm, improving quality’ theme is

refl ected in the structure of this report, showing how our

core functions of complaint management, investigation,

and standards and quality feed into our innovative and

exciting work in the development of an effective early

warning system for healthcare risk.

Each chapter describes and analyses our performance,

challenges, improvements and outlook against each of

our core functions, detailing major developments and

initiatives in improving the safety and quality of healthcare

in Queensland.

The report is a key accountability document and the principal

way in which we report on our activities to Parliament and

the Queensland community.

Case studies have been provided to demonstrate our

service. Some case details have been changed and all case

studies have been de-identifi ed to protect the privacy of

our clients.

Translation serviceWe are committed to providing accessible services to

Queenslanders from culturally and linguistically diverse

backgrounds. If you have trouble understanding our annual

report, please call us on (07) 3120 5999 and we will arrange

an interpreter to share the report with you.

FeedbackWe welcome your feedback and suggestions on our report.

Please contact the Community Engagement team,

telephone (07) 3120 5999, fax (07) 3120 5998,

email [email protected] or complete our online survey at

www.hqcc.qld.gov.au

This report, and past reports, is available on our website

at www.hqcc.qld.gov.au

Only 200 copies of our report were printed on

Sovereign Offset.

ISSN 1837-0993

© 2010 The State of Queensland (Health Quality and

Complaints Commission)

26 August 2010

The Honourable Paul Lucas MP

Deputy Premier and Minister for Health

GPO Box 48

BRISBANE Qld 4001

Dear Deputy Premier

I am pleased to present the 2009-10 Annual Report of the

Health Quality and Complaints Commission.

I certify that this annual report complies with:

• the prescribed requirements of the Financial Accountability Act 2009 and the Financial and Performance Management Standard 2009, and

• the detailed requirements set out in the Annual Report Requirements for Queensland Government Agencies.

A checklist outlining the annual reporting requirements can

be accessed at www.hqcc.qld.gov.au

Yours sincerely

Professor Michael WardCommissioner

About us 2Who we are, what we do and how we do it

Highlights 4At a glance information about our key

achievements and our fi nancial snapshot

The year in review 6Our Commissioner and CEO analyse our

performance and share future plans

Performance report card 8Reporting against our strategic objectives,

measures and targets

Preventing harm, improving quality 10Using our data, analysis and insight to identify

and act on risk

Source 1: Complaints 18Working with healthcare consumers and

providers to learn from complaints

Focus on: Quality service 28

Source 2: Investigations 30Investigating serious healthcare issues

and recommending improvement

Focus on: Effective engagement 40

Source 3: Standards and quality 42Helping our hospitals build a better,

safer health system

Focus on: Knowledge and information management 52

Our people 54Planning, attracting and retaining a

productive and healthy workforce

Corporate governance 60 Ensuring transparent and accountable

corporate governance

Financial report 74Our fi nancial performance in 2009-10

Contents

GlossaryAMI acute myocardial infarction (heart attack)

AHPRA Australian Health Practitioner Regulation Agency

CIPHA complaint and investigation case management system

eDRMS electronic document and records management system

FTE full-time equivalent

Flexible multi-skilled staff able to work in various

workforce teams across the organisation

GP general practitioner

HQCC Health Quality and Complaints Commission

HRC Health Rights Commission (predecessor organisation)

ICT information and communication technology

IP information privacy

MBQ Medical Board of Queensland

MOU memorandum of understanding

PLO patient liaison offi cer

QAS Queensland Ambulance Service

QNC Queensland Nursing Council

RCA root cause analysis

(a review undertaken following reportable, adverse and

unexpected healthcare incidents)

RTI right to information

StaRT standards reporting tool (a website used by hospitals

to report to the HQCC)

VTE venous thromboembolism

VMO visiting medical offi cer

Preventing Harm, Improving Quality | 1

What we doAn independent and impartial health watchdog is critical to

the reform of the Queensland health system and enables the

Queensland Government, Parliament and community

to have confi dence that our health services are safe and of

high quality.

To prevent patient harm and improve healthcare quality, we:

• manage healthcare complaints

• investigate serious and systemic issues and recommend

quality improvement

• set and monitor healthcare standards

• identify potential healthcare risks and recommend action

• review and report on health service improvement

• promote health rights.

Our stakeholdersWe work closely with our diverse stakeholders towards

better healthcare for Queenslanders. These stakeholders

include:

• healthcare providers – public and private, licensed and

unlicensed health services, including hospitals, general

practitioners, allied health professionals and alternative

healthcare practitioners

• healthcare consumers – the people who use health

services and their families and carers

• healthcare industry organisations, associations, colleges

and educational institutions

• Parliament, Social Development Committee, Minister for

Health and the Queensland Government

• related jurisdictions

• community organisations

• the media.

Who we areWe were established in July 2006, following a key

recommendation of the 2005 Health Systems Review

(Forster Review). Replacing the Health Rights Commission,

we have extended powers in independent management and

investigation of healthcare complaints, and a new role to

monitor and improve the safety and quality of healthcare

in Queensland.

Unlike other health complaints commissions in Australia,

we are both health watchdog and quality champion, referee

and coach. This puts us in a unique position to make a real

difference to healthcare improvement.

Our overarching aim is better healthcare for all

Queenslanders, linking with the State Government’s

Toward Q2: Tomorrow’s Queensland ambition Healthy – Making Queenslanders Australia’s healthiest people.rr

goal To improve the safety and quality of healthcare in

Queensland

vision Positive health action

values Respect – we actively listen to and support our

clients and stakeholders

Integrity – we are honest, transparent and impartial;

we use sound evidence, research and reasoning to

inform decisions

Independence – we are courageous, engage in

robust debate and question the status quo

Learning – we continuously improve our processes

to infl uence quality improvement in healthcare

Responsiveness – we are timely and accurate.

About us

We are both health watchdog and quality champion, referee and coach.

The Health Quality and Complaints Commission (HQCC) is an independent statutory body dedicated to improving the safety and quality of healthcare in Queensland. We regulate health services under the Health Quality and Complaints Commission Act 2006 (the HQCC Act).

2 | HQCC Annual Report 2009-10

How we workWe perform our role independently, impartially and in the public interest, observing natural justice and working as quickly

and with as little formality and technicality as possible.

In championing healthcare improvement, we play an important role in managing risk for the Queensland health system.

We aim to use complaint, investigation and quality monitoring data to identify emerging healthcare issues or patterns of

provider practice, enabling early intervention. We foster a culture of continuous quality improvement within the health

sector, encouraging healthcare administrators and clinicians to collect and analyse data to identify risk and then prioritise

and implement strategies to prevent harm and improve quality.

Our work is underpinned by a ‘responsive regulation’ model, which moves beyond the traditional regulation roles of

deterrence and compliance. Bringing together our complaints management and quality monitoring roles, we empower

healthcare providers to drive their own quality improvement, with our organisation stepping in to oversee, investigate or

refer to another agency, when required.

Serious problems or persistent failure to improve

Poor outcomes (cause unknown)

Medium outcomes but improving

Good outcomes maintained

Report

Investigate

Oversee

Devolve

Managing healthcare risk through responsive regulation Modifi ed from Walshe 2003/Ayres & Braithwaite 1992

References

Walshe, K, Regulating healthcare: a prescription for improvement? State of health series. 2003, Maidenhead: Open University Press. xii, 262 p.

Ayres, I and J Braithwaite, Responsive regulation: transcending the deregulation debate. Oxford socio-legal studies. 1992, New York: Oxford University Press.

viii, 205 p.


Preventing harmActing to protect patient safety

38% increase in investigation recommendations for improvement

67% of investigation recommendations implemented (since 1 July 2006)

100% of hospitals reported against our healthcare standards

91% of hospitals comply with the standards

700 hospital quality improvement initiatives reported

226 prototype hospital profi les created to identify safety and quality risks

32,223 complaints analysed in pilot study to identify patterns and trends

Improving qualityResolving healthcare concerns to identify areas for improvement

2240 enquiries received

2241 complaints received

98% of early resolution complaints closed in 30 days (up from 82%)

86% of complaints assessed in 90 days (up from 61%)

61 investigations fi nalised

7 month average investigation timeframe

102 conciliations conducted

67% of conciliations successfully resolved

Our service80% of clients satisfi ed with the way we handle

complaints

85% of clients agree our complaint offi cers are professional

Our people90% permanent staff retention rate

60% of staff agree ‘the HQCC is a truly great place to work‘

Highlights

Major eventsJuly Commenced healthcare

standards review (page 50)

September Finalised investigation into the

death of Ryan Saunders (page 38)

October Released Annual Health Check

2009 (page 44)

Launched joint ‘It’s OK to

complain’ campaign (page 40)

Presented to the International

Society for Quality in Health Care

conference, Dublin (page 41)

Released 2008-09 Annual Report

(page 63)

November Launched Indigenous information

cards (page 41)

First meeting with the

parliamentary Social Development

Committee (page 62)

January Amendments to HQCC

Act for impact assessment

statements and Queensland Civil

Administrative Tribunal (page 63)

March Launched new reporting website

for hospital standards compliance

(page 47)

April Amendments to the HQCC

Act for national registration and

accreditation scheme (page 63)

May Second meeting with the

parliamentary Social Development

Committee (page 62)

June Finalised updated standards for

July 2010 launch (page 50).


Our operational budget for 2009–10 was $9.4 million plus $1.1 million in retained rollover funds, totalling $10.5 million.This budget comprised:

• $9.217 million in recurrent funds • earned revenue of $220,433, of which $204,204 was earned from interest bearing accounts.

We ended the year with retained rollover funds of $949,669.

Where our money came fromWe received our funding as administered output revenue through an administered grant. The bulk of the funding was transferred to our investment accounts through Queensland Treasury Corporation and then drawn down throughout the year as required. Recurrent funding has increased 24% since our fi rst year of operation, from $7.453 million to $9.217 million.

Where we spent our moneyWe spent $9.597 million in 2009–10 against a forecast of $9.437 million. While this is the third year we have run at defi cit andused rollover funds, it is the lowest defi cit for three years.

Employee expenses accounted for 71% of our spending at $6.824 million, which represents a decrease of $504,662 on2008-09. This is due to a reduced number of temporary staff and a restructure of executive management positions. Oursecond largest expenditure item was supplies and services accounting for 24% of our spending.

What we ownAs at 30 June 2010, our assets totalled $4.110 million and comprised:

• $2.110 million – property, plant and equipment, including leasehold improvements, furniture and equipment• $1.014 million – cash in bank • $0.847 million – intangibles, software • $0.138 million – receivables.

What we oweOur liabilities for 2009-10 totalled $2.882 million. These included $1.041 million in accounts payable to suppliers and$0.621 million in accrued employee benefi ts, with $1.220 million in lease incentives.

Financial snapshot

Key fi nancial statistics 2006-07 2007-08 2008-09 2009-10Financial performanceTotal income $9,235,537 $8,545,844 $10,598,975* $9,437,433

Total expenditure $7,850,282 $9,347,139 $11,032,457 $9,596,764

Operating surplus/(defi cit) $1,385,255 ($801,295) ($433,482) (159,331)

Financial positionTotal assets $3,839,536 $3,440,910 $4,420,977 $4,109,534

Total liabilities $835,954 $1,238,623 $3,033,851 $2,881,739

Total equity $3,003,582 $2,202,287 $1,387,126 $1,227,795

Cash held at 30 June $3,210,361 $2,340,370 $1,108,655 $1,013,628

*We received $1.271 million in non-recurrent funds from Queensland Treasury to complete our relocation to a new offi ce in March 2009.

2006-07 2007-08 2008-09 2009-10 2010-11 2011-12Financial outlook ($’000s) ($’000s) ($’000s) ($’000s) ($’000s) ($’000s)Health Rights Commission rollover* 1,139

Revenue 9,235 8,546 10,599 9,437 9,914 9,898

Expenditure 7,850 9,347 11,032 9,597 10,614 11,018

Operating surplus/(shortfall) 1,385 (801) (433) (160) (700) (1,120)

Funds on hand

Surplus/(shortfall) 2,524 1,723 1,290 1,130 430 (690)

*On our establishment in July 2006, we received $1.139 million in rollover funds from our predecessor the Health Rights Commission.

OutlookThe 2010-11 year will be a signifi cant transition year for us. Rollover funding has been committed to information technology projects in support of frontline complaints management, quality monitoring, and the generation of provider risk profi les. This will result in our surplus being fully consumed during 2011-12. We will continue to seek effi ciencies to maintain a high level of service to the Queensland community.

With the transition to new payroll and fi nance systems this year, we will receive additional recurrent funding of $327,000 in 2010-11, $260,000 in 2011-12 and $272,000 in 2012-13 (recurrent and Consumer Price Index adjusted annually), see page 59.


Improving healthcare safety and qualityOur healthcare standards set benchmarks in key clinicaland governance areas for the state’s 226 public and privatehospitals. This year saw continued improvement in hospitalreported compliance with the standards, reaching 91%(up from 86% in 2008-09 and 61.5% in December 2007).This sustained improvement, including 100% reportedcompliance with three of our healthcare standards, willsee us raise the bar in 2010-11. Following an extensivereview of the standards, guided by public consultation andexpert reference groups, we expanded the scope of somestandards and introduced stronger reporting requirements,to commence in 2011. We also reduced the burden ofreporting, with a 44% reduction in reporting requirements.

To ensure safety and quality issues identifi ed by ourinvestigations are remedied, we began formally monitoringimplementation of investigation recommendations in 2009.Since July 2006, we have made 72 recommendations forlocal and system-wide change. At 30 June 2010, 67% ofthese were complete and the balance in progress. Thisyear, we improved our recommendations to ensure theyare deliverable and measurable. We also consulted withhealthcare providers to set appropriate timeframes forimplementation. In the coming year, we will share moreof the lessons learned from our investigations and qualitymonitoring by issuing safety and quality alerts, positionstatements and de-identifi ed case summaries.

Our success in delivering better healthcare for Queenslandersis dependent on strong relationships with healthcare providers,consumers and other stakeholders. We implemented 98%of our Stakeholder Engagement Plan 2009-10 and achieved a90% overall satisfaction rating for our service and engagement.

Identifying and acting on riskThis annual report details our performance as Queensland’s

independent healthcare regulator – how many complaints

and investigations we managed, how our standards have

been updated, how we monitor healthcare quality, and how

we have spent our share of the public purse.

As our organisation matures, we are now also able to report

on how we are achieving the objective of our regulation –

improved safety and quality of healthcare in Queensland.

This year, we developed new ways of looking for patterns of

risk to safety and quality in the large collections of data held

by ourselves and others. By using this information as an early

warning of emerging problems amongst healthcare providers

– both individuals and organisations – we aim to intervene

at a stage when harm can be prevented. This approach is

clearly preferable to the more conventional and retrospective

role of agencies such as the HQCC in analysing the causes

of harm once it has occurred.

Under our risk identifi cation and intervention strategy,we continue to manage complaints, investigate serioushealthcare issues, set standards and monitor healthcarequality. We then analyse this information – in particular,patterns and trends over time – to identify risk and work withproviders to respond. This approach is essential if we are tofully achieve our regulatory objective of preventing patientharm and improving service quality. In 2010-11, we will workon confi rming our early fi ndings and develop appropriateinterventions in consultation with stakeholders.

‘... the performance of regulators should not be judged in terms of how well they regulate but how well they achieve the objectives of regulation.’ Walshe K 2003 1

1 Walshe, K., Regulating healthcare : a prescription for improvement? State of

health series. 2003, Maidenhead: Open University Press. xii, 262 p.

The year in review

Our fourth annual report records a year of innovation for our organisation and signifi cant progress in healthcare improvement. We continue to evolve our services in response to strategic priorities, client demand and the changing national healthcare environment.

Professor Michael Ward Cheryl HerbertCommissioner Chief Executive Offi cer


Acting on staff feedback through our annual cultural survey, we

implemented 97% of our Cultural Improvement Plan 2009-10,

achieving improvements in client service, communication and

trust in leadership. Once again, staff participation in the survey

was high (91%), with 60% of our people agreeing ‘the HQCC

is a truly great place to work’ (compared with a government

public health sector norm of 43%).

We invested $97,848 in staff development and 73% of our

employees said their work practice had improved following

learning events.

Over the next year, we will focus on effectively

communicating operational changes related to our risk

identifi cation and intervention strategy, as well as building

the capacity of our people, and improving performance

development processes.

Growing within our budgetWe worked hard this year to reduce our expenditure, cutting

employee costs by $505,662 and supplies and services

costs by $1,125,402. We ended the year with an operating

defi cit of $159,331 – the lowest defi cit for three years – and

retained rollover funds of $949,669.

Planned information technology investments in 2010-11 will

see all surplus monies fully consumed during 2011-12 and

we continue to seek effi ciencies so that we maintain a high

standard of service to the Queensland community.

Thank youOur achievements in preventing patient harm and improving

healthcare quality would not be possible without the support

of the thousands of healthcare consumers and providers

we work with every year. We thank the consumers who

shared their concerns with us and the providers who acted

to improve their health services.

We also acknowledge and thank our Commission for their

leadership, our advisory committees and reference groups

for their guidance, our clinical advisers for their expertise

and our dedicated staff for their commitment to our positive

health action vision and better healthcare for Queenslanders.

We look forward to continuing our valuable work together in

the year ahead.the year ahead.

Professor Michael Ward Cheryl HerbertCommissioner Chief Executive Offi cer

Delivering better service

This year 4481 people contacted us with their healthcareconcerns and we closed 4359 complaints and enquiries.We worked hard to resolve complaints quickly:

• increasing the number of complaints managed throughinformal early resolution to 63% (2008-09: 54%)

• meeting our legislated 30-day timeframe for early

resolution in 98% of cases (2008-09: 82%)

• meeting our legislated 90-day timeframe for complaint

assessment in 86% of cases (2008-09: 61%).

• closing 59% of complaint conciliations and 73% of

investigations within 12 months.

As well as improving the timeliness of our service, we also

introduced quality audits. Some 92% of conciliation cases

audited and 97% of investigation cases audited met quality

requirements. Quality audits will be introduced for early

resolution and assessment cases in 2010-11.

For the fi rst time, we asked our complaint clients for

feedback through surveys. Some 71% of complainants

and 86% of providers were satisfi ed with the way their

complaints were handled. Overall, 81% of clients felt the

complaint was taken seriously and 79% agreed they were

given clear reasons for the complaint decision. We are acting

on ideas for improvement, such as keeping clients better

informed about the progress of their complaint.

Responding to healthcare reformAustralia’s healthcare system is in the midst of signifi cant

reform, with the introduction of the national registration and

accreditation scheme, national primary healthcare strategy

and the national health and hospitals network. The HQCC

participated in forums to help shape the national safety

and quality agenda. We also worked with our stakeholders

to develop new protocols and processes, particularly in

response to the establishment of the Australian Health

Practitioner Regulation Agency (AHPRA) on 1 July 2010.

Over the next year, we will work with the Australian

Commission for Safety and Quality in Health Care (ACSQHC)

to support the introduction of national healthcare standards.

In our standards review, we incorporated a requirement for

providers to comply with other widely recognised healthcare

standards, such as the draft national standards. We continue

to be recognised as an innovator and can provide ACSQHC

with valuable experience in standards monitoring. Our

pioneering work in bringing together hospital standards

compliance and complaints data to test the predictive nature

of this information in identifying risks is also attracting

interstate and national interest.

Creating a ‘can do’ cultureOur people are our greatest asset and we are committed to

continuously improving our organisational culture and human

resource management.


Performance against Strategic Framework 2009-10

Internal processesObjective Strategy KPI Performance Pg

08-09

actual

09-10

target

09-10

actual

variance

% pts

10-11

target

Improved

governance,

systems, processes

and measures to

improve health

service safety and

quality

Align internal

processes to

strategic and

legislative

requirements

% complaints in early

resolution closed within

30 days

82% 100% 98%

16 pts

100% 20,

22

% complaints in

assessment closed

within 90 days

61% 100% 86%

25 pts

100% 20,

22

% complaint notices of

assessment forwarded

within 14 days

new

KPI

100% 90% - 100% 19

% complaint

conciliations closed

within 12 months

71% 75% 59%

12 pts*

75% 21

% healthcare quality

investigations closed

within 12 months

64% 70% 73%

9 pts

75% 32

% conciliation case

audits that met quality

requirements

new

KPI

95% 92% - 95% 7

% investigation case

audits that met quality

requirements

new

KPI

95% 97% - 95% 7

% Queensland hospitals

reporting against HQCC

standards

100% 100% 100% - 100% 43

*59% of conciliations were fi nalised within 12 months, compared with 71% in 2008-09. This represents a difference of fi ve cases.

Our Strategic Framework 2008–2011 sets out our objectives

and strategies. We measure our success against clear key

performance indicators (KPIs), this year adding new quality

audit measures for our complaint management service.

Brief notes on major variances are included in the below

tables, while page references are provided for more detailed

analysis of our performance.

Our objectives and strategies align with the State

Government’s Toward Q2: Tomorrow’s Queensland ambition Healthy – Making Queenslanders Australia’s healthiest people.

Performance report card

We set ourselves deliberately challenging targets to drive continuous improvement across four strategy areas – internal processes, community, learning and growth and fi nancial.


CommunityStrategy KPI Performance Pg

08-09

actual

09-10

target

09-10

actual

variance

% pts

10-11

target

Improved

performance in the

safety and quality of

public and private

health services in

Queensland

Monitor and report

on the quality of

health services

% hospital compliance

with HQCC standards

86% 75% 91% 5 pts 85% 44

Manage healthcare

complaints to

foster continuous

improvement of

health service quality

% investigation

recommendations

implemented by

healthcare providers

within agreed timeframes

new

KPI

90% 67% - 90% 33,

35

Increased

stakeholder

understanding of

health service safety

and quality

Proactively inform

and educate

stakeholders

% Stakeholder

Engagement Plan

implemented

87% 100% 98%

11 pts

100% 40

% survey respondent

satisfaction with HQCC

service/engagement

90% 75% 90% no

change

75% 28,

41

Learning and growthObjective Strategy KPI Performance Pg

08-09

actual

09-10

target

09-10

actual

variance

% pts

10-11

target

Healthy, productive

and customer-

focused workplace

culture

Grow our workplace

culture based on our

values

% Cultural

Improvement Plan

implemented

91% 100% 97% 6 pts 100% 57

% staff participating in

cultural survey

98% 95% 91% 7 pts 95% 57

% staff identifi ed in

cultural survey as

‘engaged’

48% 50% 50% 2 pts 50% 57

% staff agreeing ‘the

HQCC is a truly great

place to work’

70% 70% 60%

10 pts

70% 57

HQCC attracts,

develops and retains

the right staff

Implement leading

practice human

resource processes

No. applications

suitable for

appointment per

position

2.7 3 2.9 0.2 3 55

% staff who self-

rate work practice

improvement following

learning events

70% 75% 73% 3 pts 70% 7,

57

% staff turnover

against the Queensland

Public Service average

of 6.4%

1.69% ≤6.4% 2.4%

0.7 pt

≤6.4% 55,

56

FinancialStrategy KPI Performance Pg

08-09

actual

09-10

target

09-10

actual

variance

% pts

10-11

target

Funding levels are

suffi cient to achieve

strategic objectives

Align funding to

organisational

priorities

% fi nancial

performance against

operational budget

98.8% 100% 98.3%

0.5 pt

100% 5,

74


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Analysis of the 226 prototype hospital profi les highlighted potential risks to patient safety and opportunities for quality improvement. Where anomalies were identifi ed, we verifi ed and shared information with hospitals so they could act to mitigate risks and improve their service.

We reviewed trends in complaints made about doctors, analysing our own data dating back to July 2006 and the data collected by our predecessor, the Health Rights Commission, dating back to 1992. We are using HQCC information to develop individual practitioner profi les.

This work in provider profi ling and risk identifi cation will continue to develop in the next year.

OverviewAs Queensland’s health watchdog and quality champion we gather unique information about the state’s health system. This year, we searched for patterns and trends in our data to identify opportunities to prevent patient harm and improve the quality of health services.

Our work in resolving complaints, investigating serious healthcare issues and monitoring the quality of health services provides us with a rich source of information. We used this data to develop prototype healthcare organisation and individual practitioner profi les – pictures of how these providers look to us – initially targeting the two provider groups that account for 70% of our complaints – hospitals and doctors.

complaints analysed

226 prototype hospital profi les created

72 investigation recommendations monitored

Highlights

32,223

Preventing harm, improving quality

| 11

ImprovementsWe have signifi cantly improved our process and performance

in our core functions of complaints, investigations, and

standards and quality. How each function feeds into our

healthcare provider risk identifi cation and intervention work is

set out below and in the diagram (right).

We collect unique data, so this is the fi rst time complaints

information has been combined with quality monitoring data

in this way.

Source 1: ComplaintsComplaints commissions and registration boards in Australia

have traditionally taken a case management approach

to resolving complaints. That is, each complaint is dealt

with individually. We believe that by looking for patterns

of complaints at the individual practitioner, hospital and

systemic levels, we can identify risks and work with

providers to respond to help prevent recurrence.

To establish a knowledge base for our work, we initially

conducted a pilot review of 32,223 complaints dating back

to 1992, including complaints to our predecessor the Health

Rights Commission (1992-2006).

We are now performing detailed analysis of data collected

since the HQCC was established in July 2006. This is

challenging and complex work, as we are developing

new ways to classify the severity and chronicity of the

problems identifi ed in complaints. Most importantly, we

need to develop new approaches to the management of any

recurrent complaint problems. We are consulting widely with

various healthcare provider and professional associations

to help us develop responses in line with our responsive

regulation framework.

Source 2: InvestigationsIn investigating serious healthcare issues, we seek to identify

local and systemic opportunities for quality improvement.

This year, we began to formally monitor the implementation

of our investigation recommendations (page 35). By tracking

our recommendations, we can see how we are improving

the safety and quality of healthcare and identify providers

who are failing to comply with their statutory duty to improve

under section 20 of the HQCC Act.

Source 3: Standards and qualitySince July 2007, all Queensland hospitals have reported

their compliance with our healthcare standards, which

provide guidance on implementation of best practice in key

patient safety areas (pages 44-45). We have a consistent

100% (n=226) of acute and day hospitals reporting. Through

analysis and comparison, we can identify defi ciencies and

anomalies in the information and fl ag issues for follow up.

ChallengesSharing dataOur health sector is complex and diverse and as such, we

are not the only agency that takes complaints about health

services. Analysis of our complaints can give us insight into

areas where there is room for improvement, but that analysis

is only a partial indicator of overall safety and quality. We

improved the way we work with other agencies, particularly

the Medical Board of Queensland, to share information and

ensure the integrity of our data. We are working to ensure

this information sharing continues with the introduction of

the Australian Health Practitioner Regulation Agency on

1 July 2010.

Applying necessary resourcesDue to an increased demand on our investigation and

conciliation functions, as well as the major review of our

healthcare standards, we had diffi culty in dedicating the

necessary staff to our risk identifi cation and intervention

strategy. We were also unable to purchase and develop the

information management systems needed to automate the

mining of complaints, investigations and quality monitoring

data to produce the profi les. However, we continue to

progress, with an injection of additional staff in the latter half

of the year.


Risk identifi cation and intervention strategy

External sourcesSince March 2008, hospitals have provided us with the

summaries of all Root Cause Analysis (RCA) reports. RCAs

are conducted following reportable, adverse and unexpected

healthcare incidents. In 2009-10, we received 190 reports,

87% were from public hospitals and 11% from private

hospitals (the remainder are from other healthcare providers,

such as the Queensland Ambulance Service). We rate the

strength of recommendations, monitor the timeliness of RCA

reports and identify issues for follow up.

Root Cause Analysis reports by speciality 2009-10

Specialty %

Medical 26

Mental health 24

Surgical 23

Obstetric (perinatal) 14

Emergency Department 10

Paediatric 1

Oncology <1

Dental <1

Nursing home <1

We collect unique data, so this is the fi rst time complaints information has been combined with quality monitoring data in this way.

Information sources

Safety and quality risk analysis

Analyse trends and patterns

Verify information

Identify areas for improvement

Improved safety and quality of healthcare

Complaints Investigations Standards and quality External sources

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Healthcare provider acts on risk


Analysing historical complaint trendsBy analysing complaints data going back to 1992 (when the

Health Rights Commission was formed) including complaints

made about both individual practitioners and hospitals,

we found that just under one third (10,308) of the 32,223

complaints involved medical practitioners.

Only 5% of doctors registered in Queensland generate a

complaint to the HQCC. However, once a doctor has been

the subject of one complaint, our data shows they have a

75% chance of getting further complaints. Within this group,

those doctors that have the most complaints are more likely

to be male, surgical specialists. This is similar to those at risk

of litigation.

PerformanceHealthcare practitioner trendsThe majority (78%) of individual practitioner complaints

we receive are about doctors, even though they represent

17% of the health workforce. This may be because doctors

provide more complex – and therefore higher risk – health

services, or because consumers regard doctors as having the

primary responsibility for healthcare.

Practitioner percentage of HQCC complaints 2009-10

Our diverse data gives us a unique insight into hospital healthcare quality. We’re analysing the patterns and trends to pinpoint potential problems so early action can be taken.

Practitioner %

Medical practitioner 78

Dentist 15

Dental prosthetist or technician 2

Psychologist 1

Chiropractor 1

Nurse/midwife <1

Pharmacist <1

Physiotherapist <1

Medical radiation technologist <1

Occupational therapist -

Other (optometrist, speech 1%

pathologist, osteopath,

podiatrist/chiropodist)

Practitioner %

Medical practitioner 17

Dentist 3

Dental prosthetist or technician 1

Psychologist 5

Chiropractor <1

Nurse/midwife 57

Pharmacist 5

Physiotherapist 4

Medical radiation technologist 2

Occupational therapist 2

Other (optometrist, speech 4

pathologist, osteopath,

podiatrist/chiropodist)

Practitioner percentage of workforce(registration fi gures at 30 June 2009)


Creating prototype hospital profi lesAs a fi rst step in measuring and managing hospital risk, we

created prototype profi les for all 226 Queensland public and

private hospitals using information about their standards

compliance, quality improvement activity, complaints and

Root Cause Analysis summary reports.

Issues identifi ed in this developmental work were

followed up with hospitals, and a second generation profi le

incorporating more complaint information is underway. Once

complete, we will work with hospitals to verify the profi les

so management can act on identifi ed risks. We will also

monitor and measure the improvement.

Ultimately, we are working towards publicly sharing the

improvements made through this profi ling.

Complaint management at four Queensland hospitals 2009-10

* Number of separations as per mandatory data reported to the HQCC

by hospitals.

This graph combines hospital complaint and quality

monitoring data to show how we identify potential issues.

For example, while Hospital C has a low rate of incidents

causing harm, the data also indicates it has an ineffi cient

local complaints process, with the hospital exceeding

acceptable complaint resolution timeframes. Delays in

complaint management could result in complaints escalating

to the HQCC.

At the other end of the spectrum, Hospital A records a higher

number of harm incidents, which is of concern. However it is

clear the hospital is dealing with patient concerns effi ciently

through its local complaint process.

We worked with individual hospitals to act on the issues we

identifi ed through the prototype hospital profi les.

Analysing hospital complaintsOur diverse data gives us a unique insight into hospital

healthcare quality. We are analysing the patterns and trends

to pinpoint potential problems so early action can be taken.

The majority (59%) of our facility complaints involve public

hospitals. This refl ects both the large number of patients

dealt with by public hospitals, and the more complex case

mix and range of health services they provide. For instance,

last year there were 883,000 people admitted to acute

public hospitals. In the March 2010 quarter, 280,000 people

attended public hospital emergency departments. (Source:

Quarterly Public Hospitals Report, March quarter 2010,Queensland Health.)

Complaints by provider type 2009-10

Hospital A (remote public hospital)

Hospital B (metropolitan public hospital)

Hospital C (regional public hospital)

Hospital D (metropolitan private hospital)

0 10 20 30 40 50 60

1.5

2

0.5

0

0

0

10

57

Rate of

unnecessary harm

(incidents per 100

separations*)

Rate of

complaints that

were open longer

than the standard

timeframe per 100

complaints

Provider %

Public hospital 59

Medical centre 10

Licensed private hospital 9

Public health service 6

Dental service 3

Specialised health service 3

Correctional facility 2

Pharmaceutical service 2

Aged care facility 1

Health service district 1

Laboratory service 1

Allied health service 1

Ambulance service 1

Other (community health

service, licensed day

hospital, support service,

administrative service) 1


ImprovementsActing on identifi ed trends and issuesAs well as drawing new insights from the information we hold, we also worked on new ways to share information with

our stakeholders.

In 2010-11, we will introduce healthcare issue alerts, position statements and special reports to inform healthcare providers

and the broader community about the patterns and trends we are seeing in healthcare.

The list below gives examples of our possible response when we identify high, medium and low risks. This graded approach

derives from our responsive regulation framework.

HighSerious issue or indication of systemic issue that requires immediate and serious response

MediumIssue has the potential to become serious or systemic, requiring moderate response in the near future

LowIssue is managed by the HQCC or by an external agency with HQCC oversight

Inquiry

widespread issue becomes a matter of high public interest.

Advise MinisterIn some instances it is necessary for us to provide to the

Minister for Health information on serious issues relevant to

healthcare provision.

Special reportAn issue of signifi cant public interest, such as a recurring

unresolved systemic issue identifi ed through our data,

warrants a public report.

Show cause processWhen we identify a provider contravening their legal duty

to improve the quality of their health service, we may

issue a show cause notice, make recommendations for

improvement, prepare a report, or refer the matter to an

external agency for further action (page 46).

Alert A public interest warning distributed to providers and/or the

public when we identify an emerging risk to patient safety.

Position statementPublic statements on systemic issues that require our

clarifi cation or explanation.

Information/educationInforming providers and consumers of their health rights and

responsibilities. Education about our services, standards and

healthcare quality.


Outlook Testing our response We will continue to refi ne our analysis and interpretation of

individual practitioner profi les, pursuing further discussions

with relevant agencies and professional colleges about

the responses and interventions required for doctors with

multiple complaints.

We will also develop second generation hospital profi les,

trending information against the prototype profi les to identify

improvement and pinpoint potential risks to follow up.

Expanding data setsWhen building hospital profi les, it will be important to

integrate HQCC and healthcare provider data sources to

ensure that we build a complete and representative profi le.

Some of these provider data sources are well known and

already well used, such as mortality and morbidity indicators,

but simple operational markers – for example, internal

complaints, time in operating theatre, return to operating

theatre, transfers to other hospitals – are often overlooked

sources of information that hospitals already collect.

Automating our workWe aim to automate manual data management processes

and build a decision-support system to help us quickly and

effi ciently identify risks and issues. This system will free staff

to focus on more detailed analysis and follow up work with

providers. The development of this system is dependent on

refocusing our resources on risk profi ling.

Business mapping reviewWe commissioned a review of our processes and services

to align them with our risk identifi cation and intervention

strategy and refl ect changes to the national healthcare safety

and quality landscape. To ensure rigour, the review was

facilitated by an external contractor.

The review, which commenced in October 2009, mapped

our business processes, identifying gaps in human

resources, processes and technology. Finalised in June

2010, the results and recommendations will inform resource

planning and organisational change, as well as information

and communication technology requirements.

Throughout the year, teams have reoriented their services

to support our risk identifi cation and intervention strategy.

Our Complaints Services team analysed patterns and trends

in complaint data while the Standards and Quality team

commenced tracking of investigation recommendations

and following up on issues, trends and patterns identifi ed

through risk profi ling.


KPIs

98% of complaints in early resolution closed in 30 days

(2008-09: 82%)

86% of complaints assessed in

90 days (2008-09: 54%)

90% of notices of assessment sent in 14 days (new)

59% conciliations fi nalised in

12 months (2008-09: 71%)

92% of conciliation case audits met quality requirements (new)

OverviewThis year, 4481 Queenslanders contacted us with concerns about the safety and quality of their healthcare.

While an increase in the number of enquiries shows a greater understanding of the importance of safe, high quality healthcare, it has proved a challenge for our complaints management team working within current staffi ng levels.

To maintain reasonable workloads for our complaints staff, and to ensure quality of service and decisions, we made use of our fl exible workforce staff at times of peak demand. To improve workfl ow and processes we implemented recommendations from an independent review of our Assessment service (conducted in 2008-09).

We also ensured we were prepared for the introduction of the national registration and accreditation scheme on 1 July 2010 by laying the ground work for memoranda of understanding (MOU) at the state and national level. These MOUs should be completed, signed and implemented in 2010-11.

enquiries and complaints received4359 enquiries and complaints closed

102 conciliations closed

67% of conciliations successful

Highlights

4481

Source 1

Complaints

| 19

Performance

Enquiries and complaints received/fi nalised

We continued to receive an increasing number of enquiries – up 3% on the past year and up 47% since our fi rst year of operation. While the number of complaints received

decreased overall, 60% of them were lodged in the second half of the year. We increased

the number of complaints managed through our informal resolution processes – 63% of

all complaints were resolved either directly between the client and their provider (direct

resolution) or with our help (early resolution), compared to 54% in 2008-09. We met our

legislated 30-day timeframe for the early resolution of complaints for 10 consecutive

months – our best result ever.

2006-07

2007-08

2008-09

2009-10

0 500 1000 1500 2000 2500 3000

2240

25632534

2177

2675

1895

1529

2922

2107

22252241

2134

*

*

*

*

Enquiries received

Enquiries closed

Complaints received

Complaints closed

Number of complaints

assessed

Average days to assess

Complaints assessed and average timeframe 2009-10

If a complaint is not resolved through direct or early resolution, we assess the complaint and gather information to help us decide whether to take further action. We

met our legislated 90-day assessment timeframe for two months in a row, the fi rst time we

have been able to achieve this requirement, while average monthly timeframes were kept

below 70 days. Our annual performance improved signifi cantly, with 86% of 830 complaints

assessed in 90 days, compared to 61% in 2008-09. We continue to improve our internal

processes as we strive for 100% compliance with the assessment process timeframe.

Number

Jan 2

009

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan 2

010

Feb

Mar

Apr

May

20

40

60

80

100

Geographic source of complaints fi nalised 2009-10

The geographic source of complaints is consistent with previous years, with one in three complaints about healthcare providers in the heavily populated municipality of Brisbane.

%

Brisbane 32

Gold Coast 13

Central Queensland 12

South West Queensland 9

North Queensland 8

Sunshine Coast 8

%

Moreton Bay 7

Far North Queensland 5

Logan 4

Redland 2

Gympie 1

| HQCC Annual Report 2009-10

We avoid service duplication and confusion for clients by devolving serious complaints straight to external agencies and registration boards for further action.Appointed in late 2008-09, our devolution offi cer monitors these cases through progress

reports. At 30 June 2010, the offi cer was monitoring 138 cases that we referred to

registration boards (including Medical Board of Queensland 78%, Dental Board of

Queensland 9%, Psychologists Board of Queensland 3%) and 103 cases referred to

external agencies (including Offi ce of the State Coroner 40%, Queensland Health 14%,

Queensland Health Ethical Standards Unit 12%). In the next year we will look at ways to

improve our devolution process, including the development of evaluation criteria.

Closed

Complaints referred

for conciliation

Complaints referred to

registration boards

Complaints referred

for investigation

Complaints referred to

external agencies

Outcome of complaint assessment

*We introduced a new complaints and investigations case management system in December 2007, which improved

the way we record, collate and analyse our data. However, due to this system change and the capability of the

previous system, some data sets from previous years are not available in a form that is suitable for comparison to

subsequent periods.

2008-09

2009-10

0 100 200 300 400 500 600

423

121

159

78

73

54

37

90

102

548

Conciliations accepted/fi nalised/open at 30 June 2010

The number of matters entering conciliation decreased by 19% while fi nalised conciliations rose by 13%, with a higher than average 25 cases before each of our fi ve conciliators at any one time. Bearing in mind conciliation matters are often complex

and require the participation and cooperation of external parties, 59% of conciliations

were fi nalised within 12 months, compared with 71% in 2008-09. This represents a

difference of fi ve cases. The average case time frame was 364 days (2008-09: 280);

median 427 days (2008-09: 272). The signifi cant increase in the average timeframe can be

ascribed to the fi nalisation of several complicated and lengthy conciliations – including four

two-year cases and one three-year case.

2007-08

2008-09

2009-10

0 30 60 90 120 150

*104

145

121

108

150

102

122

118

Complaints referred for

conciliation

Complaints closed in

conciliation

Open conciliations

Outcome of successful conciliations

Successful

Unsuccessful

In 2009-10, we helped resolve 67% of conciliation cases, consistent with previous years. These cases were resolved through an explanation by the healthcare provider

(45%), negotiation of fi nancial settlement (40%), an apology, reimbursement of fees/costs

and/or an offer of corrective service. The main reasons for unsuccessful conciliations were

the withdrawal from the process of either the healthcare consumer or provider (44%), or

failure by the parties to reach an agreement (30%).

2008-09

0 10 20 30 40 50 60 70 80

2009-10

66%

34%

67%

33%


ImprovementsImproving our assessment processAn external audit of our complaint assessment process was

conducted in 2008-09. In the past year we have implemented

or commenced 23 of the 28 recommendations, including:

• employment of a complaints support offi cer to streamline

the receipt of complaints

• enhanced communication through team meetings and

formal/informal feedback about case management

• a review of our complaints procedure manual and

development of an online resource centre (ongoing).

Additionally, we held two successful ‘diffusion’ sessions

to help staff manage the cumulative effects of complaint

management. Complaint offi cers are able to share their

personal experiences in a supportive environment. These

sessions were conducted by the HQCC’s employee

assistance provider and will continue in 2010-11.

Getting the best clinical adviceIn managing healthcare complaints, we often need specialist

clinical advice during assessment to help us determine

whether the healthcare provided was reasonable. We

contracted four healthcare professionals (in-house clinicians),

who provided us with 90 informal clinical advices during

the year. On a further 100 occasions we engaged external

clinicians to provide clinical opinions on conciliation and

investigation matters, at a cost of $225,755.

Bundaberg Special ProcessThe Bundaberg Special Process was established by the

Queensland Government in 2005 in response to events

surrounding the work of Dr Jayant Patel. The process has

almost concluded, with only three cases left to be resolved

out of a total of 386 claims. We played an integral role in

helping claimants.

Internal clinical reviewConsulting with our Clinical Advisory Committee, we

reviewed our internal clinical opinion model – independent

informal clinical advice on complaint and investigation cases

– and made improvements to:

• procedural guidelines for complaints staff to seek

informal advice

• the way in-house clinicians are appointed and

remunerated.

We will continue the review in 2010-11, with a focus on how

we access and use external independent experts.

ChallengesManaging complaints within timeframesWe work within legislated timeframes of 30 days for early

resolution of complaints and 90 days for assessment

decisions. While we have for the fi rst time achieved 100%

monthly compliance in both areas (for 10 consecutive

months in Early Resolution and two consecutive months in

Assessment) working within these timeframes is an ongoing

challenge, with limited staffi ng and often complex cases.

While an external review in 2008-09 found the acceptable

caseload is 28 open matters per complaints offi cer, at times

each of our offi cers was working on 40 open cases due

to surges in complaint numbers. Temporary and fl exible

workforce staff assisted in managing peaks in caseload.

Ensuring data integrityWe regularly review our data to ensure we are gathering

accurate and complete information about our complaints

and enquiries – essential for effi cient complaint management

and identifi cation of trends and emerging issues.

We upgraded the complaints and investigations case

management system to help us better manage our data

and generate useful reports. In June 2010, we commenced

implementation of voice recording technology to capture

complaint information provided over the telephone.

Recording of complaints will ensure accuracy of information

for both healthcare consumers and providers and assist with

internal reviews of our service.

The person who handled this complaint was highly professional and prepared to hear both sides of the story. Healthcare provider


Case studyA 60-year-old man complained that a general practitioner (GP) had failed to diagnose prostate cancer, despite the man’s vigilance and family history.

The man said his niece’s husband, a GP, had advised him 10 years before that the best way to detect prostate cancer was to have yearly blood tests to monitor Prostate-Specifi c Antigens (PSA). The GP offered to order the tests for the man each year but said he would not provide other treatment or perform examinations as he was a family member.

The man’s PSA levels remained within a normal range for eight years but rose slightly each year. Although the GP reassured the man that his results were normal, the man was concerned and sought a second opinion.

The doctor providing the second opinion immediately referred the man to a specialist, who diagnosed advanced prostate cancer requiring radical treatment and chemotherapy. The man said the specialist had told him he now had a poor prognosis but if he had been referred fi ve years earlier, the outcome could have been remarkably different and his life signifi cantly prolonged.

Independent clinical advice stated:

• It was inappropriate for the GP to order and monitor the blood tests and that given the GP’s refusal to examine or treat the man due to family connections, this would indicate the GP knew his involvement was inappropriate.

• The man should have been referred to a specialist fi ve years prior when there was a higher than normal PSA result.

The HQCC referred the complaint to the Medical Board of Queensland for further action.

The board investigated the complaint and agreed with the HQCC position on the GP’s failure to action elevated PSA levels in the context of a family history of prostate cancer, and the GP’s agreement to monitor the man, despite family connections. The board reprimanded the provider.

The complaints offi cer was always caring about our situation, and patiently listened to all of our concerns. Healthcare consumer

Quality recognisedCEO Cheryl Herbert signs the Memorandum of Understanding (MOU) that helped St Vincent’s & Holy Spirit Health win the 2009 St Vincent’s Health Australia National Partnership Award. The MOU details how our organisations work together to manage healthcare complaints and improve service quality. It is the fi rst of its kind in Queensland. (Left to right, front row: Daniele Doyle, Chris Flynn. Cheryl Herbert, Carl Yuile. Back row: John Leahy, Christine Foley, Suzanne Greenwood.)


Treatment breakdown 2009-10 (top 10 issues)

IssueNumber of complaints

Inadequate treatment 426

Diagnosis 247

Unexpected treatment outcome/

complications

197

Wrong/inappropriate treatment 110

Delay in treatment 68

Inadequate care 64

Rough and painful treatment 43

Coordination of treatment 24

Infection control 22

Inadequate prosthetic equipment 13

Case example: A 30-year-old construction worker presents to

his GP with pain in his right wrist. Without closely examining

the site, the GP diagnoses a repetitive strain injury. Over the

next year, the pain increases signifi cantly and the man seeks a

second opinion, whereupon a malignant tumour is discovered.

The HQCC fi nds the GP failed to adequately assess the man

and refers the matter to the Medical Board for further action.

The HQCC undertakes conciliation and compensation is

negotiated as part of the settlement.

Communication and information breakdown 2009-10


Attitude/manner 191

Inadequate information provided 97

Incorrect/misleading information provided 32

Special needs not accommodated 4

Case example: The non-custodial father of a four-year-old

boy, hospitalised for infl uenza and dehydration, complains

after hospital staff refuse to speak with him about the

boy’s care. Staff explain they were speaking with the

boy’s mother and step-father. Through our early resolution

process, a meeting is held between the hospital and family.

The hospital apologises for misunderstanding the family

situation. The hospital makes an undertaking to ensure better

communication with non-custodial parents.

Consent breakdown 2009-10


Consent not obtained or inadequate 10

Uninformed consent 6

Involuntary admission or treatment 5

Case example: A woman complains of scarring and

asymmetry following a breast augmentation. The plastic

surgeon provides the HQCC with a signed consent form,

listing all known complications and side effects from the

surgery. While the woman agrees she signed the form,

she says she had not read it. A clinical review fi nds no

evidence of neglectful or unskilful practice. The complainant

is provided with an explanation of consent, and why the

treatment she received was reasonable.

Helping to resolve concernsIssues of complaint 2009-10

As in previous years, treatment is the most common cause

of complaint, followed by communication – 20% of our

complaints were about inadequate treatment and a further

11% about diagnosis.

The following composite case examples are drawn from the

common complaints we receive and do not refl ect actual

cases (to protect the privacy of our clients).

Every complaint is an opportunity to improve.

%

Treatment 67

Communication and 15

information

Professional conduct 4

Medication 4

Fees and costs 3

Access 1

Discharge and transfer 1

arrangements

Reports/certifi cates 1

Consent 1

Medical records 1

Other <2

(environment/management

of facilities, grievance

processes, enquiry service only)


Fees and costs breakdown 2009-10


Billing practices 50

Financial consent 12

Cost of treatment 4

Case example: A few days after having new dentures fi tted,

a pensioner experiences signifi cant ongoing discomfort

and diffi culty in eating solid food. She complains to the

dentist who maintains the dentures are of a high standard.

Dissatisfi ed that she had paid for dentures she could not use,

the woman contacts us. The HQCC discusses the case with

the dentist, who, as an act of good will, agrees to refund the

fees charged.

Discharge/transfer breakdown 2009-10


Inadequate discharge 12

Patient not reviewed 8

Delay 6

Mode of transport 1

Case example: An elderly woman admitted to hospital for

surgery is discharged the next day, despite her doctor’s

belief she should stay in hospital. The woman’s family say

they can’t immediately arrange a carer, but are told the

hospital ‘need the bed’. On returning home, the woman

begins to feel unwell and subsequently requires emergency

treatment. The family’s complaint is informally resolved

through early resolution when the hospital apologises for not

giving more consideration to the woman’s home situation.

Professional conduct breakdown 2009-10


Inappropriate disclosure of information 24

Illegal practice 15

Competence 11

Assault 10

Boundary violation 7

Emergency treatment not provided 6

Sexual misconduct 5

Misrepresentation of qualifi cations 5

Discriminatory conduct 3

Case example: A man complains that a psychologist he

and his wife were seeing to resolve their marital issues has

unduly infl uenced his wife to leave the marriage. He later

discovers emails between the pair that contain evidence

they were engaged in a sexual relationship. As there is

substantive evidence of a serious boundary violation, we

refer the matter to the Psychologists Board for further action.

Medication breakdown 2009-10


Prescribing medication 36

Administering medication 23

Dispensing medication 22

Supply/security/storage of medication 1

Case example: A woman collecting cardiac medication from

her pharmacist is accidentally given the wrong tablets, a

side effect of which is drowsiness. After taking her morning

medication the next day, the woman is involved in a car

accident. She complains that the medication made her fall

asleep at the wheel. Clinical opinion states the woman was

given the wrong medication. The pharmacist apologises to

the woman and the complaint is referred to the Pharmacists

Board of Queensland for further action.

Keeping complaints out of courtOur conciliators held two education seminars for 41 government and non-government lawyers in October and November 2009. The seminars showcased our conciliation service and how it offers an alternative to costly legal action in medical negligence claims.


ImprovementsEncouraging Indigenous complainantsWe appointed a permanent Senior Complaints/IndigenousLiaison Offi cer in September 2009. As requested, the offi cerprovides culturally appropriate support to Aboriginal andTorres Strait Islander complainants through:

• assisting complainants to formulate their complaints

• seeking responses from healthcare providers

• negotiating agreements between parties.

In 2009-10, 2.7% of complaints and 1.3% of enquiries werefrom Aboriginal and Torres Strait Islander peoples. Australian Bureau of Statistics 2006 census data shows Aboriginal and Torres Strait Islander peoples account for 3.6% of Queensland’s population. Common issues were inadequate treatment and communication, which aligns with the general population

To encourage Aboriginal and Torres Strait Islander people totell us about their healthcare concerns we ran a communityand media campaign in November 2009 (page 41).

Upskilling our peopleTo develop their skills, our complaint offi cers undertook:

• Mental Health First Aid training to assist with the

management of mental health-related complaints

• Plain English writing training to improve correspondence

with clients

• medical negligence training to assist with effective

conciliation.

In the next year, we will continue our skills development

strategy for Complaint Services staff.

Case studyA 75 year old woman complained that her general practitioner (GP) mistook a blood clot for a sprained ankle, then arthritis, causing her condition to worsen to the point that it became life threatening.

The woman presented to the GP complaining of a painful swollen foot and ankle. At the time she mentioned that she had recently undergone surgery for an abdominal hernia repair however the GP said he did not believe there was a link between this surgery and the woman’s symptoms. The woman also reported having tripped in her garden at home the day before and the GP advised she had most likely sprained her ankle.

The woman visited the GP a further four times complaining of increasing pain and swelling. On the fourth visit, the GP changed the diagnosis to arthritis and prescribed medication.

At her daughter’s insistence, the woman sought a second opinion from her local hospital emergency department, where scans revealed a large blood clot in her groin. Hospital specialists said the clot was most likely to have been an outcome of the abdominal surgery.

Independent clinical advice stated the woman was at high risk of developing a clot following surgery as she had many risk factors – a sedentary lifestyle, obesity, smoking and recent surgery. The advice further stated the GP had failed to properly examine or diagnose the woman and the delays and unnecessary prescription of medication could have caused further harm.

The GP was referred to the Medical Board of Queensland for further action.

Encouraging complaints Former Indigenous Liaison Offi cer Cheryal Kyle hands out our Positive Health Action balloons during NAIDOC celebrations. We attended three NAIDOC events in July 2009 to promote our service and the importance of safe, high quality healthcare to Aboriginal and Torres Strait Islander people.


OutlookRecording complaintsWe commenced implementation of voice recording technology

to record complaints in late June 2010. The voice recording

system will ensure accuracy of complaint information for both

healthcare consumers and providers and assist with internal

reviews of our complaint management service.

Reviewing conciliationWe called for expressions of interest from fi ve tertiary

educational institutions in Queensland and New South Wales

to review our conciliation function. We anticipate appointing

a consultant to complete the review by December 2010.

Issues to be addressed include:

• current conciliation practices and their impact on the

timeliness of services

• comparison and benchmarking of timeliness of

conciliation with similar agencies and medico-legal

litigation

• current/potential use of conciliation performance data to

inform future operations

• an evaluation of the requirement to establish a monitoring

function for provider quality improvement when

recommendations are made.

We will also develop training/practice standards for our

conciliators (in conjunction with interstate colleagues) to

provide greater uniformity in service delivery and improve

client confi dence in this unique complaint resolution service.

Our case offi cer was at all times very professional and approachable, and extended compassion and understanding through emotional times for the family.Conciliation participant

Fostering patient linksCEO Cheryl Herbert and Executive Manager, Complaint Services Peter Johnstone address the Queensland Patient Liaison Offi cer (PLO) Network at a meeting hosted by the HQCC in March 2010. PLOs are important contacts for us as they act as a bridge between patients and health services. Regular meetings gave us a great opportunity to promote our service and how we can help.

Improving external adviceFollowing the review of our internal clinical advice model, we

will review how we use external experts for formal clinical

opinions. The review will cover:

• the process for recruiting external experts in frequently

used specialities

• the process for interstate expert requests

• development of information systems to better record and

report on the use of independent expert advisers.

Reaching a shared understandingSeveral major private health corporations expressed interest

in entering a memorandum of understanding (MOU) with us

to improve communication and coordination of complaints

management and resolution. These agreements will be

fi nalised early in 2010-11. Our fi rst MOU, with St Vincent’s

and Holy Spirit Health, was signed in 2008-09.

We are also developing MOUs at the state and national level

to ensure effi cient and effective complaint management

following the establishment of the Australian Health

Practitioner Regulation Agency (AHPRA).


Accessing our serviceWhile telephone calls to our complaints hotline remain the

principal method of contacting us, there was an increase in

the number of people coming to see us to make a complaint

this year. This increase is likely due to our growing public

profi le and relocation to a new one-stop-complaints-shop at

53 Albert Street, Brisbane, where we share premises with

four other complaint agencies.

Method of contact

Telephone

Mail

Email

Online

Other – fax, in person

*We will be launching an improved online complaint form in 2010-11 to

provide another way of lodging a complaint. The online form was fi rst

introduced in June 2009, but was removed in preparation for a website

upgrade in November 2009. Unfortunately, due to technical and process

errors, 23 new complaints lodged between September and November

2009 were not actioned. When alerted to the problem in February 2010,

we immediately conducted an indepth search of our systems and located

the complaints. We initiated contact with all complainants within 24 hours,

apologised for the error and progressed the complaints as speedily as

possible. At 30 June, four complaints remained in progress, fi ve had been

referred to external agencies and the balance had been closed.

Gauging client experienceWe send our recently reviewed Complaint Service Charterto all new complainants, outlining the standard of servicethey can expect from us. To measure how we meet thoseexpectations, we introduced a client experience survey forEarly Resolution, Assessment and Conciliation case closures.In 2009-10, 198 clients responded (43% complainants, 40%providers and 17% unknown) helping us to identify areas forimprovement, such as keeping clients better informed aboutthe progress of their complaint.

Client experience surveys were introduced for Investigationclients in June 2010.

As part of our commitment to providing exceptional service, we started conducting quality audits of our conciliation and investigation case management. These measures are nowincluded in our strategic reporting framework – 92% of conciliation cases and 97% of investigation reports met quality requirements. Quality audits of complaint early resolution and

assessment processes will be introduced in 2010-11.

Client experience survey results 2009-10

HQCC staff were polite

HQCC staff were professional

My view was heard in a fair and unbiased way

I felt the complaint was taken seriously

I was given clear reasons for the decision made about the complaint

Overall, I was satisfi ed with the way my complaint was handled*

*This question was added to the survey in January 2010, receiving 70 responses.

Quality serviceFocus on

We are committed to providing a high quality service. All feedback – both compliments and complaints – gives us an opportunity to improve our services.

2007-08

2008-09

2009-10

0 10 20 30 40 50 60 70 80

65%30%

3%–

2%

59%33%

4%

4%

58%30%

4%2%*

6%

–

0 20 40 60 80 100

Complainants

(n=85)

Providers

(n=80)

Overall(n=198)

85%81%

71%71%71%71% (n=35)

80%86%

81%89%

84%86% (n=22)

84%85%

78%81%

79%80% (n=69)


Some 17% of our complainants are referred to us by ahospital or doctor, with 15% referred by a governmentdepartment and 15% by a family member or friend. Some11% fi nd out about us through the internet or media while4% have had previous contact with our organisation.

We are committed to making our services as accessible aspossible. Complainants can lodge their written complaint intheir own language. This year we spent $3356 (excludingGST) on translation services. That is more than double the$1569 we spent in 2008-09, showing an increase in theuse of our services by Queenslanders from culturally andlinguistically diverse backgrounds.

Improving our serviceTo help us improve our service, we invite our clients to letus know if our service or decision has not met expectations.We received fi ve complaints about our complaint andinvestigation processes.

Our Complaints Management Policy aligns with theInternational and Australian Standard AS ISO 10002-2006 Customer Satisfaction – Guidelines for complaints handling in organisations, issued by Standards Australia in April 2006;Directive 12/06 Complaints Management Systems, issued bythe Public Service Commission, Queensland, in November2006; and Effective Complaints Management: Guide to developing effective complaints management policies and procedures, published by the Offi ce of the QueenslandOmbudsman in December 2006. Our ComplaintsManagement Policy and Complaints Service Charter areavailable on our website.

In June 2009, the Queensland Ombudsman providedfeedback on our internal complaints process, makingsix recommendations for improvement. All of therecommendations related to our Complaints ManagementPolicy, in particular ensuring a documented process for ourstaff to follow in the event of a complaint about us. We havereviewed our policy and provided it to the Ombudsman forfeedback prior to publication. We will implement anotherOmbudsman recommendation to provide an online form formaking complaints about us as part of a web developmentproject in 2010-11.

Making good decisionsTo promote fair and open decision-making, we improvedcommunication of our review process through fact sheets,our website, client experience surveys and correspondence.This resulted in a 33% increase in the number of reviewsundertaken following the closure of a complaint. To put thatfi gure in perspective, 3% of our complaint managementdecisions were subject to review and 70% of our decisionswere upheld. Clients may seek further review by theQueensland Ombudsman.

Complaints and reviews

Complaints about our processes

Reviews of our decisions

Sharing informationClient confi dentiality and privacy is at the foundation of our

service. We respect the right of people to access or amend

personal information, as well as to access information about

our activities that will give a better understanding of the

decisions we make.

In the fi rst year following the repeal of the Freedom of Information Act 1992, we achieved 100% compliance with

statutory timeframes for processing applications under the

new Information Privacy (IP) Act 2009 and9 Right to Information (RTI) Act 2009. No privacy breaches were reported to us or

the Information Privacy Commissioner in 2009-10.

We appointed a permanent dedicated Right to Information

Offi cer and three staff members undertook external training

on the new legislative provisions. In-house education was

provided to the Commission and staff. We also developed

an Administrative Access Policy to ensure that legislative

requests for information were a last resort for clients wishing

to access their personal information.

We received 95 applications for access to information under

both laws – an large increase on the 44 applications we

received in 2008-09. We released in full 91% of the 13,700

documents we considered. There was one application for

both internal and external review. The internal review was

successful and the document was released. The external

review decision was pending at 30 June 2010. Information

about how to lodge an application, including fees and

charges, can be found on our website.

Setting the standardQueensland hospitals report on their standards compliance

twice a year through a secure online tool, StaRT. Following

each reporting round, hospitals receive an individualised

report on their performance. We simplifi ed the report this

year in response to hospital feedback.

Our StaRT helpdesk actioned 200 service requests from

hospitals over the two reporting rounds and we surveyed

facilities about their experience following the introduction

of a new StaRT system in March 2010. The 34 survey

respondents provided detailed feedback about what they did

and did not like about the new tool. We are implementing

12 recommendations for improvement to better meet user

needs in future reporting rounds (page 47).

2008-09

2009-10

0 10 20 30 40 50 60 70 80

10

48

5

64


recommendations for improvement made

KPIs

88% of investigations fi nalised in

12 months (2008-09: 64%)

67% of investigation recommendations implemented (new)

97% of investigation case audits met quality requirements (new)

OverviewWe investigate serious and widespread healthcare issues to recommend action that will improve the safety and quality of healthcare for all Queenslanders.

Since July 2006, healthcare providers have implemented 67% of our recommendations – each seeking to prevent patient harm and address service failures and system-wide shortcomings. Our new ability to formally track uptake of our recommendations allows us to map the quality improvement processes undertaken by healthcare providers, and to issue a show cause notice if events reoccur.

This year we focused on reducing investigative timeframes, while improving the quality of our investigation reports and how we make recommendations.

9% increase in accepted investigations

7 month average investigation timeframe

Highlights

62

Source 2

Investigations

| 31

Performance

2006-07

2007-08

2008-09

2009-10

0 20 40 60 80 100 120

38

7

31

24

35

61

59

85

104

78

94

105

Accepted, fi nalised and open investigations at 30 June

We started the year with 35 active investigations, accepting a further 85 cases.Our caseload peaked at 62 cases and we made use of our fl exible workforce staff to meet

demand. Finalised investigations decreased from the previous year, however the large

number of investigations fi nalised in 2008-09 was due to a 12-month injection of resources

and temporary staff aimed at clearing a backlog of open investigations.

Number

0 5 10 15 20 25 30 35

35

14

6

2

4

Timeliness of investigations fi nalised 2009-10

We closed 61 investigations within an average timeframe of seven months.At 30 June, seven cases had been open for more than a year. These longer investigations are

inherently more complex, and involve multiple witnesses, clinical opinions and legal/medical

indemnity providers – all of which can contribute to delays in the investigation process.

Accepted investigations

Finalised investigations

Open investigations at

30 June

Health service complaint

Health quality complaint

Accepted

0 10 20 30 40 50

Finalised

35

30

31

50

Type of accepted/fi nalised investigations 2009-10

We accept two kinds of complaints – health service complaints and health quality complaints.

Health service complaints are made by patients, or someone acting on a patient’s behalf,

about a healthcare provider. These complaints must be made within one year of the

incident, or within one year of the complainant becoming aware of a problem. Some 35

such complaints were accepted for investigation, with 30 cases closed.

Health quality complaints can be made by anyone, including current or former staff or

other healthcare providers. They can be about one health service or a problem found in

multiple health services and there is no time limit. We commenced investigation of 50

health quality complaints, fi nalising 31 matters.

We received one public interest disclosure (2008-09: four) under the Whistleblowers

Protection Act 1994, which protects complainants who disclose unlawful, negligent or

improper conduct in the public sector, or a danger to public safety. In 2009-10, three

whistleblower complaints were investigated and fi nalised, with one case still under

investigation at 30 June 2010.

We initiated three investigations based on our own concerns about the safety and quality

of healthcare and closed one of these matters.

<6 months

6-12 months

12-18 months

18-24 months

>24 months


Number of

recommendations

Finalised investigations

2007-08

2008-09

2009-10

0 20 40 60 80 100 120

8

24

45

104

61

62

Recommendations for improvement

Through investigation we aim to identify areas for improvement and make recommendations for action. It is not our role to fi nd fault or apportion blame,

but we can refer matters involving registered providers to their registration board

for consideration. Recommendations generally include changes in individual and

organisational practice, and specifi c initiatives to address identifi ed failings. Allegations

are proven or evidence of a systemic issue is found in about half of our investigations.

The 38% growth in the number of recommendations we made (despite fi nalising

fewer investigations) shows our ongoing focus on identifying opportunities for

improvement and learning from every investigation. Of our recommendations, 96%

were made to public healthcare providers.

Quality of a health

service

Reportable death

Ministerial direction

Systemic quality issue

Accepted

Finalised

0 1 2 3 4 5 6 7 8

8

5

5

3

7

2

2

3

Referred investigations accepted/fi nalised 2009-10

Investigations may also be referred to us by the Minister for Health, the Coroner or another agency, such as a professional registration board or healthcare provider.We accepted 21 referrals and fi nalised 14 referred investigations.

We hold a memorandum of understanding (MOU) with agencies such as the Crime and

Misconduct Commission and the Queensland Police Service, to determine the role of

agencies when investigating serious adverse health events. We took the lead role in 11

multi-agency investigations involving systemic health issues and professional misconduct by

a non-registered provider. As part of our oversight role, we also reviewed 205 professional

registration board investigation reports and 26 Queensland Ambulance Service (QAS)

matters, as well as investigations undertaken by Queensland Health’s ethical standards unit,

the Commission for Children, Young People and Child Guardian, and the Coroner.

From 1 July 2010, we will no longer review registration board investigations following the

formation of the Australian Health Practitioner Regulation Agency.

%

Fully implemented 67

by provider

Partially implemented 33

by provider

Outcome of recommendations since July 2006

As at 30 June 2010, 67% of the investigation recommendations we monitored were fully implemented, with the balance in progress.A further 43 recommendations were not due for reporting

before 30 June and these will be captured in 2010-11.

All HQCC recommendations are monitored.


ChallengesManaging our caseload Under the new investigations model adopted in 2008-09,

we planned to reduce the number of investigations we

conduct to 40 a year to allow for more in-depth investigation

of serious, system-wide healthcare issues. The model works

to eliminate any duplication between investigating bodies

and to empower healthcare providers to identify areas for

improvement before issues escalate. However, due to high

profi le healthcare incidents and an increased awareness of

the HQCC, we accepted 85 investigations in 2009-10.

With a permanent team of only seven investigators,

managing our caseload has been an ongoing challenge.

To cope in periods of high demand we made temporary use

of our fl exible workforce.

Case studyA 34 year old woman complained ultrasound scans during her pregnancy had failed to identify her baby had Downs Syndrome and multiple congenital abnormalities.

While it was determined the woman underwent multiple scans, it was noted only two (at 20 and 30 weeks gestation) were to screen for abnormalities.

Independent clinical opinion obtained by the HQCC found some abnormalities such as an umbilical hernia, would not have been visible by ultrasound scanning. The independent adviser also stressed fetal ultrasounds have limitations as a diagnostic tool and that even if the abnormalities had been diagnosed, it is unlikely the woman’s antenatal care would have been signifi cantly different.

However, the independent expert identifi ed some features on the fi lms that should have been seen by the reporting radiologists. The HQCC recommended the Medical Board review the radiologists involved.

As a result of the investigation, the radiology clinic introduced information pamphlets to clearly inform patients of the limitations of ultrasound scans and reviewed staff development and training programs.

We investigate for quality improvement.


Working with CoronersWe continued to work with the State Coroner and regional

Coroners to improve investigation of medical-related deaths

under the Coroner’s Act 2003. The collaboration involved:

• clarifying the Coroners’ investigation and review

requirements

• determining whether we can offer formal or informal

advice

• providing investigative assistance or conducting

investigations as the lead agency

• reviewing matters referred to, or fi nalised by, the

Coroner(s).

This year, the Northern Coroner established a triage process

that involves the HQCC and other parties, such as the

Queensland Police. This system is proving to be resource

and outcome effective.

Upskilling investigatorsAs part of their professional development our investigation

staff undertook:

• Plain English writing course to ensure investigation

reports are well-structured and clear

• Discipline Investigation and Court Protocols workshop to

give HQCC investigators experience in the witness box

• Certifi cate IV in Government (Investigations).

ImprovementsBeing timely

We worked hard to streamline our process and fi nalise

investigations as quickly as practicable having regard to

the nature of the matter being investigated and without

undermining the integrity of our investigation reports. We

changed our processes on accepting an investigation to

ensure early triage, consultation with clinicians and relevant

agencies, and use of in-house legal advice to establish the

parameters and focus of the investigation. In 2009-10, we

increased the proportion of investigations fi nalised within a

year from 64% to 88%.

Monitoring recommendations

For the fi rst time, we formally monitored the implementation

of our recommendations. All healthcare providers who have

been the subject of HQCC investigation recommendations

(dating back to July 2006) were asked to report on the

implementation status. We are in regular contact with

providers to check on their progress. This monitoring was

not previously possible due to resource constraints.

Additionally, in 2009-10 we improved the way we make

recommendations to ensure they are deliverable and

measurable. We consulted with external parties to determine

adequate timeframes for implementation to ensure

recommendations and healthcare improvements can be

effectively monitored.


Our recommendations are based on evidence and independent clinical advice. The majority of the investigations that resulted in recommendations were about inadequate treatment, coordination and conduct of treatment, and/or facility cleanliness/hygiene.

The following recommendations were made in 2009-10 to prevent harm and improve quality (identifying information has been removed to protect the privacy of those involved).

Amendment to care manual A 50-year-old man with a history of irritable bowel syndrome

complained that a standard procedure to lance a boil

resulted in a painful, permanent condition requiring ongoing

treatment. A nurse at a remote hospital lanced the boil on

the man’s buttock, following guidelines set out in the Primary

Clinical Care Manual. The boil site later became infected and

despite antibiotic therapy, did not improve.

Independent clinical advice stated the procedure did not

contribute to the man’s condition, although it would have

been best for a medical offi cer to have reviewed and treated

the man, given the site of the boil and the patient’s history of

bowel disease.

We recommended the Primary Clinical Care Manual be

amended to include a specifi c caveat for the management

of perianal boils/abscess in patients with bowel disease.

We will monitor implementation of this recommendation in

2010-11.

%

Treatment 70

Environment/management 22

Communication 4

Professional conduct 4

Issues of investigation resulting in recommendation 2006-10

Lessons learned through investigation

Day in courtHQCC investigators skilled in gathering and analysing evidence were given an opportunity to test themselves in the witness box during a full-day Discipline Investigation and Court Protocols workshop and mock court session at Brisbane Magistrates Court in October 2009. Five investigators are studying a Certifi cate IV in Government (Investigations).


Care complaintAn elderly man underwent successful knee replacement

surgery but in the following days it became evident the

surgical site was infected. Over the next two weeks, the

man’s health deteriorated to the point where he was unable

to eat, then swallow, and he died. His family complained

about the level of nursing care given to the man and said

other specialists (such as a speech therapist) were not

engaged to assist in the man’s care.

The HQCC found evidence of poor documentation, including

incomplete oral intake records, incorrect labelling of patient

records and x-rays, and inadequate progress notes.

The HQCC recommended:

• timely referral of patients for specialist reviews

as required

• audits of patient records to assess levels of

documentation and identify areas for improvement

• formal education for staff on expected documentation

standards.

These recommendations have been implemented.

Reportable death at remote hospitalA 30-year-old woman presented to a small, remote hospital

with shortness of breath and throat tightness. The day after

her admission, her condition signifi cantly worsened and she

required an increasing amount of oxygen. The woman was

diagnosed with acute pulmonary oedema and pneumonia. She

suffered a cardiac arrest and was unable to be resuscitated.

Her family said her death could have been prevented.

We investigated and agreed with the fi ndings of the

hospital’s internal review of the incident, which found

care was appropriate but identifi ed areas for improvement

in processes and staff education. We recommended full

implementation of the nine review recommendations.

At 30 June, fi ve recommendations were implemented,

with the remaining four in progress.

Mental health deathA 20-year-old man with a history of paranoid schizophrenia

was admitted to a mental health unit under an involuntary

treatment order. His mental health declined and he was

assessed to be at a medium risk of suicide. He was placed

on 15 minute observations, which were later reduced to 30

minutes. The following day, the man absconded from the

unit and committed suicide.

The Coroner’s report into the death was provided to

the HQCC and concluded the medical care provided

was appropriate. An internal review of the death made

recommendations to improve the notifi cation process

and documentation for missing patients. We will monitor

implementation of these recommendations in 2010-11.

Claim of neglect An elderly woman was transferred from a nursing home

to a private hospital for a number of health concerns. Her

son stated that his mother was badly treated and neglected

by hospital staff, then discharged in a poor condition with

multiple pressure ulcers on her back, buttocks and heels.

Following investigation, we recommended the hospital:

• introduce mandatory training in wound care

• introduce a formalised system of auditing, review and

reporting

• obtain an expert independent review of the policies

and procedures in place to provide risk assessment,

management and treatment plans for patients at risk of

developing pressure areas and requiring wound care to

ensure best practice is being maintained.

One of these recommendations has been implemented, with

the remaining two in progress.


Death of two-year-old in EidsvoldThe Queensland Ambulance Service investigated how an

ambulance was sent to the wrong address when responding

to a toddler drowning on an Eidsvold property, west of

Bundaberg, in February 2010. The boy later died. The HQCC

monitored the investigative process and outcome. A coronial

inquiry into the child’s death will also be held.

Allegations about provision of cosmetic injections The HQCC and the Queensland Nursing Council launched a

joint investigation in March 2010 after receiving complaints

about the provision of cosmetic injections (Schedule 4 drug

botulinum toxin) in Cairns. The HQCC executed a search

warrant on a premises. The multi-agency investigation

is continuing.

Prescription of abortion drugs at Bundaberg HospitalAllegations that a pregnant woman was wrongly prescribed

abortion drugs after a misdiagnosed miscarriage were

referred to the HQCC in March 2010. The allegations were

raised in the Queensland Parliament. The investigation is

continuing.

Death of Gregory van MoolenbroekThe Queensland Ambulance Service is investigating why

ambulances took more than an hour to attend to a heart

attack victim in North Mackay in May 2010. The HQCC is

monitoring the investigative process and outcome. Both the

Crime and Misconduct Commission and the HQCC will assist

the Coroner.

Several of our investigations were reported in the media in the past year. Sixty per cent of our media coverage was about current or former investigations.

Zoe’s Place hospice careIn May 2009 the HQCC, along with the Queensland Nursing

Council, launched an investigation after receiving complaints

about the standard of care provided by Zoe’s Place, a hospice

for terminally ill children in Brisbane. During the course of the

investigation, the hospice closed. The Queensland Nursing

Council appointed an external inspector to investigate two

nurses involved, with assistance from one of the council’s

lawyers. This investigation continues.

Child death in DoomadgeeTo determine if any further action is necessary, the HQCC

is awaiting the outcome of a coronial inquest into the death

of a four-year-old girl at Doomadgee in July 2009. The family

say the sick child, who was displaying fl u-like symptoms,

was taken to Doomadgee Hospital and seen by nursing staff

several times before she was admitted. We continue to

monitor investigations into the death.

Dental sterilisation failuresIn November 2009, Queensland Health investigated how

dental patients in Bundaberg came to be operated on

with unsterile equipment, putting them at potential risk of

blood-borne virus infection. We are working with the Chief

Dental Offi cer to monitor the implementation of Queensland

Health’s recommendations. As there were two other similar

cases within seven months – in Mackay and on the Gold

Coast – the recommendations will be rolled out statewide.

The death of Ryan Saunders In September 2009, we fi nalised our investigation report

into the death of Emerald toddler Ryan Saunders.

Two-year-old Ryan died at Rockhampton Hospital in

September 2007 after a fi ve-day illness which was not

diagnosed in life. Due to confi dential medical information

contained in the report, it was not publicly released, however

in line with the HQCC Act, the report was provided to all

relevant parties, including Ryan’s parents, Queensland

Health, the Deputy Premier and Minister for Health Paul

Lucas and the Offi ce of the State Coroner. We hope the

information, comments and recommendations made in the

report provided Ryan’s family with the answers they were

seeking and that the signifi cant recommendations we made

will prevent further patient harm and improve the safety and

quality of health services across Queensland.

Investigations in the news


Case studyCredentialing – a special report

We launched our fi rst special report investigation after concerns were raised about the management and practice of a doctor at Emerald Hospital.

With concern over the continued recurrence of credentialing failures despite multiple investigations at various levels, the HQCC extended the investigation to issues surrounding registration, credentialing, supervision and performance management of medical practitioners in Queensland.

This investigation is a comprehensive, overarching review to identify why the same issues keep occurring and how they can be prevented in future. The special investigation will be fi nalised in 2010-11, encompassing related internal reviews by Queensland Health and the Crime and Misconduct Commission.

It involves independent review of:

• Queensland Health credentialing processes

• the interaction and information-sharing between the Medical Board of Queensland and Queensland Health

• Queensland Health’s complaint management process.

OutlookPublic reporting To overcome confi dentiality and privacy constraints that

prevent us from publicly releasing the majority of our

investigation reports, we will develop further special

reports about systemic issues. Special reports will be

provided to the Minister for Health, who is required under

the HQCC Act to table such reports in Parliament. Special

reports will inform the public about lessons learned

from our investigations and the service and system

improvements being made by healthcare providers.

Tracking technologyWe are hoping to secure resources to develop an online

reporting tool for healthcare providers to report their

implementation of investigation recommendations.

The same system will be used to track reports on

recommendations from quality monitoring.

Complaint managers meet Executive Manager, Complaint Services Peter Johnstone and Manager, Investigations Dave McKenzie chat to the ACT Human Rights Commission’s Matt Hingston at the annual meeting of Australia’s health complaint managers, hosted by the HQCC in October 2009. These meetings enable us to share information and initiatives with our interstate counterparts.

There has been signifi cant review and reform over the past four years. This shouldn’t keep happening. CEO Cheryl Herbert

| 39

Effectiveengagement

Focus on

As Queensland’s health watchdog, we engage with a wide range of stakeholders – healthcare consumers and providers, industry and community groups, Members of Parliament, the media and the wider community.

Reaching the regionsIn 2009-10 our regional engagement program was guided by

our risk identifi cation and intervention strategy. We visited two

regions where concerns had been identifi ed in our complaints

and standards data, meeting with relevant industry and

community groups. Our investigations staff visited a further

fi ve regions to conduct public meetings and site inspections,

and interview witnesses. Our CEO met with regional, rural and

remote community leaders in Normanton to showcase our

prototype hospital profi les in May 2010.

Promoting healthy campaigns

It’s okay to complainWe joined forces with our fellow independent complaint agencies

to develop an online complaint portal, launched in October 2009.

Attracting 4342 visits (13% linked from the HQCC website), the

website has information about 13 state and national integrity

agencies. The new portal was launched through a joint media

campaign and a brochure entitled, ‘It’s OK to complain’, which is

available in 15 community languages.

In 2008-09, we refreshed our corporate image, with an updated website and new promotional material. We put in place effective plans and processes to ensure engagement could continue in a smarter, more cost effective way with a reduced team of three managing community engagement, corporate communications, media liaison and marketing. We implemented 98% of our Stakeholder Engagement Plan 2009-10, available on our website.

Improving communicationThis year we launched two quarterly e-newsletters – the

Loop for community groups, consumers and Members

of Parliament, and the Pulse for industry groups and

healthcare professionals. We use these newsletters to share

organisational information about programs, initiatives and

events. We have 550 newsletter subscribers.

Public interest in the HQCC’s work continued to rise

in 2009-10, with media coverage increasing by 38%,

on top of the 698% increase in 2008-09, when we fi rst

appointed a dedicated media offi cer. We also strengthened

awareness and understanding of our work among healthcare

professionals by working with specialist media.

Posting the latest newsRecognising the link between media activity, visitation to our

website and enquiries to our complaints hotline, we make

sure our website offers the latest information about our

organisation and activities. This year, we focused on extending

the range of information, presenting it in a user-friendly way

and increasing information in languages other than English.

Celebrating diversity We exhibited at the Queensland Multicultural Festival, held at Roma Street Parklands in October 2009. We promoted the independent complaint agency ‘It’s OK to complain’ web portal and community language brochures. In 2009-10, we exhibited at eight community events to increase consumer awareness of our services and encourage people to play an active role in their healthcare.


Indigenous complaintsWe developed and distributed Indigenous information cards,

featuring commissioned artwork depicting the role of the

HQCC and the importance of safe, high quality healthcare.

Through a successful media launch, we distributed 10,000

cards to community groups, health clinics, legal centres, and

to Aboriginal and Torres Strait Islander organisations.

With only one identifi ed Indigenous staff member and

following feedback from an Indigenous focus group in

July 2009, we decided not to proceed with our plans to

share leading practice in Indigenous healthcare. Instead

we have focused on making our complaints service more

accessible to Aboriginal and Torres Strait Islander people

by improving internal processes and engaging with

Indigenous organisations.

Australian Charter of Healthcare RightsTo promote patient rights, we

encourage consumers and

providers to become familiar

with the Australian Charter

of Healthcare Rights. All new

complaint clients receive a

copy of the charter, along

with our own service charter.

Information is available on

our website in 17 languages.

Working with our Consumer

Advisory Committee (page

66), we are developing a

consumer presentation

and promoting the charter

through our networks.

Multicultural awareness

We distributed information packages to 150 community and

multicultural organisations promoting access to our services

for culturally and linguistically diverse Queenslanders,

and shared the campaign through community radio. Staff

received refresher information on translation and interpreter

services, and managing complaints from people who speak a

language other than English.

Men’s healthIdentifying that only 35% of our complainants are men, we

ran a community and media campaign during Men’s Health

Week (14-20 June) to encourage more men to complain

about their healthcare concerns.

Participating in eventsWe attended 20 industry conferences/events and presented

at a further 58, including three presentations on our

standards and compliance monitoring at the International

Society for Quality in Health Care conference in Dublin.

We also participated in eight community events – such

as NAIDOC Week celebrations and the Queensland

Multicultural Festival.

International travel 2009-10

Staff member Event CostPat Avey, project

manager standards

review

International Society for

Quality in Health Care

conference, Dublin

$2828

We hosted monthly meetings of the Health Services

Improvement Network, a group initiated by Commissioner

Professor Michael Ward to share information and initiatives

between health researchers, administrators and clinicians.

One hundred percent of respondents to a June 2010 survey

agreed the sessions were relevant and useful, provided a

great networking opportunity and that the topics discussed

were a refl ection of current and emerging issues. A new

format for meetings and web support is under development

to better accommodate the diversity of the network.

We held two educational seminars about our conciliation

process for members of the legal community in October/

November 2009. Our complaint offi cers also continued

to attend monthly meetings with the Queensland Patient

Liaison Offi cer Network (QPLON). We hosted a QPLON

conference in August 2009 to help the offi cers, who provide

an important link between patients and providers, understand

our processes and improve their complaint management.

Another conference is planned in 2010.

%

Safety 55

Communication 30

Access 6

Respect 5

Privacy 2

Participation 1

Comment 1

Complaint issues mapped against the Australian Charter of Healthcare Rights

Talking with nurses Clinical Manager Alison Murley speaks with nurses at the Queensland Nurses Union annual conference in July 2009. Attendees picked up information packages about our services and healthcare standards. We attended 78 industry events in 2009-10.


42424244 | H H H HHHHQCCQCCQCCCCQCCCCQCCQCCCQCCCC An An An An AnAnAnAnAnA nuanuanuanuanuanuaunnnu l Rl Rl Rl Rl Rl Rl RRRRRepoepoepoepoepepoepoepoepoe oport t rt rtrttrttttt 2002002000020020000002002 0222 9-19-19-19-11119-19-9-9-9-19-10000000000

KPIs

100% (226) hospitals reported against our standards (2008-09: 100%)

91% hospital compliance with our healthcare standards (2008-09: 86%)

OverviewIntroduced in July 2007, our healthcare standards address identifi ed gaps in service delivery and provide best practice guidelines to ensure all patients receive safe, high quality care. Acute and day hospitals report on their compliance with the standards twice a year, empowering healthcare providers to monitor their service through audit and review, and drive a quality improvement culture.

This year, we reviewed our healthcare standards to ensure they keep pace with changing evidence-based best practice. Updated standards were launched on 1 July 2010, encompassing stakeholder feedback and refl ecting the advent of national healthcare standards, expected to be launched in 2011.

In a busy year, we also launched a new online system for hospitals to report their standards compliance, improved our analysis of quality monitoring data and developed processes to verify hospital improvement in line with our risk identifi cation and intervention strategy.

quality improvement activities undertaken by hospitals

93% of hospitals align with seven to nine key patient safety areas under our standards

55 submission issues and 100 expert recommendations considered in standards review

Highlights

700

Source 3

Standards and quality

| 43443

Performance

Performance of Queensland hospitals* against HQCC healthcare standards

Hospitals (public and private) report their compliance against the standards every six months, including the documented processes they have in place, and whether they align with our standard.

We publicly report this information through our Annual Health Check every October. Overall, there is 91% compliance with

our standards. There is consistent high performance in Hand hygiene, Complaints management and now Surgical safety – incorrect surgery.

Standard

Facilities have a process Process aligns with HQCC standard

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Provider’s duty to improve the safety and quality of health services standard

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Credentialing and scope of clinical practice standard

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Complaints management standard

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Review of hospital-related deaths standard

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Management of acute myocardial infarction on and following discharge standard

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Hand hygiene standard

*Includes acute hospitals and day hospitals.

Self-assessment questions on the process and its alignment to the HQCC standards were not asked for reporting periods 3 (Jan-Mar 2008) and 4 (Apr-June 2008).

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Surgical safety – prevention of venous thromboembolism standard

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Surgical safety – prevention of incorrect surgery standard

1

Jul-Sep

2007

2

Oct-Dec

2007

5

Jul-Dec

2008

6

Jan-Jun

2009

7

Jul-Dec

2009

0

20

40

60

80

100

%

Surgical safety – appropriate use of surgical antibiotic prophylaxis standard


Trend analysis: comparison with peersThe biggest improvement over time has been in the Management of acute myocardial infarction (AMI) on and following discharge standard (from 34% to 85%). The AMI standard defi nes four recommended medicines that doctors

should consider prescribing to heart attack patients (if there are no contra-indications) to minimise the risk of further attacks.

Hospitals provide data on this standard to demonstrate patients are getting the care and advice necessary to prevent further

heart attacks. The graphs below show the prescription rates for the four medicines. The fi rst graph is for a medium-sized

urban hospital. The second graph shows the same information for the peer group, all medium-sized urban hospitals.

Oct-Dec

2007

Jan-Mar

2008

Apr-Jun

2008

Jul-Dec

2008

Jan-Jun

2009

Jul-Dec

2009

% of

patients

prescribed

medicines

0

20

40

60

80

100Hospital A: Rate of prescription of four medicines after AMI

Beta blocker

Anti-platelet

ACE inhibitor

Cholesterol lowering agent

The graph above shows steady improvement from September 2007 to December 2009. While there have been increases in the other drugs, beta blocker

prescription (grey line) appears to have reached a plateau at 65% – possibly a result of

contra-indications, although this requires closer examination.

% of

patients

prescribed

medicines

Oct-Dec

2007

Jan-Mar

2008

Apr-Jun

2008

Jul-Dec

2008

Jan-Jun

2009

Jul-Dec

2009

0

20

40

60

80

100

Beta blocker

Anti-platelet

ACE inhibitor

Cholesterol lowering agent

Peer hospitals: Rate of prescription of four medicines after AMI

The peer hospitals have a steady but slower increase in the prescription of the recommended medicines. As there is no plateau for the prescription of beta blockers

(grey line) in the peer group, this suggests Hospital A should look for internal factors to

explain the plateau in prescription of beta blockers.

As our Surgical safety standard comprises three parts, our standards actually cover nine key patient safety areas. In December 2009, 93% of facilities aligned with

seven to nine areas, compared to 89% in December 2008.

Generally, private hospitals perform better, with 98% of

hospitals complying with seven to nine areas, compared

with 89% of public hospitals. All hospitals now align with

four or more of the standards. This shows more facilities

now have better processes in place to gather clinical safety

and quality data.

Hospitals* aligning with nine key patient safety areasNumber of patient safety areasp y

0-3 4-5 7-9

State

Dec 2007 4% 33% 62%

Dec 2008 0% 10% 89%

Dec 2009 0% 7% 93%

Public hospitalsp

Dec 2007 7% 47% 46%

Dec 2008 0% 16% 84%

Dec 2009 0% 11% 89%

Private hospitalsp

Dec 2007 2% 18% 80%

Dec 2008 1% 4% 95%

Dec 2009 0% 2% 98%

*Includes acute hospitals and day hospitals. Figures are presented as rounded percentages and may not add up to 100%.


ChallengesReaching frontline cliniciansEnsuring hospital clinicians are aware of our standards

and understand their role in implementing best practice

guidelines continues to be a challenge. Healthcare

professionals, especially visiting medical offi cers, are diffi cult

for us to reach directly so we have concentrated our efforts

on building relationships with hospital management and

quality offi cers, through whom we can share information

with frontline clinicians. In partnership with Mater Health

Services, we developed a co-branded fact sheet explaining

the role of the visiting medical offi cer in implementing

our standards.

Extending the standardsAfter evaluating and consulting broadly on our plans to

extend our ‘care after a heart attack’ standard (Management of Acute Myocardial Infarction (AMI) on and following)discharge standard), beyond the treating hospital to

community practitioners, we have decided not to progress at

this time. We thank our Key Stakeholder Reference Group,

which helped us with the AMI project.

Sharing best practiceSince 2007 we have collected 7000 quality improvement

initiatives – practical examples of how hospitals are

improving the safety and quality of their care (pages 48-49).

We aim to identify the best of these initiatives and share

them with other facilities. However, to undertake indepth

analysis of these initiatives and share those that represent

best practice requires signifi cant resources, which were not

available in 2009-10.

Case studyBundaberg show cause report

The HQCC issued a show cause notice to the Director-General of Queensland Health after concerns arose about the credentialing of doctors at Bundaberg Base Hospital.

Credentialing is a process all hospitals must undertake to ensure their doctors are registered, qualifi ed, well-supported and practising within their recognised ability. To help hospitals, we have a Credentialing and scope of clinical practice standard. We expect 100% compliance with this standard as part of each hospital’s duty to improve the safety and quality of their service.

The show cause notice, or ‘please explain’, was prompted by inconsistencies between the fi ndings of Queensland Health audits and data directly reported by the hospital against our Credentialing standard.

Between July 2007 and December 2008, the hospital reported full compliance with our standard. However, an internal audit conducted in November 2008 found seven anomalies in the hospital’s credentialing (six of these related to an oversight resulting from a change in the credentialing cycle). Further review found credentialing for 26% of medical offi cers required urgent rectifi cation. Acting on the anomalies, Queensland Health advised that all medical practitioners were properly credentialed by 23 January 2009.

An external review in May 2009 found no remaining credentialing issues. There were however residual issues around documentation, such as:

• no evidence of referee checks for two doctors

• no evidence of more than one referee check for one doctor

• no application form found for one doctor.

We made six recommendations, including:

• the immediate implementation of an effective credentialing process at Bundaberg Base Hospital, with review every three years

• education for Queensland Health managers on the importance of data integrity and accountability.

Queensland Health has reported that all recommendations have been implemented. Our full report can be viewed at www.hqcc.qld.gov.au

Promoting high standards of care Commissioner Professor Michael Ward, pictured with Cystic Fibrosis Queensland CEO Jane Andersen, helped launch national standards of care for the management of Cystic Fibrosis in July 2009. The standards cover evidence-based practice guidelines and promote safe, high quality care for children and adults living with the nation’s most common life-threatening genetic disorder.


Verifying and driving improvementAs standards reporting includes a self-assessment

component, we ran a verifi cation pilot in 2008-09. This year,

we developed a framework to check data and standards

compliance in a way that encourages open discussion

with the provider about what they do well and where

opportunities for improvement exist.

Typically, we check a hospital’s responses entered in

StaRT over time and look for anomalies. We then cross-

check data from other sources (both internal and external).

We may then:

• visit and inspect the hospital

• review patient medical records and other documentation

• speak with or interview staff

• make observational assessments

• review records, meeting minutes and IT systems

• conduct ward, chart and other audits

• use data from external sources.

ImprovementsStaRTing anewIn mid-2007, the HQCC implemented StaRT, an online

reporting tool used by hospitals to submit data about the

quality of their health service. We use StaRT data to help

identify healthcare trends, to build facility profi les, to refi ne

and improve standards, conduct research and disseminate

quality improvement information.

After a review directed by stakeholder feedback and internal

requirements, Queensland hospitals began reporting through

a new StaRT in March 2010. To ensure a smooth transition

for providers, we will progressively introduce new reports

and features in subsequent reporting rounds. The changes

are designed to make reporting easier for hospitals, and

enable us to better analyse and report on how healthcare

safety and quality is improving.

We surveyed hospitals about the new system in March.

We received some positive feedback about new automated

forms as well as improvement suggestions. We will work to

improve the layout and navigation of StaRT in 2010-11.

We are only at the beginning of our learning and there is still much to be done, but the standards have helped us focus on making a difference to health outcomes.

Hospital


Management of AMI on and following discharge standardA large metropolitan hospital has begun surveying

discharged patients to measure the quality of its service

and compliance with this standard. The hospital’s discharge

summary form has been revised to include questions

about patient satisfaction with (and acknowledgement of)

discharge information about managing and preventing future

heart attacks. For the period July-September 2009, 77%

of patients acknowledged ‘receiving information in writing

about going home or about your condition’. Patient surveys

will form the basis of future initiatives to improve handover

at the bedside.

Surgical safety standardsA streamlined process to ensure surgical safety has

signifi cantly increased the level of reporting at a private

hospital in Brisbane. An electronic pre-admission form is now

completed for each surgical patient, encompassing the three

safety checks – venous thromboembolism assessment,

use of antibiotic prophylaxis and checks of patient, site,

side and surgery. By combining the safety checks and

streamlining the process, the time taken is signifi cantly

reduced. Increasing acceptance and use of the form by

visiting medical offi cers enables greater data collection,

which is providing more meaningful reporting to drive patient

care improvements. The initial pilot in April 2009 was run in

limited areas of the hospital, but has since been extended to

all surgical patients.

Surgical safety – appropriate use of surgical antibiotic prophylaxis standardA cluster of regional public hospitals reported in 2008

that they did not have a documented process to measure

their performance against this standard. That is, hospital

management did not know if clinicians were providing

surgical patients with the appropriate antibiotics to help

prevent surgical infections. Identifying this as a potential

safety risk, the hospitals pooled resources to develop

and implement a standardised audit process based on

the Therapeutic Antibiotic Guidelines. Within a year, the

hospitals turned their reporting level around, reporting 96%

compliance with our standard.

Surgical safety – prevention of venous thromboembolism (VTE) standardIn reporting against our standards, a private hospital

identifi ed its compliance with this standard was low. In

March 2009, the hospital reported 69% compliance. To

ensure surgical patients are assessed for their risk of VTE,

it developed a practical solution to standardise the process

and increase its use, consulting with visiting medical offi cers

and management. A new VTE assessment form is now

completed by surgeons, using stickers to track patients with

documentation of prophylaxis. Six months later, the hospital

reported 91% compliance with the standard.

Improving qualityIn 2009-10, hospitals reported 700 quality improvement

initiatives through StaRT, with 7000 initiatives logged since

July 2007. Audit and data collection improvements are cited

in 48% of the reported initiatives, while education features

in 32%.

Quality improvement initiatives 2009-10

*Quality improvement activities may include multiple themes and therefore

percentages do not add up to 100 per cent.

Standards driving improvementThe de-identifi ed case studies below demonstrate how the

standards are helping hospitals spot shortcomings in their

processes and practice, and the practical changes being

made to improve the safety and quality of services.

Review of hospital-related deaths standardRural and remote public hospital compliance with this

standard has greatly improved since the introduction of a

centralised database that captures the number of deaths and

hospital reviews. The database allows all hospitals to enter

data which is collated by a Quality and Safety team. Hospitals

receive a monthly report, with benchmarking between like

facilities. This new database improves data capture and

reporting capabilities, improves effi ciency and includes

reminder memos to clinicians about outstanding reviews.

Death review reports, including quality improvement

initiatives, are generated from the database and monitored

by the Queensland Health District Quality and Patient

Safety Committee.

0 10 20 30 40 50 60 70 80

48%

32%

27%

8%

13%

16%

71%

Improvement initiative theme

Audit and collection

Education

Management/governance

Personnel allocated

Policy/process/procedure

Resource allocated

Other


Credentialing and scope of clinical practice standardA private day hospital, which in the past struggled to report on

appropriate credentialing of visiting medical offi cers (as they

are not employed by the facility), introduced a new by-law to

ensure comprehensive, regular checks on doctor registration

and skills. Integrating with our standard, the hospital introduced

annual checks for visiting medical offi cers, including medical

indemnity insurance coverage and registration status. Re-

credentialing occurs every three years along with required

evidence of ongoing professional development. The process

forms part of a code of conduct, linked with the hospital by-

laws. The code was circulated to all credentialed staff and has

led to improved compliance with the standard.

Complaint management standardA cluster of rural hospitals joined forces to employ a

dedicated, full-time complaints offi cer to give patients and

their families a way to provide feedback or complain about

the standard of healthcare delivered. The offi cer established

a standardised complaints form and process, as well as a

centralised database and records management process.

Managers are now required to report monthly on their

consumer feedback and take responsibility for outstanding

complaints. The hospitals reported that satisfaction levels

increased in the community as complaints were addressed

and resolved at the local level, without escalation to

the HQCC.

Provider’s duty to improve the quality of health services standardA cluster of regional public hospitals conducted an external

review of patient triage and registration in emergency

departments. The review led to changes in the admission

process and the initiation of a quality improvement project

designed to standardise ‘front desk’ processing, and improve

the fl ow of admitted patients to ward beds by virtue of

assigning time periods to different phases of the patient

journey. The outcome is reduced waiting times despite

increasing patient numbers, improved service, and cubicles

are freed up for newly arrived patients.

Surgical safety – prevention of incorrect surgery standardA private day hospital introduced a ‘fi nal check’ to ensure

each surgical patient has the correct surgery and on the

correct site and side. Medical staff relayed that checks

were completed orally before surgery, but there was no

documentary evidence on patient charts. As the CEO is

accountable for compliance with this standard and ensuring

every surgery is correct, the hospital introduced ‘fi nal check’

forms to be completed and added to the patient fi le. This

gave the CEO evidence the checks were being completed.

Management also identifi ed the need to change internal

culture around surgical safety and provided training to staff

and visiting medical offi cers.

Hand hygiene standardThere has been a remarkable increase in compliance rates

with this standard in one Queensland Health district in the

space of a year through the introduction of a standardised

quarterly audit and measurement process. For example, one

of the smaller hospitals reported only 20% compliance – it

is now 90%. The results of the new quarterly compliance

audits are published on the district’s intranet, with

benchmarking between like facilities. The hospitals have also

installed antiseptic hand wash dispensers and educational

posters at clinical hand basins to make it easy for staff to

clean their hands before and after seeing patients to prevent

the spread of infection.

Better hand hygieneHand hygiene is essential to prevent the spread of infections. Our standard requires healthcare providers to ensure processes are consistent with the World Health Organisation’s evidence-based/best practice guidelines, which have been adopted by Hand Hygiene Australia as the ‘5 moments for hand hygiene’ culture change program for healthcare workers, patients and visitors.


public facilities and direct communication with professional

and consumer groups. We developed and launched updated

material for our website, with resources for healthcare

providers. The success of this campaign will be reported in

the 2010-11 annual report.

Thank you

We recognise the invaluable support that our Clinical

Governance Reference Group has provided during the

development of our standards and thank members for their

contribution. The group was primarily established to guide

the standards and initial quality monitoring arrangements. Its

function was reviewed this year and a decision was made to

retire the group in April 2010.

Engaging visiting medical offi cers

To engage visiting medical offi cers (VMOs) in implementing

our healthcare standards, we worked with the Private

Hospitals Association of Queensland to inform changes

to private hospital by-laws. The by-laws now include

compliance with HQCC standards and apply to VMOs

working in private facilities.

We also worked with Mater Health Services to develop

a co-branded fact sheet to help VMOs understand their

obligations in implementing the standards.

Reviewing healthcare standards

To ensure our healthcare standards refl ect current evidence-

based best practice, we began a comprehensive review

in January 2009. The review involved a detailed literature

search and the development of nine discussion papers,

which were published for consultation through an open

submission process. To inform changes to our standards,

we appointed Expert Reference Groups through an

expression of interest process. The groups each met once

over the three-stage program, in October and December

2009 and March 2010, and made 100 recommendations to

the Commission. We also consulted with our Consumer and

Clinical Advisory Committees (page 66) on the standards

review communication strategy.

As required by the HQCC Act, the draft standards and

accompanying impact assessment statements, were

released for public comment (attracting 42 submissions

and raising 55 issues) before their launch on 1 July 2010.

In updating the standards, we:

• reviewed and revised 151 reporting requirements to 84

(44% reduction)

• redeveloped 98 principles to 91 criteria (7% reduction).

To launch the updated standards, we undertook a

communication and education campaign, working through

professional colleges and craft groups, as well as private and

Key amendments to HQCC standards, effective 1 July 2010

Standard Key amendments

Providers’ duty to improve health

services standard

Clarifi ed to focus on governance for safety and quality, including risk management

and clinical incident management, reducing patient harm and improving the quality of

health services provided.

Credentialing and scope of clinical

practice standard

Focuses on medical and dental practitioners requiring credentialing and delineated

clinical privileges or a defi ned scope of practice.

Complaints management standard Incorporates the Better Practice Guidelines on Complaint Management and the

Australian Charter of Healthcare Rights to ensure effective management

of complaints.

Review of hospital-related deaths

standard

The three levels of death review have been clarifi ed and timeframes amended

to allow more time to complete reviews. The standard now also applies to

outpatient clinics.

Management of AMI on and following

discharge or transfer standard

Categorises different types of AMI to clarify application of this standard to Type 1

only. Focuses on the discharging or transferring provider, governing medication

therapy, lifestyle advice, chest pain action plan, referral to cardiac rehabilitation and

communication of care plan.

Reducing the risk of VTE standard This standard was part of a suite of three. Expanded to include medical patients in

addition to surgical patients.

Ensuring correct patient, site, side and

procedure standard

This standard was part of a suite of three. Now focuses on surgical procedures and

other invasive procedures (including but not limited to radiology, nuclear medicine,

radiation therapy and oral surgery). Promotes the use of a surgical safety checklist.

Hand hygiene standard Expanded to include ‘all people’ entering and leaving the hospital or day hospital,

including patients and visitors as well as staff.

Appropriate use of surgical antibiotic

prophylaxis standard

This standard was part of a suite of three. New requirement to educate patients prior

to discharge about signs and symptoms of surgical site infections.


OutlookReporting publiclyWe will work with our Clinical and Consumer Advisory

Committees (page 66) to extend our public reporting on

quality improvement, including trends and learnings from

Root Cause Analysis report summaries.

Applying national standardsHealthcare standards governing safety and quality

processes in hospitals are due to be implemented by

the Australian Commission on Safety and Quality in

Health Care in 2011. We considered these standards

during our own standards review, and where possible,

we aligned our standards with the draft national

standards. As a result of a clearer national agenda for

healthcare standards, we do not plan to make any

further Queensland-only standards. We will continue

to contribute to the development of national healthcare

standards to avoid duplication, reduce the burden of

reporting, and share lessons learned in monitoring seven

rounds of standards compliance reporting.

Case studySafety shortcomings improved through standards reportingAnomalies in data reported to us by a private hospital led to proactive improvement and the identifi cation of a major safety issue for all facilities.Reporting on its standards compliance, the hospital indicated that it had complied with our standard and processes around preventing blood clots in surgical patients.

The Reducing the risk of venous thromboembolism (VTE) standard requires medical practitioners to assess each surgical patient’s risk of developing blood clots, and consider the use of preventive medicines and compression stockings (as well as other devices). Blood clots can cause ulcers and long-term damage to veins – or they can be fatal if they break away and travel in the bloodstream to the lungs or brain.

While the hospital stated it aligned with our standard, it also said it was unable to report the number of risk assessments performed. That is, how many times medical practitioners had asked surgical patients about existing medical conditions, medicines, habits or family history that could contribute to a high risk of developing a blood clot.

The HQCC was concerned by this anomaly and asked the hospital for further information on how it reduced the risk of VTE.

The hospital’s response highlighted its diffi culty in getting visiting medical offi cers (VMOs) to follow hospital procedure on VTE prevention. It reported that doctors had refused to complete risk assessment forms during the six-month reporting period.

The hospital said it had developed a new policy and action plan to ensure compliance with our standard. The plan involved:

• introducing a pre-assessment form for nurses, which is to be handed to the medical practitioner for review, consideration and follow-up

• empowering nurses to report any failure of a medical practitioner to perform the necessary patient risk assessment.

The hospital volunteered to update us on the implementation of the system.

This case highlighted a common problem in private hospitals, where there may be a lack of clarity about where the responsibility for standards implementation resides – with hospital management or with VMOs. The HQCC commended the hospital for identifying areas for improvement within its service, the aim of all of our standards. We also supported the hospital’s efforts in developing a proactive strategy to resolve the problem.

We intend to raise the bar by asking hospitals to report against new healthcare outcome indicators, as part of our strategy to facilitate continuous quality improvement in health services.

Annual Health Check, October 2009


Focus on

We continually look at ways to improve how we capture and use information to support improvement in healthcare safety and quality.

Making a new StaRTWe launched a new Standards Reporting Tool (StaRT) in

March 2010 to make it easier for hospitals to enter their data

and improve the way we analyse and report information

(page 47). The new system, with substantially improved

capability, is managed internally, with contracted external

support. We are reviewing the level of information that can

be shared with hospitals and the community, and are

considering a provider quality improvement tracker module.

Enhancing our complaints systemIn line with our risk profi ling work, we enhanced our complaints

and investigations case management system (CIPHA), to make

it easier for our complaints offi cers to enter data and generate

more meaningful analysis reports. CIPHA has been recognised

by Queensland State Archives as a business system that

conforms with records management requirements.

This year, as part of our rolling internal audit program, we undertook a major review of our information management systems (page 67), to align systems with our future needs. Our response to the recommendations of the audit will be reported in our 2010-11 annual report. We also commenced work on our three-year online strategy, planning for new internet capabilities and higher levels of automation to extend our stakeholder reach in a cost-effective way.

Supporting staff through information managementUnder phase one of our strategy, we began working with

external specialists to improve our internet capabilities. We

also introduced and refi ned a number of new technologies to

keep people in touch and support our work.

Improving our website and intranet We have assessed our website and intranet capabilities

against our current and future requirements and plans. A

new vendor has been appointed to provide an out-of-the-box

content management system to minimise cost. The new

system has increased capability, allowing us to plan for a

more user-friendly and informative website that will allow

stakeholders to interact with us and each other online.

Knowledge and information management

The website is very friendly and easy to use.

Healthcare consumer


Keeping excellent recordsWe continue to be among the fi rst State Government

agencies to implement an electronic document and records

management system (eDRMS), ensuring we make, manage,

keep and preserve our records. Now 18 months into our new

system (including our record keeping policy, framework and

classifi cation system), we have improved the way we share

information internally, maintain full and accurate records of

our activities, track paper-based records through the use of

bar codes, and register mail. We produce more than 24,000

electronic documents a year, complying with legal and best

practice requirements including:

• the Public Records Act 2002

• Information Standard 18 – Information security

• Information Standard 31 – Retention and Disposal of

Public Records

• Information Standard 34 – Metadata

• Information Standard 40 – Recordkeeping.

Maximising system effi ciencyWe rolled out virtualisation technology across our server

infrastructure to maximise effi ciency and minimise costs.

We also delivered virtual desktops, so staff working off-site

can access their offi ce systems and applications regardless

of their physical location. This technology has benefi ted

our investigators when working in the fi eld as well as staff

who telecommute.

Helping outWe expanded our support helpdesk to enable staff to

request community engagement, library and recordkeeping

assistance, as well as ICT and facilities help. The helpdesk

responded to 1694 staff requests.

Voicing our opinionWe work closely with fellow complaint and quality agencies

to share ideas and contribute to the national quality

improvement agenda. We made submissions on two

signifi cant health sector reforms planned for 2010-11:

• National registration and accreditation scheme – our

suggested amendment to the draft Health Practitioner Regulation National Law 2009 (known as Bill B) to9maintain conciliation privilege was adopted.

• National safety and quality standards – with our

experience in setting and monitoring healthcare

standards, we made suggestions to the framework and

draft standards proposed by the Australian Commission

on Safety and Quality in Health Care.

We also made submissions about:

• National approach to electronic health records discussion

paper – Australian Health Ministers’ Advisory Council

(August 2009)

• Inquiry into the operation of the Health Care Complaints Act 1993 – NSW Parliamentary Committee on the Health3Care Complaints Commission (October 2009)

• Inquiry into suicide in Australia – Senate Community

Affairs References Committee (November 2009)

• Reducing youth suicide in Queensland discussion paper

– Commission for Children, Young People and the Child

Guardian (November 2009)

• Review of Standards for General Practices – Royal

Australian College of General Practitioners (November

2009/June 2010)

• Clinical Handover strategy options paper – Queensland

Health Patient Safety Centre (January 2010).

Forming research partnershipsTo manage increasing requests for research partnerships,

we developed a research governance framework and policy

with the help of our Knowledge and Research Governance

Committee (page 68). Our framework encompasses

transparent, accountable and effi cient processes for the release

of our data to external researchers and will be fi nalised in 2010.

Our current research priorities are:

• risk profi ling and regulation

• complaints management

• the patient experience

• emerging safety and quality issues in healthcare.

Industry leading researcher and author, Judith Healy is

leading a team to analyse our responsive regulation model

and its role in improving the safety and quality of healthcare.

The project secured an Australian Research Council grant in

October, and will combine examination and evaluation of the

regulatory strategies of the health complaint commissions in

Queensland and News South Wales. Other current research

topics include hospital quality and risk evaluation.

Categorising our resources We employed a part-time librarian to assist with research,

and manage and expand on the 3000 books, government

reports, annual reports, specialist healthcare publications and

Indigenous resources we have collated to inform us about

healthcare, quality improvement and government policy.

Working with universities We worked closely with the Faculty of Law at Griffi th

University to develop content for a health specifi c confl ict

management program, aligned with the university’s Graduate

Certifi cate in Dispute Resolution. The university is developing

a course outline. Once complete, we expect this program

will be delivered to HQCC complaints staff, as well as staff

from other agencies including public and private hospitals

and interstate health complaints entities.

The Commissioner also worked with the University of

Queensland medical school and other medical schools to

place greater emphasis on safety and quality elements of

the curriculum.


5444 | HQCC Annual Repppopopopopooopopoopopoopoopopooooopooopopooooooppopopopopooooopopopopooopooooooopopooooopppoooooooooooooooopooooooooooppoooooooppp rrtrtrt rt rtrt rtt rrrrrrrrrtrrrrtrt rt rt rtrrrrtrrrrtrrtrtrrrtrrrrrrrrtrrtrrrrt rrrt 2002002002002002002000000000002002002002002002000000000020009-19-19-19-19-119-19-19-19-19-199-19-1-1-19-9-1-9-9-1--9-11999 000000000000000000

permanent retention rate

KPIs

2.4% staff turnover (2008-09: 1.69%)

2.9 suitable applications for each vacancy (2008-09: 2.7)

97% of Cultural Improvement Plan implemented (2008-09: 91%)

91% of staff participated in cultural survey (2208-09: 98%)

50% of staff engaged (2008-09: 48%)

60% of staff agree ‘the HQCC is a truly great place to work’ (2008-09: 70%)

73% of staff say work practice has improved after training events (2008-09: 70%)

OverviewOur people are our greatest asset. To support them, we place great emphasis on fostering a positive culture, ensuring effective communication and providing fl exible work conditions.

We track our success in planning, attracting, developing and retaining a productive and healthy workforce to help us achieve organisational objectives.

Our annual cultural survey showed an increase in staff engagement and staff turnover continues to be signifi cantly lower than the Queensland Public Service average.

$97,848 invested in staff training

Highlights

90%Our people

| 55

Our staff profi le

Staff employment at 30 June 2010

* Figures include those on parental leave and leave without pay

In June 2009, after operating with a high proportion of temporary staff for two years, we increased our permanent staffi ng by 11 full-time equivalents (FTE) to 69.New permanent roles were fi lled between July and September, reducing our temporary workforce.

Our permanent retention rate for the year was 90%. The permanent separation rate was 0.2%.

Our human resource management and associated policies comply with the Public Service Act 2008 and the Anti-Discrimination Act 1991, providing for the rights and obligations of

employees, and equal employment opportunity.

Full-time equivalent staff

Permanent staff

Temporary staff

2007-08

2008-09

2009-10

0 10 20 30 40 50 60 70 80

49

58.2

32

69.2

60

20

71.4

63

9

Number of staff

Level+

AO2 ($37,321-44,294)

AO3 ($47,269-52,721)

AO4 ($55,891-61,459)

AO5 ($64,772-70,397)

AO6 ($74,313-79,510)

AO7 ($83,160-89,163)

AO8 ($92,140-97,441)

SO2 ($102,671-106,999)

SO1 ($112,192-117,388)

PO5 ($83,160-89,163)

Contract

Permanent staff by level and gender at 30 June 2010

* Figures include permanent staff in acting positions. They do not include temporary staff or those on leave or secondment.

+ Staff are employed under the Public Service Act 2008 and the Public Service Award – State and the Queensland

Public Health Sector Certifi ed Agreement (No.7) 2008. We contribute 12.75% of each employee’s salary to their

QSuper managed superannuation account. Our employee contribution is 5% and staff also have the option to salary

sacrifi ce contributions to their superannuation fund.

Under the Industrial Relations Act 1999, our recruitment process aims to prevent discrimination and ensure equal remuneration for men and women.Some 79% of our workforce is female. Our family friendly policy includes options for

job sharing, fl exible work hours and telecommuting. Offi ce parenting facilities are available.

Women held 60% of management roles (AO8 and above).

No employees left as a result of redundancy or voluntary early retirement this year.

No disputes were lodged with the Queensland Industrial Relations Commission, the Public

Service Commission or the Anti-Discrimination Commission.

Women

Men

0 2 4 6 8 10 12 Number of staff

17

210

1112

31

20

1

13

222

21

0

0

00

To allow for an effi cient, effective allocation of tasks, all administration staff work as part of our fl exible workforce team, which was introduced in late 2008-09 to provide a pool of multi-skilled staff members who can work across the organisation in response to increased service demand.

Permanent and temporary staff by team at 30 June 2010

Team %

Complaint Services 37

Flexible Workforce 19

Standards and Quality 16

Business Services 9

Team %

Information Management 9

Community Engagement 4

Offi ce of the CEO 3

Legal Services 3


Employee participation

Getting feedback from our people helps us to continually grow and improve. Our fourth

annual cultural survey attracted a continued high percentage of staff participation (91%). Staff

engagement increased to 50% (the average for the government public health sector is 28%),

while disengagement decreased from 10% to 9%. Some 60% of our staff agreed the HQCC

is ‘truly a great place to work’. Staff cited improvements in communication, direction and

future, management, morale, staff relations, systems and procedures, and teamwork during

2009-10. (Source: Best Practice Australia, HQCC 2010 Cultural Survey).yy

After each survey we develop a Cultural Improvement Plan based on the opportunities

identifi ed in the survey. This year we will build staff capacity to better serve our strategy,

improve performance development processes, communicate change effectively and

support our staff to make the most of change.

Survey participation

Staff are engaged

Staff agree the HQCC

is ‘truly a great place

to work’

Annual cultural survey results

2008-09

2007-08

2006-07

2009-10

0 20 40 60 80 100

79

28

26

83

40

44

98

48

70

91

50

60

%

Participation in HQCC programs at 30 June 2010

We offer a range of work and life balance options, such as fl exible work hours, job-share arrangements and telecommuting. Two job-share partners retired during 2009-10. Almost

one third of our workforce telecommuted – three staff regularly and 18 staff on an ad hoc basis.

One employee received study assistance while fi ve staff participated in our Employee Assistance

Program, a confi dential counselling service to help staff with personal or work-related issues.

Number

of staff

involved

0 5 10 15 20 25

4

21

1

5

Program

Job-share arrangements

Home-based telecommuting

Study and Research

Assistance

Employee Assistance

Program

Participation in external training activities 2009-10

Business Services

Community Engagement

team

Complaints Management

team

Information Management

Legal Services

Offi ce of the CEO and

Commission

Standards and Quality

We invested $97,848 in training our staff (compared with $140,000 in 2008-09).Training expenditure was reduced as we worked to bring down costs across the

organisation. We focused on aligning training with identifi ed individual and business

needs through our performance development plan process. We have budgeted $1000 per

person for training in 2010-11.

A total of 50 staff participated in 31 training activities, including Mental Health First

Aid training, medical negligence training, Plain English writing, and leadership and

management training for senior managers. Additionally, we supported staff to attend 20

industry seminars and conferences, and nine professional development forums.

We delivered internal training and professional development programs, including Mura

Ama Wakanna Indigenous awareness training, fortnightly journal club meetings and a

registered nurses professional development group.

Number

of

activities

Number

of staff

involved

0 5 10 15 20 25 30

37

274

22

5

52

126

31

3


Valuing DiversityWe held mandatory Valuing Diversity awareness sessionsto give all staff an overview of our responsibilities in anti-discrimination, employment equity, workplace harassment,and work and life balance.

Supporting a healthier workforceTo ensure a safe and healthy workplace and prevent injury orillness (under the Workplace Health and Safety Act 1995), we:55

• reviewed policies covering fi re and emergencyevacuation, personal security, duress alarm response,unannounced visitors and workplace rehabilitation

• trained four new First Aid offi cers

• introduced a health and wellbeing program to informour employees about health issues and to encourage ahealthy lifestyle, assisted by our Workplace Health andSafety Offi cers

• participated in an annual infl uenza vaccination clinic(21 staff immunised)

• undertook an annual check of electrical appliances andinformation technology equipment

• began planning with our fellow complaint agencies for aHealth and Wellbeing expo in 2010-11.

Stimulating ideasWe have three internal committees to help us continuallyimprove and foster staff participation. All committeemembers are appointed through an expression of interestprocess and serve for one year.

Positive Workplace Committee The committee met monthly to discuss ways to improveinternal culture and to facilitate communication. This year,the committee organised Melbourne Cup and Christmasevents, collected donations for charities including WorldVision, Rosies Youth Mission and Club 139, and developed apolicy on workplace fundraising.

Cultural Broker Group The group champions Indigenous and multicultural actionwithin our organisation and serves as a resource to co-workers. This year, the group held events to mark HarmonyDay and World Refugee Day, and developed a calendar of

multicultural events.

ChallengesManaging change Organisational change can be challenging for leaders and

staff. We anticipate that our work will continue to evolve

and mature to meet ever-changing demands. Our risk

identifi cation and intervention strategy is central to our

strategic direction and will change the way we work.

To help staff make the most of the changes, and to develop

an adaptive and innovative organisational culture, we held

a series of change readiness workshops for managers and

team members, and regularly shared with staff our progress

in implementing project plans.

ImprovementsManaging performanceWe reviewed and revised our performance development

plan as part of our Performance Management System.

The system helps:

• our people to implement the organisation’s objectives

• managers and executives to effectively motivate, support

and coach individuals and teams

• achieve sustainable improvements in performance

• the ongoing knowledge and skills development of

employees.

Performance development plans are now completed by all

employees following the business operational planning cycle

each year. Individual plans are reviewed formally at six and

12-month intervals.

Developing capability and leadershipAs part of our Workforce Planning Framework, we

commenced implementation of the Public Service

Commission’s Capability and Leadership Framework to

develop employees at all levels of our organisation. The

framework is being progressively integrated into recruitment

processes and change readiness training. Additionally, our

executive underwent leadership development, with plans

to roll out the framework to senior managers. In the next

year, we will integrate the framework into our Performance

Management System.

Promoting professional conductOur people are educated about the behaviour expected of

them as integrity agency employees on commencement and

more formally at biannual workshops. Our code of conduct

aligns with the Public Service Ethics Act 1994 and details the 4standards fundamental to good public administration – respect,

integrity, diligence, economy and effi ciency. It demonstrates

our commitment to ethical behaviour in the conduct of our

duties and applies to all staff and Commission members.

There were no reported breaches and no reported incidents

of misconduct under the Crime and Misconduct Act 2001.

Farewell to conciliation pioneersAfter 18 years’ leading health dispute resolution in Queensland, our chief conciliators Joan Welsh and Carmel Blick retired in June 2010. The pair established Queensland’s healthcare conciliation service under the former Health Rights Commission. We wish Joan and Carmel the best, and thank them for their years of service, achievement and unfailing dedication.


Giving something backWe helped our World Vision child and his community in the

Gaza through gold coin donations each ‘casual Friday’. We

also collected Christmas donations of food and clothing

for Rosies and Club 139, charities that support those most

disadvantaged in our community.

OutlookPlanning the workforceWhile work continued on our Workforce Planning Framework

in 2009-10, two major strategies under the framework

will commence from 2010-11 – a training needs analysis

for core competencies and the introduction of succession

planning for key roles across the organisation. The

analysis will provide an opportunity to take stock of the

skills that our people will require in the future, particularly

for our risk identifi cation and intervention work. The

framework encompasses a four-year rolling plan to ensure

workforce capability aligns with our strategic direction and

organisational goals. Other features include continued

leadership development program for senior managers and

new 360 degree feedback processes.

Changing payroll and fi nance systemsWe secured additional recurrent funding to implement new

payroll and fi nance systems in 2010-11. This will see us

transition from the Queensland Health payroll and upgrade

our fi nance system with the support of the Queensland

Government Corporate Administration Agency. The new

system includes employee self service, enabling staff to

access payroll, leave and other information electronically and

reducing our reliance on paper-based systems.

Innovations Committee Newly established, the committee aims to attract ideas

on how to improve business processes and productivity.

The group met to act on staff suggestions. Ideas this year

included introducing a green policy, improved rostering

arrangements for complaints offi cers and a more effective

format for whole-of-organisation staff meetings.

Sustainability reporting

Promoting environmental awarenessTo contribute to the development of a sustainable

environment, we are working to measure and reduce

our environmental impact through developing a ‘green

policy’, initially championed by an interested staff member.

This policy aims to increase staff awareness of green

practices and improve the way we report on environmental

impact. We relocated to a 4-star green star (offi ce design)

rated building in March 2009 and have since integrated

environmental initiatives into our daily business activities.

Waste management and recyclingWe provided paper recycling bins at every work station

and glass and plastic recycling bins in our kitchen. We also

recycle ink cartridges and computer equipment.

Paper consumptionWe reduced our paper use through uptake of our electronic

document and records management system (page 53).

Double-sided printing ensures paper use is minimised.

We also purchased recycled paper.

Energy and water effi ciencyWe ensure our use of electricity and water is minimised

through:

• energy effi cient offi ce equipment, such as printers and

photocopiers

• energy effi cient lighting which turns off at night in

unstaffed areas

• white goods with superior energy ratings

• offi ce policy to turn computers off at night

• dual-fl ush toilets.

Achieving economic sustainabilityEffi cient economic management enables us to devote more

of our resources to improving the safety and quality of

healthcare in Queensland.

We relocated to our new premises at 53 Albert Street in

March 2009 along with four of our fellow complaint agencies.

This has resulted in signifi cant annual savings in lease costs

($105 a square metre annually) and through shared resources

and training. The collocation also improves the way we share

expertise and knowledge, with regular meetings of inter-

agency groups including Commissioners/CEOs, corporate

services, communications and Indigenous liaison staff to

share ideas and plan joint projects. We also continued our

cross-agency mentoring program in 2009-10 with 13 staff

participating in the program.

Sharing the Christmas spirit CEO Cheryl Herbert and staff members Paolo La Penna and Suzanne Gogolin present a Christmas hamper donated by HQCC staff to Rod Kelly, Manager of the 139 Club, a Brisbane-based homeless support service.


Parliamentary review recommendations implemented

Our Commission, governance and advisory committees, and the Offi ce of the Commission work together towards better healthcare for Queenslanders.

This year, we completed implementation of the recommendations made following the parliamentary review of our fi rst year. We also met twice with the newly formed bi-partisan Social Development Committee, as well as regular meetings with the Deputy Premier and Minister for Health.

As part of our rolling internal audit program, we conducted independent audits of our legislative compliance and information management.

We responded to changes to our legislation in preparation for the introduction of the national registration and accreditation scheme on 1 July 2010.

OverviewOur governance structure refl ects our commitment to meeting our statutory obligations and delivering an open and transparent healthcare complaint management and quality improvement service.

Corporate governance is based on the values that underpin our everyday operations to ensure we:

• effectively manage our operations and performance

• act independently, impartially and in the public interest

• meet our legislative obligations• identify and mitigate risks• foster a culture of continuous quality

improvement• report on our performance.

2 independent internal audits completed

99% legislative compliance achieved

Highlights

31

Corporate governance

| 61

Social Development CommitteeThe Social Development Committee, established in April

2009, monitors and reports on the Commission and

its functions. The bi-partisan parliamentary committee

comprises:

• Ms Lindy Nelson-Carr MP (chair)

• Ms Ros Bates MP

• Mr Michael Choi MP

• Mrs Liz Cunningham MP

• Ms Mandy Johnstone MP

• Mr Mark McArdle MP

• Mrs Desley Scott MP.

We met with the Committee twice in the past year

to discuss:

• Commission functions and performance

• our 2008-09 Annual Report

• potential legislative changes.

The committee tabled their reports in April and August 2010.

The reports, available at www.parliament.qld.gov.au, include

our response to the Committee’s questions on notice,

a transcript of the meeting, and the Committee’s report

to Parliament.

Minister for HealthWhile we are an independent statutory body, we are funded

by the Queensland Government. We report to Parliament

through the Minister for Health, who may direct us to

investigate serious healthcare complaints.

Our Commissioner and CEO met regularly with the Deputy

Premier and Minister for Health Paul Lucas. In March, the

Deputy Premier visited our offi ce to speak with staff about

their work and meet with the Commission.

In recognition of our independence and to ensure fair

process, we recruit membership for Queensland

Health’s Health Community Councils. These councils

help ensure public sector health services are highly

responsive within their local district. The future structure

and role of the councils is being considered by Queensland

Health in light of national health reforms and the

recommendations of the Weller Review (an independent

review of State Government boards, committees and

statutory authorities completed in March 2009). As a result,

no recruitment took place this year.

Reporting structure

ReportingWe are accountable to the Queensland community, so we have established a corporate governance framework to ensure we are transparent and accountable in the way we operate, make decisions and report to our stakeholders.

Queensland community

Queensland Parliament

Minister for Health

Social Development Committee

Health Quality and Complaints

Commission


Adapting to legislative changeThe Health Quality and Complaints Commission Act 2006(HQCC Act) was amended in January 2010 to introduce

provisions for the development of impact assessment

statements (cost/benefi t analysis) should we make new

standards or signifi cantly change existing standards. As part of

the standards review project, we drafted impact assessment

statements for all updated standards and released the

statements for public consultation in May (page 50).

Consequential amendments to the HQCC Act were

also made to accommodate the new Queensland Civil

Administrative Tribunal, which began operating on

1 December 2009.

Further amendments were made in April, in relation to the

national registration and accreditation scheme. The scheme

provides for consistent national registration of 10 specifi ed

health professions from 1 July 2010. We are working closely

with the Australian Health Practitioner Regulation Agency

and our interstate colleagues to establish a memorandum

of understanding which outlines our respective roles and

responsibilities under the Health Practitioner RegulationNational Law Act 2009. This includes:

• inter-agency notifi cations

• preliminary assessment and consultation about

complaints

• information exchange.

Reporting to the communityAnnual reports are key accountability documents and the

principal way we report on our activities to Parliament and

the Queensland community. Our 2008-09 Annual Report

was completed and tabled in Parliament by the Minister for

Health on 13 November 2009 within the required deadlines. In

recognition of reporting excellence, our report received a Silver

award and was a fi nalist in the Best First Time Entry category

at the Australasian Reporting Awards. We also received two

Queensland Public Sector Annual Report Awards – second,

Best Other Public Sector Entity Annual Report and third,

Most Readable Annual Report.

Reinforcing our independenceIn meeting with the Social Development Committee, we

requested amendments to our legislation regarding:

• our complaint management processes and timeframes

• the confi dentiality of conciliation

• investigation report publication

• how we report to the Queensland community.

We raised concerns about a theoretical risk inherent in

Queensland’s independent healthcare watchdog reporting

to Parliament through the Minister for Health, the Minister

responsible for Queensland’s largest healthcare provider.

There is also a potential confl ict of interest for Queensland

Health in managing our requests for increases in funding and

legislative change. We stressed that in practice these risks

have not been realised, however we believe any potential or

perceived risk undermines the HQCC’s independence. We

proposed that we report to a Parliamentary Committee in the

same way as the Crime and Misconduct Commission. We

note that the Social Development Committee has expressed

similar concerns.

Implementing Parliamentary recommendationsOur operation and performance was reviewed at the end

of our fi rst year by the Health Quality and Complaints

Commission Select Committee. In November 2007, the

bi-partisan committee made 37 recommendations to

improve our interaction with consumers and providers in

its report Review of the Health Quality and Complaints Commission and the Health Quality and Complaints Commission Act 2006.

This year, we fi nalised implementation of all 31

recommendations that were our responsibility.

The remaining six recommendations are the responsibility

of Health Consumers Queensland and the Minister for

Health, while others will inform any future review.


Mr Graham (John) Amery BHA, RN, Dip Admin

Assistant Commissioner, Nursing

First appointed July 2006. Now serving three-year

term to 31 December 2010.

John has more than 40 years’ experience as a healthcare

practitioner and administrator. He is currently Chief Executive

Offi cer of Mater Health Services North Queensland in

Townsville and a Director of the Australian Private Hospitals

Association and Private Hospitals Association of Queensland.

With exposure to the private and public sectors, John, a

registered nurse, worked in general, psychiatric and obstetric

positions before moving into administration.

Professor Michele Clark PhD, B OccThy (Hons),

BA, Grad Cert Health Econ

Assistant Commissioner, Allied Health

First appointed January 2008. Now serving three-year


With a background in occupational therapy and community

health, Michele is a Professor in Health Policy in the School

of Public Health at Queensland University of Technology. In

2000, she was the Inaugural Director of the Australian Centre

for Prehospital Research and was Foundation Professor

of Rehabilitation Sciences and Head of the Occupational

Therapy Unit at James Cook University. In 1998-99 she

worked on the International Year of Older Persons for the

United Nations in New York.

Professor John Devereux BA (Qld), LLB (Qld), Grad Dip Mil Law

(Melb), DPhil (Oxon), Barrister of the Supreme Court of Queensland

Assistant Commissioner, Legal

Appointed January 2010 for one-year term to

31 December 2010.

A former Rhodes Scholar, John has served as a Law Reform

Commissioner for Queensland as well as a legal member

of the Commonwealth Social Security Appeals Tribunal.

With a special interest in medical law, he is Associate Vice

Chancellor (Brisbane) at Australian Catholic University. He

previously held positions at the University of Queensland,

Griffi th University and the University of Tasmania.

Led by Commissioner Professor Michael Ward, the

Commission’s role is to:

• set the strategic direction

• establish annual health priorities, milestones, and

timeframes for completion

• identify emerging health issues and ensure these are

acted upon

• determine whether inquiries into health issues should be

conducted

• review the completion status of all complaints monthly

• provide guidance, support and mentoring to the CEO and

senior staff

• ensure the Commission’s role and performance are

communicated to healthcare consumers, providers and

the media

• review the HQCC’s progress and performance against

stated goals.

Professor Michael Ward MBBS, FRACP,

FRCP (Edin)

Commissioner



An Emeritus Professor at the University of Queensland,

Michael’s previous positions include Director of Medicine

at the Royal Brisbane and Women’s Hospital, Head of the

Central Clinical Division of the University of Queensland

School of Medicine and Senior Director of the Queensland

Health Clinical Practice Improvement Centre. More recently,

Michael contributed to the development of Queensland

clinical networks. In 2008, Michael was awarded a Public

Service Medal for services to medicine.

Our CommissionWith wide-ranging and specialist expertise, our Commission sets our strategic direction and oversees our operations and performance.

Offi ce of the Health Quality

and Complaints Commission

Governance structure

Governance committees

Advisory committees:

Consumer / Clinical

Health Quality and Complaints

Commission

| HQCC Annual Report 2009-10

Mr Rodney Metcalfe LLB, Solicitor

Assistant Commissioner, Public Service



Rodney comes from a successful career in local government,after 20 years with Brisbane City Council. Prior to hisappointment as the Deputy Queensland Ombudsmanin 1995, Rodney was Executive Director of theQueensland Olympic 2000 Task Force. His role as theDeputy Ombudsman to 2006 included developing andimplementing strategic organisational change and conductinghigh level investigations. Rodney has recently beenappointed to the South East Regional Conduct Review

Panel for Councillors.

Professor Margaret Steinberg AM PhD (Child

Health and Education), MPhty (Research), BPhty (Hons),

Dip Phty

Assistant Commissioner, Consumer



Margaret was Community Commissioner on the Crime and Misconduct and Criminal Justice commissions. Trained inpopulation/public health, she has held signifi cant academicpositions, including establishment director of a research unit at the University of Queensland Medical School. She is Director on a number of boards and is a Governor of the QueenslandCommunity Foundation. She became a Member of the Order of Australia in 2003 in recognition of her work in social justice.

Professor Ken Donald AO MBBS, PhD, FRCPA,

FRCPath, FRACS (Hon), FRACMA

Assistant Commissioner, Medical



Ken was the Deputy Director-General of Queensland Health

for a decade in the 1980s. Currently Chair of the Repatriation

Medical Authority, other previous roles include Acting Director

of Medical Services at Royal Darwin Hospital, Head of the

School of Medicine and Head of the Department of Social

and Preventive Medicine at the University of Queensland.

Originally trained as a pathologist, Ken has held Director of

Pathology positions at large hospitals and healthcare services.

Ms Susan Johnston JD, BA, Barrister at Law

Assistant Commissioner, Safety



Susan is Head of Safety and Sustainable Development

with Anglo American Metallurgical Coal. She has extensive

experience in dealing with safety issues, having led and

participated in signifi cant reviews of the mining and energy

industries. She has provided advice to both private industry

and government on how to improve implementation and

monitoring of safety systems and programs. Susan is a former

Chief Executive of the Queensland Resources Council, and a

former Associate Professor with the Minerals Industry Safety

and Health Centre at the University of Queensland.

AppointmentsCommission members are appointed by the Governor in Council for a term of no more than four years. In January 2010,

Commissioner Michael Ward was re-appointed for a three-year term, along with Assistant Commissioners Rodney Metcalfe

and Michele Clark. John Devereux, our new Assistant Commissioner, Legal, was appointed in January for a one-year term to

fi ll a vacancy arising from the resignation of Dr Kim Forrester in March 2009.

Commission meeting attendance 2009-10

Jul Aug Sep Oct Nov Dec Feb Mar strategymeeting

Apr May Jun

Mr John Amery + +

Professor Michele Clark

Professor John Devereux* - - - - - -

Professor Ken Donald

Ms Susan Johnston +

Mr Rodney Metcalfe

Professor Margaret Steinberg

Professor Michael Ward

The Commission held 12 meetings, including an annual two-day strategy review and planning meeting on 11-12 March.

* Professor Devereux joined the Commission in January 2010

+ teleconference

Commission remuneration 2009-10

Position Number RemunerationCommissioner 1 $106, 587

Assistant Commissioner 7 $25,452

The remuneration payable to the Commissioner and Assistant Commissioners was approved by the Governor in Council on 22 June 2006

(Executive Council Minute No. 593).


The Consumer Advisory Committee held four meetings; the

Clinical Advisory Committee held three meetings. In addition,

a special joint advisory committee meeting was held on

6 May to brief the committees on the outcomes of the

standards review (page 50) and seek advice on the standards

review communication strategy.

Consumer Advisory Committee meeting attendance 2009-10

Aug Nov Feb 6 May 27 MayProfessor Michele Clark

Ms Margaret Deane

Mr Andy Froggatt

Ms Adele Gibson* - - - -

Mrs Myrtle Greene

Ms Kathy Kendell

Mr Terry Lees

Ms Mary Martin**

Mr Gary Penfold

Mrs Marie Pietsch

Mrs Myra Pincott

Mrs Coral Rizzalli

Professor Margaret

Steinberg

Ms Helen Whitehead

* Ms Gibson resigned in September 2009.

** Ms Martin resigned in June 2010.

Clinical Advisory Committee meeting attendance 2009-10

Aug Dec Mar 6 MayDr Cameron Bardsley

Dr Monique Beedles

Ms Leanne Bissett

Professor Ken Donald

Associate Professor

Stephanie Fox-Young

Dr Allan Hilless

Dr Derek Lewis

Dr Jacinta Powell

Ms Theresa Rutherford

Dr Ian Scott

Dr Jane Truscott

Dr Peter Woodruff

Advisory committee remuneration 2009-10

Position Number RemunerationAdvisory committee

member

23 Meeting > 4 hours @281

Meeting < 4 hours @141

Advisory committee member remuneration is according to the

Remuneration of Part-time Chairs and Members of Government

Boards, Committee and Statutory Authorities policy administered

by the Department of Justice and Attorney-General.

Governance committeesIn 2009-10, four governance committees reported and provided

advice to our Commission. These committees are chaired by

a Commission member and comprise Commissioners, staff

and in some cases, external stakeholders. For membership and

terms of reference, see pages 68-69.

• The Audit and Risk Governance Committee met

quarterly to review the Commission’s strategic risk

management, budget and fi nancial performance.

• The Complaint Governance Committee met monthly to

review the status of complaints and investigations.

• The Knowledge and Research Governance Committeemet monthly to facilitate knowledge sharing and the

development of research opportunities.

• The Stakeholder Engagement Governance Committeemet quarterly to oversee implementation of our

stakeholder engagement strategy.

In the past year, we reviewed and retired the Stakeholder

Engagement and Knowledge and Research governance

committees. These committees helped establish effective

internal processes and strategies that have been embedded

in core activities. Stakeholder engagement is now sponsored

and monitored by a member of the Commission.

Advisory committeesTo ensure our Commission remains in touch with grassroots

consumer issues and the latest clinical developments, we

have two advisory committees. The committees are a highly

valued part of our organisation, providing essential consumer

and clinical insight, advice and feedback on healthcare

issues, as well as supporting our work in improving the

safety and quality of healthcare.

The Consumer and Clinical Advisory Committees are

each led by Assistant Commissioners and comprise up to

13 members from a variety of specialties and backgrounds.

Members serve two-year terms. Terms have been extended

from September 2010 to April 2011 due to changes at the

Commission level. For membership, including member

biographies, and terms of reference, see pages 68-71.

Due to recognised vacancies, three new consumer advisers

– Terry Lees, Andy Froggatt and Adele Gibson – were

appointed in July 2009. Ms Gibson subsequently resigned

from her position in September 2009 due to ill health.

Consumer adviser Mary Martin resigned in June 2010 after

four years on the committee.

Advice and scrutinyOur corporate governance framework demands that we effectively mitigate risk, seek advice to improve, regularly scrutinise our performance, decisions and processes, and comply with legal requirements.


Managing risk Risk management is an integral part of our decision-making,

planning and service delivery, and we review and report

our progress quarterly. Our risk management process is

modelled on the Australian/New Zealand Standard for Risk

Assessment AS/NZS 4360.

Disaster recovery and business continuity plans, including

clearly defi ned procedures and responsibilities, are in place

to ensure our service is able to withstand abnormal events.

This year, we also developed a crisis communication plan to

ensure we can keep in touch with staff and stakeholders in

the event of an emergency.

Auditing fi nancesIn addition to our internal audit plan, the Queensland

Audit Offi ce undertakes an annual audit of our fi nancial

documentation – both source documents and electronic

systems – to ensure the accuracy and fairness of our

reporting under the Financial Administration and Audit Act 1977. We met 2009-10 deadlines for the preparation of

fi nancial reports. See page 101 for the independent auditor’s

report. We also attended an Estimates Committee hearing

for scrutiny of our fi nancial and non-fi nancial performance

(both current and future) as part of the Queensland

Government budget process.

Mapping business processTo align our businesses processes with our risk identifi cation

and intervention strategy we engaged an external contractor

to help us map and review the way we work (page 16).

Expenditure on consultancies 2009-10

Category CostManagement (includes business process

mapping review and legislative compliance audit) $84,100

Human resources (includes annual staff cultural

survey) $5848

Auditing our performanceOur Strategic Internal Audit Plan 2010-2012 and annual

internal audit plans set out how we check the effectiveness

and effi ciency of our internal control systems and compliance

with legislation, policies and procedures. Ensuring we meet

our obligations is our Audit and Risk Governance Committee,

now in its second year. We report quarterly to the

committee, which works within the Queensland Treasury’s

Audit Committee Guidelines to ensure we:s

• meet our legislative obligations

• identify and mitigate operational, fi nancial and

compliance risks

• test, evaluate and recommend improvements

to internal control systems

• perform fi nancially.

The committee comprises three Commissioners and an

external member, former Auditor General of Queensland

Len Scanlan (remuneration $3025 in 2009-10). Our CEO is

an ex-offi cio member (see page 68 for committee terms of

reference).

Meeting our legislative obligations As part of our internal audit plan, we conduct quarterly

reviews of our compliance with the 67 applicable

mandatory obligations of the Health Quality and Complaints Commission Act 2006. At 30 June our audit showed

we achieved compliance with all but one provision– we

have yet to achieve 100% compliance with the legislated

complaint assessment timeframe, this year closing 86% of

assessments within 90 days (pages 20 and 22).

We also commissioned an independent internal audit of our

compliance with other legislation. While we comply with all

of our key legislative obligations, the audit identifi ed a need

to introduce a formal compliance management framework

to set out obligations, accountabilities, reporting and audit

mechanisms. A framework and policy have been drafted and

will be fi nalised and implemented in 2010-11.

Reviewing information managementAn independent internal audit of our information

management processes and controls was conducted in late-

2009. It mapped our current processes in the management

of complaints and standards information against our long-

term strategy. We are in the process of implementing the

fi ve recommendations aimed at improving how we capture,

use and report organisational information in a timely manner.


Knowledge and Research Governance CommitteeRetired May 2010.

Objective

To facilitate knowledge and research within the HQCC.

Responsibilities include advising the Commission on:

• identifi cation and prioritisation of emerging issues

• opportunities to be involved in healthcare quality

improvement research

• the development of research proposals

• sources of knowledge related to quality improvement,

complaints management and investigations

• application of knowledge to the HQCC’s activities and to

the wider health sector

• identifi cation of healthcare quality measures particularly

for evaluation of services

• effective distribution of key messages about the HQCC’s

work in knowledge and research

• presentation and publication activities to increase the

HQCC’s profi le

• the involvement of tertiary students in HQCC activities.

Chair Professor Michele Clark – Assistant Commissioner,

Allied Health

MembershipMs Pat Avey – Principal Quality Offi cer

Ms Rose Bovey – Manager, Research and Development

Mr Colin Smyth – Workforce Coordinator

Ms Kate Grant-Taylor – Flexible Workforce

Mrs Cheryl Herbert – CEO

Mr Peter Johnstone – Executive Manager, Complaint Services

Ms Liz Kearins – Manager, Community Engagement

Ms Sandy Lewis – Principal Conciliator

Mr Andrew Lockhart – Manager, Quality Monitoring

Mr David McKenzie – Manager, Investigations

Mr Shaun Nesbitt – Manager, Information Management

Mr Greg Pratt – Senior Complaints/Indigenous Liaison Offi cer

Dr Alyson Ross – Executive Manager, Standards and Quality

Professor Michael Ward – Commissioner

Committee roles and membershipGovernance committees

Audit and Risk Governance Committee

ObjectiveTo review the budget, fi nancial performance and

the strategic risk management of the Commission.

Responsibilities include:

• reviewing the annual budget

• reviewing quarterly fi nancial performance

• reviewing the annual fi nancial statement before sign off

by the auditor

• reviewing the quarterly risk register

• planning annual risk analysis with the HQCC executive

• monitoring implementation of audit recommendations.

Chair Mr John Amery – Assistant Commissioner, Nursing

MembershipMrs Cheryl Herbert – CEO (ex offi cio member)

Mr Rodney Metcalfe – Assistant Commissioner,

Public Service

Mr Len Scanlan – external member


Complaint Governance Committee

ObjectiveTo advise the Commission about complaint and investigation

matters and to assist Complaint Services. Responsibilities

include:

• statistical reporting to the Commission, highlighting

complexity or importance and any early warning patterns

for particular hospitals or providers

• making recommendations to the Commission about

investigations and conciliation

• considering whether investigation of referred matters

is appropriate

• considering draft investigation reports and the response

to any adverse comments from parties named in reports

• assisting decisions about the assessment, conciliation or

investigation of complaints.

Chair Mr Rodney Metcalfe – Assistant Commissioner,

Public Service

MembershipMs Carmel Blick/Ms Joan Welsh – Chief conciliators

Ms Megan Fairweather – General Counsel

Mr Peter Johnstone – Executive Director, Complaint Services

Mr Brett Heath/Mr Gavin Gleeson – Assessment Manager

Mrs Cheryl Herbert – CEO

Mr Dave McKenzie – Manager, Investigations



Advisory committees

Clinical Advisory Committee

Objective

To advise about clinical matters relevant to the Commission’s

functions. Responsibilities include:

• providing strategic advice from a current clinical

perspective

• facilitating communication between clinical groups and

the HQCC

• participating in the monitoring and evaluation of the

HQCC’s engagement of healthcare providers

• advising on education needs for clinicians in relation to

the HQCC.

Chair Professor Ken Donald – Assistant Commissioner,

Medical

MembershipDr Cameron Bardsley (October 2006 – present)

Cameron has worked as a doctor for the past 20 years,

most of that time at St George Hospital where he is medical

superintendent. He has worked as a procedural rural doctor

across Queensland, including Redcliffe, the Gold Coast,

Rockhampton and Kippa Ring, as well as doing fl y-in fl y-out

work in Aboriginal communities.

Dr Monique Beedles (October 2008 – present)

Monique is a pharmacist with hospital, community and

management experience. She has previously served

on hospital committees, was the director of pharmacy

services at the Noosa Hospital and is a past member of the

Pharmaceutical Society of Australia Queensland Council.

With qualifi cations in management and pharmacy, Monique

has had research published in Australia and overseas.

Ms Leanne Bisset (October 2008 – present)

A physiotherapist with 20 years’ experience in both public

and private services, Leanne is also a senior lecturer in

physiotherapy and rehabilitation sciences. She has been

recognised nationally for advanced standing in the fi elds of

sports and musculoskeletal physiotherapy research and is

working as a senior research fellow with the Royal Brisbane

and Women’s Hospital and Griffi th University. Leanne

is president of the Queensland branch of the Australian

Physiotherapy Association.

Associate Professor Stephanie Fox-Young(October 2008 – present)

Stephanie is the national president of the Royal College of

Nursing Australia and has more than 30 years’ experience in

clinical practice, education and regulation roles. She works

part time with the School of Nursing and Midwifery at the

University of Queensland. Her work has been published in

nursing and medical journals.

Dr Allan Hilless (October 2008 – present)

Founding director of cardiothoracic surgery at the Wesley

Hospital, Allan has a wide range of practical and clinical

experience in quality control within health services. He has

worked in New Zealand and the United Kingdom as a surgical

and senior registrar, including 13 years as the director of

cardiothoracic surgery and services with the Wellington Area

Health Board. Allan has also held positions on health boards,

committees and national advisory councils.

Stakeholder Engagement Governance CommitteeRetired February 2010.

Objective

To oversee the implementation of the HQCC’s stakeholder

engagement strategy for:

• healthcare consumers in Queensland

• healthcare providers in Queensland

• entities with community infl uence (including the media).


• advising the Commission on the ongoing effi cacy of the

stakeholder engagement strategy

• engaging the HQCC advisory committees in the effective

development and implementation of the strategy

• reviewing the strategy annually

• monitoring the implementation of the strategy against

agreed measures

• assisting to embed stakeholder engagement processes

within the ongoing work of the organisation

• reporting to the Commission on the success of the

stakeholder engagement strategy.

Chair Ms Susan Johnston – Assistant Commissioner, Safety

MembershipMrs Cheryl Herbert – CEO

Mr Peter Johnstone – Executive Manager, Complaint

Services

Ms Liz Kearins – Manager, Community Engagement

Dr Jacinta Powell – Clinical Advisory Committee

representative

Dr Alyson Ross – Executive Manager, Standards and Quality

Dr Margaret Steinberg – Assistant Commissioner, Consumer

I value the opportunity to have a positive impact on the safety and quality of health services for all Queenslanders.

Dr Monique Beedles, Clinical Advisory Committee


Consumer Advisory Committee

Objective

To advise on consumers’ concerns about health services

and other matters relevant to the Commission’s functions.


• providing strategic advice from a consumer, carer and

community perspective

• facilitating communication between consumer, carer and

community groups and the HQCC

• participating in the monitoring and evaluation of the

HQCC’s engagement of healthcare consumers

• advising on education needs for consumers, carers and

the community in relation to the HQCC.

Chair Professor Margaret Steinberg – Assistant

Commissioner, Consumer

Assistant ChairProfessor Michele Clark – Assistant Commissioner,

Allied Health

MembershipMs Margaret Deane (October 2006 – present)

Now CEO of Queensland Aged and Disability Advocacy Inc,

Margaret has a background in healthcare policy and program

management, including community health services. She is

a member of the Aged Care Standards and Accreditation

Liaison Group. Margaret has been instrumental in

establishing and participating in a number of community

networks focused on improving healthcare outcomes.

Mr Andy Froggatt (July 2009 – present)

CEO of the Mental Illness Fellowship of North Queensland,

Andy has more than 25 years’ experience in the mental

health fi eld, working across the public, private and not-

for-profi t sectors in Queensland and the United Kingdom.

He has developed and managed mental health services in

North Queensland and was the operations director of the

Townsville Cancer Centre in 2005-07. Andy is a qualifi ed

mental health nurse and holds an honours degree in Politics.

Mrs Myrtle Green (October 2006 – present)

Myrtle represents consumers through the Queensland

Health Cancer Screen Unit Consumer Reference Group, the

West Moreton South Burnett Primary Health Partnerships

Council and the West Moreton Division General Practitioners

Board. She was on numerous health registration boards

such as the Queensland Medical Radiation Technologists

Registration Board and Queensland Pharmacists Registration

Board. In 2005 she was awarded an Order of Australia Medal

for service to the community through health, law, education

and women’s affairs.

Ms Kathy Kendell (October 2006 – present)

Kathy has represented health consumers at both a state and

national level for more than 15 years, writing Queensland

Health’s fi rst published code of health rights in 1992 and

recently contributing to the Australian Commission on

Safety and Quality in Health Care’s Charter of Healthcare

Rights. Kathy was a founding member of the former Health

Consumer Advocacy Network. She is a member of the

Australian Health Care Reform Alliance, Health Consumers

Queensland and Consumer Health Forum.

Dr Derek Lewis (October 2006 – present)

Derek has been a dental practitioner in Queensland for

almost 30 years, including 12 years in remote and regional

areas. He was a member of the Health Rights Advisory

Council (under the former Health Rights Commission) for

six years, serving as president for three. Derek is a member

of both state and national councils of the Australian Dental

Association and is a member of several dental study groups.

Dr Jacinta Powell (October 2006 – present)

An experienced psychiatrist, Jacinta is the Clinical Director

of Mental Health at Prince Charles Hospital. Her previous

roles include chair of the Royal Australian and New Zealand

College of Psychiatrists Queensland branch and principal

advisor in psychiatry and director of mental health with the

State Government.

Ms Theresa Rutherford (October 2006 – present)

Theresa is a registered nurse experienced in the training and

supervision of medical and nursing staff. She has been a

clinical nurse in the cardiology unit at the Gold Coast Hospital

since 1996. Theresa holds a Diploma of Health Science

(Nursing) from the University of Western Sydney.

Dr Ian Scott (October 2006 – present)

Ian is a senior consultant and general physician with a

longstanding involvement in health quality improvement.

Currently director of the Department of Internal Medicine

and Clinical Epidemiology at Princess Alexandra Hospital, he

is also an associate professor of medicine at the University

of Queensland, an adjunct associate professor in public

health and preventive medicine at Monash University and a

member of the Queensland Health Patient Safety and Quality

Executive Committee.

Dr Jane Truscott (October 2006 – present)

A nurse practitioner with a background in acute and

community settings, Jane has more than 25 years of

experience in clinical, education, research and business

areas. She has extensive qualifi cations in both clinical and

management disciplines.

Dr Peter Woodruff (October 2006 – present)

Peter is a member of the Medical Board of Queensland

and has held senior executive positions such as president

of the Australian and New Zealand Society of Vascular

Surgeons, president of the Australian Council on Health Care

Standards, chairman and director of vascular surgery at the

Princess Alexandra Hospital and vice president of the Royal

Australasian College of Surgeons.


Mr Terry Lees (July 2009 – present)

Terry’s background is in consulting, media, business

development, training and management. In 2006, Terry

contributed to the establishment of the Centre for Rural

and Remote Mental Health Queensland and he remains

a director on the board. He participates in various health-

related network groups in north west Queensland and has

held numerous board and directorship positions, including six

years as a director and chair of Australian Rotary Health.

Ms Mary Martin (October 2006 – June 2010)

With extensive experience in rural and Aboriginal and

Torres Strait Islander health, Mary has played a role in

community organisations at a board and member level. She

works with the Queensland Aboriginal and Islander Health

Council. Mary previously worked as a registered nurse with

the Aboriginal and Islander Community Health Service in

Brisbane and was instrumental in establishing Yulu Burri

Ba Aboriginal Corporation for Community Health on North

Stradbroke Island.

Mr Gary Penfold (October 2008 – present)

Gary is a long-time housing and disability worker. He

has worked with Queensland Shelter and has also held

positions with West End Community House, the Queensland

Disability Housing Coalition, the Homelessness Task Force

(as coordinator), the Queensland Public Housing Tenants

Association and the Hepatitis Council of Queensland.

Mrs Marie Pietsch (October 2008 – present)

Marie’s tireless work in representing health consumers

earned her a 2005 Australia Day Medal and a 2003 Centenary

Medal. She is currently chair of the Southern Downs Health

Community Council. She is also a member of various health

committees, including the Patient Transport Quality Council,

the Queensland Medical Transport Board and the Patient

Safety and Quality Executive Committee.

Mrs Myra Pincott (October 2006 – present)

Myra is a member of the Queensland Primary Health Care

Research, Evaluation and Development Advisory Committee,

Health Consumers Queensland and Patient Safety Council

Advisory Committee. Myra served on the Queensland Dental

Board and the Dental Board of Australia, as well as the Rural

Health Advisory Council. Her work has been recognised with

an Offi cer in the Order of Australia award and the Centenary

Community Service Medal.

Mrs Coral Rizzalli (October 2006 – present)

Motivated by a lack of regional services to support her son,

Coral has worked to establish various services for children

with disabilities, receiving an Order of Australia medal in

1993. She has served on regional disability councils in north

Queensland, as well as many state and federal advocacy

groups. Coral is a member of the Australian Consumer

Health Forum and chairs the Ingham Consumer Group.

Ms Helen Whitehead (October 2006 – present)

Helen founded the Queensland Acoustic Neuroma

Association and subsequently the Brain Tumour Support

Group. She has since served as the CEO of Epilepsy

Queensland for 17 years and has more than 30 years’

experience in the health sector. Helen has qualifi cations in

speech therapy and psychology.

Members of this Committee are active in the community with strong networks and a sound understanding of local and regional issues.

Kathy Kendell, Consumer Advisory Committee


Peter Johnstone BCom, MBA

Executive Manager, Complaint Services

Appointed July 2007.

Peter joined us in our second year, having worked for 15

years in the dispute resolution fi eld within the Department of

Justice and Attorney-General. During this time, Peter spent

four years as Executive Manager of the Dispute Resolution

Branch and received an Australia Day Award for service

to government. Peter is a nationally accredited mediator and

an adjunct lecturer with Griffi th University’s Law School.

Our Complaint Services team provides an impartial,professional service in complaint management and resolution, conciliation and investigation.

Alyson Ross EdD, PGradDipEd, BA(SocSc),

DipBus(HRM)

Executive Manager, Standards and Quality

Appointed August 2009.

Alyson has a wealth of experience in large scale reform,

strategy and organisational development, most recently

leading the development of Gold Coast City Council’s

30-year vision. She has held roles in the health and

community sector and has worked with the National Health

Service in England.

Our Standards and Quality team carries out diverse work in standards development, quality monitoring and improvement, and research and development.

Meeting weekly, the group this year focused on staff

communication and fostering a positive culture in a time

of organisational change. Four senior appointments to

permanent positions were made during the year.

Cheryl Herbert RN, RM, DipAppSc, BAppSc,

FRCNA

Chief Executive Offi cer

Appointed September 2006 for a fi ve year term to

September 2011.

Cheryl is our founding CEO, joining us in September 2006

after 10 years as CEO of Spiritus (formerly St Luke’s

Nursing Service), which she transformed to be one of

Queensland’s largest not-for-profi t community organisations.

As a registered nurse and midwife, Cheryl has worked in

community, aged care and acute settings, as well as in

academic and management positions. Cheryl is an Adjunct

Associate Professor of the Faculty of Health Sciences at the

University of Queensland and is a member of various boards

and committees.

The CEO is appointed by the Governor in Council for a fi ve-year term.

Core services Support services

Organisational structure

CEO

ComplaintsServices

Legal Services

Information Management

Community Engagement

Business Services

Standards and Quality

Our offi ce Our executive team provides leadership and direction to our staff and ensures we meet our strategic priorities and legislative responsibilities in a way that is open, accountable, ethical and responsible.


Julie Imber BBus, GCertHlthMgmt

Manager, Business Services

Appointed November 2006.

Julie Imber has been our Manager, Business Services since

2006. She has 18 years’ experience in corporate services

roles with Queensland Health, including four years with

the Brisbane North Division of General Practice, working

in general practice policy. Julie went on maternity leave

in March 2010. Sharon Radicke (not pictured) has been

Acting Manager Business Services since then. Sharon has

more that 30 years’ experience in government, mostly in

fi nance and human resources. She is an associate member

of Certifi ed Practising Accountants and holds a Masters in

Business Administration.

Our Business Services team manages our fi nances,human resources, learning and development program, and administrative support.

Former executive members Steven Moskwa was Manager, Information Management

from December 2007 to August 2009.

Geoff Murphy was Director, Complaint Services from July

2006 to September 2009.

Megan Fairweather BA, LLB (Hons I)

General Counsel

Appointed December 2008.

Megan was previously Senior Associate in private legal

practice, specialising in health law and commercial litigation.

She has experience in complex healthcare-related coronial

inquests and has acted in claims arising from negligent

medical care, clinical drug trials and registration board

matters. Megan holds Bachelor Degrees in Arts and Law

with Honours (I), and is a member of the Medico-Legal

Society of Queensland.

Our Legal Services team provides legal advice on matters from investigations to human resources, and manages applications for access to our information.

Liz Kearins Cert Journalism, DipBusStud, MPRIA

Manager, Community Engagement

Appointed May 2008.

Liz has more than 20 years’ experience in public/private

sector community relations, communications, marketing,

media and journalism. She has worked in her native New

Zealand, the United Kingdom and Australia. Before joining

us, Liz worked in engagement and communication with

Seqwater, Brisbane City Council, Keep Australia Beautiful

and Tourism Queensland.

Our Community Engagement team manages our engagement strategy, corporate communications, media liaison and online presence.

Shaun Nesbitt BSc, MBA

Manager, Information Management

Appointed August 2009.

Shaun has more than 10 years’ wide ranging experience

in public/private sector information and communication

technology (ICT). Since relocating from his native South

Africa he has worked with IBM and Telstra to develop

and manage ICT process, architecture and strategy. Most

recently, he was instrumental in developing a Queensland

Government IT consolidation framework.

Our Information Management team manages our ICT infrastructure, network, applications, web,telecommunications and records.


OverviewGrowing our business within a limited budget continues to challenge us. This year we made effi ciencies so we could continue our important risk identifi cation and intervention work, while striving to improve our services in complaint and investigation management and standards and quality monitoring.

We spent $9.597 million in 2009–10 against a budget forecast of $9.437 million.

An issue identifi ed in our 2008-09 audit meant we had to change our depreciation methodology from diminishing value to straight line. The impact was an increase in depreciation expenditure of $232,526, which together with a reduction in interest income of $191,432 due to the global fi nancial crisis, contributed to our end of year defi cit position of $159,331. However, cost reductions across staffi ng and supplies and services resulted in the lowest defi cit for three years and we ended the year with retained rollover funds of $949,669.

Employee expenses accounted for 71% of our spending at $6.824 million, a decrease of $504,662 on 2008-09. We reduced the number of temporary staff employed and restructured executive management positions.

Our second largest expenditure item was supplies and services, accounting for 24% of our spending.

Through more robust governance and internal control procedures, we reduced these costs by $930,155, including:

• information technology operating costs reduced by $325,814

• consultancy services reduced by $211,216• building lease expenses reduced by $143,163• travel costs reduced by $39,486• motor vehicle costs reduced by $25,148.

We secured additional recurrent funding to support our transition to new payroll and fi nance systems in 2010-11 ($327,000 in 2010-11, $260,000 in 2011-12 and $272,000 in 2012-13 recurrent and Consumer Price Index adjusted annually).

Outlook2010-11 will be a year of signifi cant transition for us. Rollover funding has been committed to information technology projects in support of frontline complaints management, quality monitoring, and the generation of provider risk profi les. This will result in our surplus being fully consumed during 2011-12. We will continue to seek effi ciencies to maintain a high level of service to the Queensland community.

reduction in supplies and services spending

$504,662 reduction in employee costs

Secured recurrent funding secured for new payroll and fi nance systems

Highlights

$930,155

Financial report

KPI

98 3% fi nancial performanceagainst operational budget (2008-09: 98.8%)

| 75

Contents

Statement of comprehensive income 77

Statement of fi nancial position 78

Statement of changes in equity 79

Statement of cash fl ows 80

Notes to and forming part of the fi nancial statements 81

Certifi cate of the HQCC 100

Independent Auditor’s report 101

General informationThese fi nancial statements cover the Health Quality and

Complaints Commission. It has no controlled entities.

The Health Quality and Complaints Commission is a Queensland

Government Commission established under the Health Quality and Complaints Commission Act 2006 (Queensland).6

The Commission is controlled by the State of Queensland which is

the ultimate parent.

The head offi ce and principal place of business of the

Commission is:

Level 18, 53 Albert Street

BRISBANE QLD 4000

A description of the nature of the Commission’s operations and

its principal activities is included in the notes to the fi nancial

statements.

For information about the Commission’s fi nancial statements

please call (07) 3120 5999, email [email protected], or visit the

Commission’s website www.hqcc.qld.gov.au.

Health Quality and Complaints Commission

Financial statements 2009-10


2010 2009

Notes $ $

Income from Continuing Operations

Revenue

Grants and contributions 2 9,217,000 10,194,815

Other revenue 3 220,433 404,160

Total Income from Continuing Operations 9,437,433 10,598,975

Expenses from Continuing Operations

Employee expenses 4 6,824,481 7,329,143

Supplies and services 5 2,291,196 3,221,351

Depreciation and amortisation 6 443,621 211,095

Other expenses 7 37,466 270,868

Total Expenses from Continuing Operations 9,596,764 11,032,457

Operating Result from Continuing Operations (159,331) (433,482)

Other Comprehensive Income - -

Total Comprehensive Income (159,331) (433,482)

The accompanying notes form part of these statements.


Statement of comprehensive incomefor the year ended 30 June 2010


2010 2009

Notes $ $

Current Assets

Cash and cash equivalents 8 1,013,628 1,108,655

Receivables 9 92,599 238,618

Other current assets 10 45,767 38,970

Total Current Assets 1,151,994 1,386,243

Non Current Assets

Intangible assets 11 847,439 728,669

Property, plant and equipment 12 2,110,101 2,306,065

Total Non Current Assets 2,957,540 3,034,734

Total Assets 4,109,534 4,420,977

Current Liabilities

Payables 13 1,041,004 777,919

Accrued employee benefi ts 14 507,821 794,253

Other current liabilities 15 139,387 139,388

Total Current Liabilities 1,688,212 1,711,560

Non Current Liabilities

Accrued employee benefi ts 14 113,273 124,152

Other non current liabilities 15 1,080,254 1,198,139

Total Non Current Liabilities 1,193,527 1,322,291

Total Liabilities 2,881,739 3,033,851

Net Assets 1,227,795 1,387,126

Equity

Accumulated surpluses 1,227,795 1,387,126

Total Equity 1,227,795 1,387,126



Statement of fi nancial positionas at 30 June 2010


Retained Surpluses

2010 2009

$ $

Balance as at 1 July 1,387,126 1,820,608

Operating result from continuing operations (159,331) (433,482)

Balance as at 30 June 1,227,795 1,387,126



Statement of changes in equityfor the year ended 30 June 2010


2010 2009

Notes $ $

Cash Flows from Operating Activities

Infl ows:

Grants and other contributions 9,217,000 10,194,815

GST input tax credits from ATO 378,017 312,461

GST collected from customers 6,648 71

Interest receipts 202,638 398,582

Other 16,229 29,997

Outfl ows:

Employee expenses (6,862,127) (7,371,605)

Supplies and services and other expenses (2,400,672) (3,197,287)

GST paid to suppliers (280,566) (432,855)

GST remitted to ATO - (79)

Net Cash Provided by (used in) Operating Activities 16 277,167 (65,900)

Cash Flows from Investing Activities

Outfl ows:

Payments for property, plant and equipment (127,146) (919,289)

Payments for intangibles (245,048) (246,526)

Net Cash (used in) Investing Activities (372,194) (1,165,815)

Net (decrease) in Cash Held (95,027) (1,231,715)

Cash at Beginning of Financial Year 1,108,655 2,340,370

Cash at End of Financial Year 8 1,013,628 1,108,655



Statement of cash fl owsfor the year ended 30 June 2010


Objectives and Principal Activities of the Commission

Note 1: Summary of Signifi cant Accounting Policies

Note 2: Grants and Contributions

Other RevenueNote 3:

Note 4: Employee Expenses

Note 5: Supplies and Services

Note 6: Depreciation and Amortisation

Note 7: Other Expenses

Note 8: Cash and Cash Equivalents

Note 9: Receivables

Note 10: Other Current Assets

Note 11: Intangible Assets

Note 12: Property, Plant and Equipment

Note 13: Payables

Note 14: Accrued Employee Benefi ts

Note 15: Other Liabilities

Note 16: Reconciliation of Operating Result to Net Cash from/(used in) Operating Activities

Note 17: Non-Cash Financing and Investing Activities

Note 18: Commitments for Expenditure

Note 19: Contingencies

Note 20: Controlled Entities of the Health Quality and Complaints Commission

Note 21: Restricted Assets

Note 22: Events Occurring After Balance Date

Note 23: Financial Instruments


Notes to and forming part of the fi nancial statements 2009-10


Objectives and Principal Activities of the CommissionThe objectives of the independent Health Quality and Complaints Commission are to monitor, review and report on the

quality of health services, recommend action to improve the quality of health services, receive and manage complaints about

health services, help healthcare consumers and providers to resolve health complaints and preserve and promote health

rights in Queensland. The organisation was established under the Health Quality and Complaints Commission Act 2006, 6commencing on 1 July 2006. The Commission was established by the Queensland Government in response to a major

recommendation of the Queensland Health Systems Review (known as the Forster Report) in late 2005.

All assets, liabilities and fi nancial commitments were effectively transferred from the Health Rights Commission to the

Health Quality and Complaints Commission on 1 July 2006. The Health Rights Commission ceased to exist from 1 July 2006.

1. Summary of Signifi cant Accounting Policies

(a) Statement of Compliance

The Health Quality and Complaints Commission has prepared these fi nancial statements in compliance with

section 43 of the Financial and Performance Management Standard 2009.

These fi nancial statements are general purpose fi nancial statements, and have been prepared on an accrual basis

in accordance with Australian Accounting Standards and Interpretations. In addition, the fi nancial statements

comply with Treasury’s Minimum Reporting Requirements for the year ending 30 June 2010, and other

authoritative pronouncements.

With respect to compliance with Australian Accounting Standards and Interpretations, the Commission has

applied those requirements applicable to not-for-profi t entities, as the Commission is a not-for-profi t entity. Except

where stated, the historical cost convention is used.

(b) The Reporting Entity

The fi nancial statements include the value of all revenues, expenses, assets, liabilities and equity of the

Commission. The Commission does not have any controlled entities.

(c) Administered Transactions and Balances

The Commission does not administer resources on behalf of the Queensland Government.

(d) Grants and Other Contributions

Grants, contributions and gifts that are non-reciprocal in nature are recognised as revenue in the year in which the

Commission obtains control over them. The Commission is primarily funded by grant revenue from Queensland

Treasury through Queensland Health.

Where grants are received that are reciprocal in nature, revenue is accrued over the term of the funding

arrangements.

(e) Other Revenue

Other revenue is principally interest derived from short term investments of surplus cash.

(f) Cash and Cash Equivalents

For the purposes of the Statement of Financial Position and the Statement of Cash Flows, cash assets include all

cash and cheques receipted but not banked at 30 June as well as deposits at call with fi nancial institutions. The

Commission is party to the government’s banking arrangement conducted by Queensland Treasury.

(g) Receivables

Trade debtors are recognised at the amounts due at the time of sale or service delivery. i.e. the agreed purchase/

contract price. Settlement of these amounts is required within 30 days from invoice date.

The collectability of receivables is assessed periodically. All known bad debts were written-off as at 30 June.

There is no provision for doubtful debts at the balance sheet date.




1. Summary of Signifi cant Accounting Policies (contd)

(h) Acquisitions of Assets

Actual cost is used for the initial recording of all non-current physical and intangible asset acquisitions. Cost is

determined as the value given as consideration plus costs incidental to the acquisition, including all other costs

incurred in getting the assets ready for use, including architects’ fees and engineering design fees. However, any

training costs are expensed as incurred.

Where assets are received free of charge from a Queensland Government entity (whether as a result of

a machinery-of-Government or other involuntary transfer), the acquisition cost is recognised as the gross

carrying amount in the books of the transferor immediately prior to the transfer together with any accumulated

depreciation.

Assets acquired at no cost or for nominal consideration, other than from an involuntary transfer from a

Queensland Government entity, are recognised at their fair value at date of acquisition in accordance with

AASB116 Property, Plant and Equipment.

(i) Property, Plant and Equipment

Items of property, plant and equipment with a cost or other value equal to or in excess of the following thresholds

are recognised for fi nancial reporting purposes in the year of acquisition.

Intangibles $100,000

Plant and equipment $5,000

Leasehold improvements $5,000

Items with a lesser value are expensed in the year of acquisition.



(j) Revaluations of Non-Current Physical and Intangible Assets

Intangible assets are measured at cost.

Plant and equipment are measured at cost. The carrying amounts for plant and equipment at cost should not

materially differ from their fair value.

(k) Intangibles

Intangible assets with a cost or other value equal to or greater than $100,000 are recognised in the fi nancial

statements, items with a lesser value being expensed. Each intangible asset is amortised over its estimated

useful life to the Commission, less any anticipated residual value. The residual value is zero for all the

Commission’s intangible assets.

It has been determined that there is not an active market for any of the Commission’s intangible assets. As such,

the assets are recognised and carried at cost less accumulated amortisation and accumulated impairment losses.

Purchased Software

The purchase cost of this software has been capitalised and is being amortised on a straight line basis over the

period of the expected benefi t to the Commission, namely seven (7) years.



(l) Amortisation and Depreciation of Intangibles and Property, Plant and Equipment

Property, plant and equipment (PP&E) and Purchase Software is depreciated on a straight line (SL) basis so as to

allocate the net cost or revalued amount of each asset, less its estimated residual value, progressively over its

estimated useful life to the Commission.

This represents a change in accounting estimate applied prospectively from 1 July 2009 against all items of PP&E

and Intangibles that were previously depreciated on a diminishing value (DV) basis.

A review of assets previously depreciated under the DV method concluded that on balance SL was a more

appropriate treatment for the Commission’s assets whereas DV had more relevance to ‘for-profi t’ organisations

and their income tax positioning around accelerated depreciation.

SL is an accepted method across many areas of government. SL also simplifi es the forward analysis of

depreciation effects on the Commission.

Assets under construction (work in progress) are not depreciated until they reach service delivery capacity.

Service delivery capacity relates to when construction is complete and the asset is fi rst put to use or is installed

ready for use in accordance with its intended application. These assets are then reclassifi ed to the relevant

classes within intangible assets.

Any expenditure that increases the originally assessed capacity or service potential of an asset is capitalised and

the new depreciable amount is depreciated over the remaining useful life of the asset to the Commission.

The depreciable amount of improvements to or on leasehold property is allocated progressively over the

estimated useful lives of the improvements or the unexpired period of the lease, whichever is the shorter. The

unexpired period of the leases includes any option period where exercise of the option is probable.

For each class of depreciable asset, where held, the following depreciation rates were used:

Class Depreciation Rate %

Plant and equipment 20% to 25%

Leasehold improvements 10%

Intangibles Amortisation Rate %

Software purchase 14%

(m) Impairment of Non-Current Assets

All non-current physical and intangible assets are assessed for indicators of impairment on an annual basis. If an

indicator of possible impairment exists, the Commission determines the asset’s recoverable amount. Any amount

by which the asset’s carrying amount exceeds the recoverable amount is recorded as an impairment loss.

The asset’s recoverable amount is determined as the higher of the asset’s fair value less costs to sell and

depreciated replacement costs.

An impairment loss is recognised immediately in the Statement of Comprehensive Income, unless the asset is

carried at a revalued amount.

Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised

estimate of its recoverable amount, but so that the increased carrying amount does not exceed the carrying

amount that would have been determined had no impairment loss been recognised for the asset in prior years. A

reversal of an impairment loss is recognised as income.





Notes to and forming part of the fi nancial statements 2009-101. Summary of Signifi cant Accounting Policies (contd)

(n) Payables

Trade creditors are recognised upon receipt of the goods or services ordered and are measured at the agreed

purchase/contract price gross of applicable trade and other discounts. Amounts owing are unsecured and are

generally settled on 30 day terms.

(o) Financial Instruments

Recognition

Financial assets and fi nancial liabilities are recognised in the Statement of Financial Position when the

Commission becomes party to the contractual provisions of the fi nancial instrument.

Classifi cation

Financial instruments are classifi ed and measured as follows:

Cash and cash equivalents – held at fair value through profi t and loss

Receivables – held at amortised cost

Payables – held at amortised cost

The Commission does not enter into transactions for speculative purposes, nor for hedging. Apart from cash and

cash equivalents, the Commission holds no fi nancial assets classifi ed at fair value through profi t and loss.

All disclosures relating to the measurement basis and fi nancial risk management of other fi nancial instruments

held by the Commission are included in Note 23.

(p) Employee Benefi ts

Wages, Salaries, Recreation Leave and Sick Leave

Wages, salaries and recreation leave due but unpaid at reporting date are recognised in the Statement

of Financial Position at the nominal salary rates. Payroll tax and workers’ compensation insurance are a

consequence of employing employees, but are not counted in an employee’s total remuneration package.

They are not employee benefi ts and are recognised separately as employee related expenses. Employer

superannuation contributions and long service leave levies are regarded as employee benefi ts.

For unpaid entitlements expected to be paid within 12 months the liabilities are recognised at their undiscounted

values. Entitlements not expected to be paid within 12 months are classifi ed as non-current liabilities and are

recognised at their present value, calculated using yields on Fixed Rate Commonwealth Government bonds of

similar maturity, after projecting the remuneration rates expected to apply at the time of likely settlement.

Prior history indicates that on average, sick leave taken each reporting period is less than the entitlement accrued.

This is expected to continue in future periods. Accordingly, it is unlikely that existing accumulated entitlements

will be used by employees and no liability for unused sick leave entitlements is recognised.

As sick leave is non-vesting, an expense is recognised for this leave as it is taken.

Long Service Leave

Under the Queensland Government’s long service leave scheme, a levy is made on the Commission to cover the

cost of employees’ long service leave. The levies are expensed in the period in which they are payable. Amounts

paid to employees for long service leave are claimed from the scheme quarterly in arrears.

No provision for long service leave is recognised in the Commission’s fi nancial statements, the liability being held

on a whole-of-Government basis and reported in the fi nancial report prepared pursuant to AASB 1049 Whole of Government and General Government Sector Financial Reporting.

Superannuation

Employer superannuation contributions are paid to QSuper, the superannuation plan for Queensland Government

employees, at rates determined by the Treasurer on the advice of the State Actuary. Contributions are expensed in

the period in which they are paid or payable. The Commission’s obligation is limited to its contribution to QSuper.




(p) Employee Benefi ts (contd)

Therefore, no liability is recognised for accruing superannuation benefi ts in the Commission’s fi nancial

statements, the liability being held on a whole-of-Government basis and reported in the fi nancial report prepared

pursuant to AASB 1049 Whole of Government and General Government Sector Financial Reporting.

Executive Remuneration

The executive remuneration disclosures in the employee expenses note (Note 4) in the fi nancial statements

include:

• the aggregate remuneration of all senior executive offi cers (including the Chief Executive Offi cer) whose

remuneration for the fi nancial year is $100,000 or more; and

The remuneration disclosed is all remuneration paid or payable, directly or indirectly, by the entity or any related

party in connection with the management of the affairs of the entity or any of its subsidiaries, whether as an

executive or otherwise. For this purpose, remuneration includes:

• wages and salaries;

• accrued leave (that is, the increase/decrease in the amount of annual and long service leave owed to an

executive, inclusive of any increase in the value of leave balances as a result of salary rate increases or the

like);

• performance pay paid or due and payable in relation to the fi nancial year, provided that a liability exists (namely

a determination has been made prior to the fi nancial statements being signed), and can be reliably measured

even though the payment may not have been made during the fi nancial year;

• accrued superannuation (being the value of all employer superannuation contributions during the fi nancial

year, both paid and payable as at 30 June);

• car parking benefi ts and the cost of motor vehicles, such as lease payments, fuel costs, registration/insurance,

repairs/maintenance and fringe benefi t tax on motor vehicles incurred by the agency during the fi nancial year,

both paid and payable as at 30 June, net of any amounts subsequently reimbursed by the executives;

• housing (being the market value of the rent or rental subsidy – where rent is part-paid by the executive –

during the fi nancial year, both paid and payable as at 30 June);

• allowances (which are included in remuneration agreements of executives, such as airfares or other travel

costs paid to/for executives whose homes are situated in a location other than the location they work in); and

• fringe benefi ts tax included in remuneration agreements.

The disclosures apply to all senior executives appointed under the Public Service Act 2008 and classifi ed as 8SES1 and above, with remuneration above $100,000 in the fi nancial year. ‘Remuneration’ means any money,

consideration or benefi t, but excludes amounts:

• paid to an executive by an entity or any of its subsidiaries where the person worked during the fi nancial year

wholly or mainly outside Australia during the time the person was so employed; or

• in payment or reimbursement of out-of-pocket expenses incurred for the benefi t of the entity or any of its

subsidiaries.





(q) Provisions

Provisions are recorded when the Commission has a present obligation, either legal or constructive as a result

of a past event. They are recognised at the amount expected at reporting date at which the obligation will be

settled in a future period. Where the settlement of the obligation is expected after 12 or more months, the

obligation is discounted to the present value using an appropriate discount rate.

(r) Insurance

The Commission’s non-current physical assets and other risks are insured through the Queensland Government

Insurance Fund, premiums being paid on a risk assessment basis. Motor vehicles are leased from QFleet and

insurance is provided by the leasing arrangements. In addition the Commission pays premiums to Workcover

Queensland in respect of its obligations for employee compensation.

(s) Leases

Operating lease payments are representative of the pattern of benefi ts derived from the leased assets and are

expensed in the periods in which they are incurred.

Incentives received on entering into operating leases are recognised as liabilities. Lease payments are allocated

between rental expense and reduction of the liability.

(t) Taxation

The Commission is a State body as defi ned under the Income Tax Assessment Act 1936 and is exempt from6Commonwealth taxation with the exception of Fringe Benefi ts Tax (FBT) and Goods and Services Tax (GST).

FBT and GST are the only taxes accounted for by the Commission. GST credits receivable from, and GST

payable to the ATO, are recognised (refer to note 9).

(u) Issuance of Financial Statements

The fi nancial statements are authorised for issue by the Commissioner and the Chief Executive Offi cer of the

Health Quality and Complaints Commission.

(v) Judgements

The preparation of fi nancial statements necessarily requires the determination and use of certain critical

accounting estimates, assumptions, and management judgements that have potential to cause a material

adjustment to the carrying amounts of assets and liabilities within the next fi nancial year. Such estimates,

judgements and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates

are recognised in the period in which the estimate is revised and in future periods as relevant.

Estimates and assumptions that have a potential signifi cant effect are outlined in the following fi nancial

statement notes:

Valuation of Property, Plant and Equipment – note 12




(w) Rounding and Comparatives

Comparative information has been restated where necessary to be consistent with disclosures in the current

reporting period.

(x) New and Revised Accounting Standards

The Commission did not voluntarily change any of its accounting policies during 2009-10. Those new and

amended Australian accounting standards that were applicable for the fi rst time in the 2009-10 fi nancial year and

that had a signifi cant impact on the Commission’s fi nancial statements are as follows.

The Health Quality and Complaints Commission complied with the revised AASB 101 Presentation of Financial Statements as from 2009-10. This revised standard does not have any measurement or recognition implications.

Pursuant to the change of terminology used in the revised AASB 101, the Balance Sheet is now re-named to the

Statement of Financial Position, and the Cash Flow Statement has now been re-named to the Statement of Cash

Flows. The former Income Statement has been replaced by a Statement of Comprehensive Income. In line with

the new concept of ‘comprehensive income’, the bottom of this new statement contains certain transactions

that previously were detailed in the Statement of Changes in Equity (refer to the items under the sub-heading

‘Other Comprehensive Income’ in the new Statement of Comprehensive Income). The Statement of Changes in

Equity now only includes details of transactions with owners in their capacity as owners, in addition to the total

comprehensive income for the relevant components of equity.

The Commission is not permitted to early adopt a new accounting standard ahead of the specifi ed

commencement date unless approval is obtained from the Treasury Department. Consequently, the Commission

has not applied any Australian accounting standards and interpretations that have been issued but are not

yet effective. The Commission applies standards and interpretations in accordance with their respective

commencement dates.

At the date of authorisation of the fi nancial report, the only signifi cant impacts of new or amended Australian

accounting standards with future commencement dates are as set out below.

AASB 9 Financial Instruments and AASB 2009 – 11 Amendments to Australian Accounting Standards arising from AASB 9 [AASB 1, 3, 4, 5, 7, 101, 102, 108, 112, 118, 121, 127, 128, 131, 132, 136, 139, 1023 & 1038 and

Interpretations 10 & 12] become effective from reporting periods beginning on or after 1 January 2013. The main]impacts of these standards are that they will change the requirements for the classifi cation, measurement and

disclosures associated with fi nancial assets. Under the new requirements, fi nancial assets will be more simply

classifi ed according to whether they are measured at either amortised cost or fair value. Pursuant to AASB 9,

fi nancial assets can only be measured at amortised cost if two conditions are met. One of these conditions is the

business model whose objective is to hold assets in order to collect contractual cash fl ows. The other condition

is that the contractual terms of the asset give rise on specifi ed dates to cash fl ows that are solely payments of

principal and interest on the principal amount outstanding.

On initial application of AASB 9, the Health Quality and Complaints Commission will need to re-asses the

measurement of its fi nancial assets against the new classifi cation and measurement requirements, based on

the facts and circumstances that exist at that date. Assuming no change in the types of transactions the Health

Quality and Complaints Commission enters into, it is not expected that any of the Commission’s fi nancial assets

will meet the criteria in AASB 9 to be measured at amortised cost. Therefore, as from the 2013-14 fi nancial

statements, all of the Commissions fi nancial assets will be required to be classifi ed as ‘fi nancial assets required

to be measured at fair value through profi t or loss’ (instead of the measurement classifi cations presently used

in Notes 1(o) and 23). The same classifi cation will be used for net gains/losses recognised in the Statement of

Comprehensive Income in respect of those fi nancial assets. In the case of the Commission’s receiveables, the

carrying amount is considered to be a reasonable approximation of fair value.

All other Australian accounting standards and interpretations with future commencement dates are either not

applicable to the Health Quality and Complaints Commission’s activities, or have no material impact on the

Commission.




2010 2009

$ $

2. Grants and Contributions

Operational grant 9,217,000 10,194,815

Total 9,217,000 10,194,815

3. Other Revenue

Interest earned 204,204 395,636

FOI application fees 667 471

Other 15,562 8,053

Total 220,433 404,160

4. Employee Expenses

Employee Benefi ts

Wages and salaries 5,249,247 5,661,135

Employer superannuation contributions * 671,304 691,989

Long service leave levy 104,260 116,376

Annual leave expenses 426,524 461,413

Employee Related Expenses

Payroll tax and fringe benefi ts 346,319 382,532

Workers’ compensation premium ** 26,827 15,698

Total 6,824,481 7,329,143

* Employer superannuation contributions and the long service leave levy are regarded as employee benefi ts.

** Costs of workers’ compensation insurance and payroll tax are a consequence of employing employees, but are not

counted in employees’ total remuneration package. They are not employee benefi ts, but rather employee related

expenses.

The total number of employees includes both full-time employees and part-time employees measured on a full-time

equivalent basis.

2010 2009

Number of employees: 72 75




2010 2009

$ $

4. Employee Expenses (contd)

Executive Remuneration

The following is remuneration paid/payable to senior executives or were due to

receive total remuneration of $100,000 or more:

$140,000 to $159,999 1 -

$200,000 to $219,999 - 2

$340,000 to $359,999 - 1

$360,000 to $389,999 1 -

Total 2 3

Aggregate amount of total remuneration of executives shown above # 536,714 783,181

# The amount calculated as executive remuneration in these fi nancial statements includes the direct remuneration

received, as well as items not directly received by senior executives, such as the movement in leave accruals and

fringe benefi ts tax paid on motor vehicles. This amount will therefore differ from advertised executive remuneration

packages which do not include the latter items.

Aggregate amount of separation and redundancy/termination benefi t payments

during the year to executives shown above 102,004 128,696

5. Supplies and Services

Administrative expenses 259,841 323,130

Catering 11,641 10,274

Consultancy 316,577 527,793

Legal expenses 150,925 47,557

Library expenses 1,020 8,234

Maintenance costs 38,428 26,026

Motor vehicle – operating lease 28,338 47,015

Motor vehicle – other 57,485 63,956

Plant & equipment purchases <$5,000 15,826 32,842

Printing expenses and postage 23,730 28,293

Network support 210,995 376,820

Rent – operating lease 705,596 848,759

Software licences 21,189 181,178

Staff development 97,925 177,640

Stationery and offi ce supplies 63,209 79,535

Telephone expenses 137,879 141,382

Temporary staff expenses 108,819 222,829

Translation services 3,356 1,569

Travel expenses 35,262 74,748

Memberships 3,155 1,772

Total 2,291,196 3,221,351




2010 2009

$ $

6. Depreciation and Amortisation

Depreciation and amortisation were incurred in respect of:

Plant and equipment 102,407 68,629

Leasehold improvements 214,935 79,377

Software purchased 126,279 63,089

Total 443,621 211,095

7. Other Expenses

Insurance premiums – QGIF 178 2,065

Audit fees – external* 16,600 14,500

Audit fees – internal 14,920 -

Losses from disposal of plant & equipment 5,768 254,303

Total 37,466 270,868

* Total audit fees relating to the 2009-10 fi nancial year are estimated to be $15,300 (2008-09: $14,500). There are no

non-audit services included in this amount.

8. Cash and Cash Equivalents

Cash at bank 437 631,028

Cash on hand 500 500

QTC 24 hour call deposits 1,012,691 477,127

Total 1,013,628 1,108,655

Annual effective interest rate on cash held with the Queensland Treasury Corporation for 2009-10 was 5.25% (2008-09:

3.39%). Interest earned on cash held with the Commonwealth Bank was 3.3% in 2009-10 (2008-09: 2.25%).

The Treasurer’s approval has been obtained for these investments.

9. Receivables

GST receivable 74,665 178,764

Accrued interest 2,492 926

Fringe benefi t tax receivable 9,879 -

Long service leave reimbursements 5,563 58,928

Total 92,599 238,618

10. Other Current Assets

Prepayments 45,767 38,970

Total 45,767 38,970




2010 2009

$ $

11. Intangible Assets

Software Purchased:

At cost 1,004,202 804,753

Less: Accumulated amortisation (202,363) (76,084)

801,839 728,669

Work in Progress:

At cost 45,600 -

45,600 -

Total 847,439 728,669

Reconciliations of the carrying amounts of each class of intangible assets at the beginning and end of the current

reporting period.

SoftwarePurchased

SoftwarePurchased

SoftwareWork In

Progress

SoftwareWork In

Progress Total Total

2010 2009 2010 2009 2010 2009

$ $ $ $ $ $

Carrying amount at 1 July 728,669 545,232 - - 728,669 545,232

Acquisitions 199,449 246,526 45,600 - 245,049 246,526

Transfers between classes - - - - - -

Amortisation (126,279) (63,089) - - (126,279) (63,089)

Carrying amount at 30 June 801,839 728,669 45,600 - 847,439 728,669

Amortisation of intangibles is included in the line item ‘Depreciation and Amortisation’ in the Statement of

Comprehensive Income.

All intangible assets of the Commission have fi nite useful lives and are amortised using the straight line method. This

represents a change in accounting estimate applied prospectively from 1 July 2009 against all items of intangibles that

were previously depreciated on a diminishing value (DV) basis. Refer to Note 1(l).

No intangible assets have been classifi ed as held for sale or form part of a disposal group held for sale.




2010 2009

$ $

12. Property, Plant and Equipment

Plant and Equipment:

At cost 440,398 445,754

Less: Accumulated depreciation (220,493) (146,466)

219,905 299,288

Leasehold Improvements:

At cost 2,158,302 2,059,948

Less: Accumulated depreciation (268,106) (53,171)

1,890,196 2,006,777

Total 2,110,101 2,306,065

Plant and equipment is valued at cost in accordance with Queensland Treasury’s Non-Current Asset Accounting Guidelines for the Queensland Public Sector.

Property, plant and equipment (PP&E) is depreciated on a straight line (SL) basis so as to allocate the net cost or

revalued amount of each asset, less its estimated residual value, progressively over its estimated useful life to the

Commission. Refer to Note 1(l).

This represents a change in accounting estimate applied prospectively from 1 July 2009 against all items of PP&E that

were previously depreciated on a diminishing value (DV) basis.

ReconciliationReconciliations of the carrying amounts of each class of property, plant and equipment at the beginning and end of the

current reporting period.

Plant & Equipment

Plant & Equipment

LeaseholdImprovements

LeaseholdImprovements Total Total

2010 2009 2010 2009 2010 2009

$ $ $ $ $ $

Carrying amount

at 1 July 299,288 134,051 2,006,777 261,159 2,306,065 395,210

Acquisitions 28,792 258,650 98,354 660,639 127,146 919,289

Acquisitions

received through

fi t out - - - 1,393,875 - 1,393,875

Disposals (5,768) (24,784) - (229,519) (5,768) (254,303)

Transfers - - - - - -

Depreciation (102,407) (68,629) (214,935) (79,377) (317,342) (148,006)

Carrying amount

at 30 June 219,905 299,288 1,890,196 2,006,777 2,110,101 2,306,065

13. Payables

Trade creditors 987,520 759,275

Accrued expenses 53,484 18,644

Total 1,041,004 777,919




2010 2009

$ $

14. Accrued Employee Benefi ts

Current Liability

Salary and wages payable 60,255 330,793

Annual leave liability 422,214 438,285

Long service leave levy payable 25,352 25,175

507,821 794,253

Non-Current Liability

Annual leave liability 113,273 124,152

Total 621,094 918,405

15. Other Liabilities

Current Liability

Lease incentive 139,387 139,388

139,387 139,388

Non-Current Liability

Lease incentive 1,080,254 1,198,139

Total 1,219,641 1,337,527

16. Reconciliation of Operating Result to Net Cash from/(used in) Operating Activities

Operating surplus/(defi cit) (159,331) (433,482)

Depreciation and amortisation expense 443,621 211,095

Leasehold liability amortisation (117,887) (56,348)

Loss on disposal of assets 5,768 254,303

Changes in Assets and Liabilities:

(Increase)/decrease in GST input tax credit receivables 104,099 (120,402)

(Increase)/decrease in FBT receivables (9,879) -

(Increase)/decrease in accrued interest (1,566) 2,946

(Increase)/decrease in sundry debtors - 21,473

(Increase)/decrease in long service leave reimbursements 53,365 (54,694)

(Increase)/decrease in prepayments (6,797) (26,992)

Increase/(decrease) in payables 263,085 177,760

Increase/(decrease) in accrued employee benefi ts (297,311) (41,559)

Net Cash from/(used in) Operating Activities 277,167 (65,900)




2010 2009

$ $

17. Non-Cash Financing and Investing Activities

Non-cash investing activities in the 2008-09 reporting period consisted of the acquisition of leasehold improvements

through operating lease incentives. These acquisitions are set out in the property, plant and equipment reconciliation

in Note 12.

There were no non-cash fi nancing and investing activities during the 2009-10 reporting period.

18. Commitments for Expenditure

(a) Non-Cancellable Operating Lease

Commitments under operating leases at reporting date are inclusive of anticipated GST and are payable

as follows:

Not later than one year 857,938 808,860

Later than one year and not later than fi ve years 3,747,813 3,235,442

Later than fi ve years 4,243,082 3,707,277

Total 8,848,833 7,751,579

Operating leases are entered into as a means of acquiring access to offi ce accommodation and storage facilities.

Lease payments are increased annually by CPI, in line with infl ation escalation clauses on which contingent

rentals are determined.

(b) Capital Expenditure Commitments

There were no material capital commitments at reporting date that are not included in the accounts.

19. Contingencies

There were no material contingent assets or liabilities as at 30 June 2010.

20. Controlled Entities of the Health Quality and Complaints Commission

HQCC did not have control over any other entities during the 2009-10 reporting period.

21. Restricted Assets

There were no restrictions on the use of cash held as at 30 June 2010.

22. Events Occurring After Balance Date

There were no signifi cant events occurring after 30 June 2010.

23. Financial Instruments

(a) Categorisation of Financial Instruments

The Commission has the following categories of fi nancial assets and fi nancial liabilities:

2010 2009

Category Note $ $

Financial Assets

Cash and cash equivalents 8 1,013,628 1,108,655

Receivables 9 92,599 238,618

Total 1,106,227 1,347,273




2010 2009

Note $ $

23. Financial Instruments (contd)

(a) Categorisation of Financial Instruments (contd)

Financial Liabilities

Financial liabilities measured at amortised costs:

Payables 13 1,041,004 777,919

Total 1,041,004 777,919

(b) Financial Risk Management

The Commission’s activities expose it to a variety of fi nancial risks – interest rate risk, credit risk, liquidity risk and

market risk.

Financial risk management is implemented pursuant to Government and Commission policy. These policies focus on

the unpredictability of fi nancial markets and seek to minimise potential adverse effects on the fi nancial performance of

the Commission.

All fi nancial risk is managed by Executive Management under policies approved by the Commission. The Commission

provides written principles for overall risk management, as well as policies covering specifi c areas.

The Commission measures risk exposure using a variety of methods as follows -

Risk Exposure Measurement Method

Credit Risk Ageing analysis, earnings at risk

Liquidity Risk Sensitivity analysis

Market Risk Interest rate sensitivity analysis

(c) Credit Risk Exposure

Credit risk exposure refers to the situation where the Commission may incur fi nancial loss as a result of another party

to a fi nancial instrument failing to discharge their obligation.

The maximum exposure to credit risk at balance date in relation to each class of recognised fi nancial assets is the gross

carrying amount of those assets inclusive of any provisions for impairment.

The following table represents the department’s maximum exposure to credit risk based on contractual amounts net of

any allowances:

Maximum Exposure to Credit Risk 2010 2009

Category Note $ $

Cash 8 1,013,628 1,108,655

Receivables 9 92,599 238,618

Total 1,106,227 1,347,273

No collateral is held as security and no credit enhancements relate to fi nancial assets held by the Commission.

The Commission manages credit risk through the use of management reports. This strategy aims to reduce the

exposure to credit default by ensuring that the Commission invests in secure assets and monitors all funds owed on a

timely basis. Exposure to credit risk is monitored on an ongoing basis.



Notes to and forming part of the fi nancial statements 2009-1023. Financial Instruments (contd)

(c) Credit Risk Exposure (contd)

No fi nancial assets and fi nancial liabilities have been offset and presented net in the Statement of Financial Position.

The method for calculating any provisional impairment for risk is based on past experience, current and expected

changes in economic conditions and changes in client credit ratings. Economic and geographic changes form part

of the Commission’s documented risk analysis assessment in conjunction with historic experience and associated

industry data.

No fi nancial assets have had their terms renegotiated so as to prevent them from being past due or impaired, and are

stated at the carrying amounts as indicated.

Aging of past due but not impaired as well as impaired fi nancial assets are disclosed in the following tables:

2010 Financial Assets Past Due But Not Impaired

Overdue

Note Less than 30

Days

30-60 Days 61-90 Days More than 90

Days

Total

$ $ $ $ $

Financial Assets

Receivables 9 92,599 - - - 92,599

Total 92,599 - - - 92,599

2009 Financial Assets Past Due But Not Impaired

Overdue

Note Less than 30

Days

30-60 Days 61-90 Days More than 90

Days

Total

$ $ $ $ $

Financial Assets

Receivables 9 238,618 - - - 238,618

Total 238,618 - - - 238,618

(d) Liquidity Risk

Liquidity risk refers to the situation where the Commission may encounter diffi culty in meeting obligations associated

with fi nancial liabilities.

The Commission is exposed to liquidity risk in respect of its payables.

The Commission manages liquidity risk through the use of management reports. This strategy aims to reduce the

exposure to liquidity risk by ensuring the Commission has suffi cient funds available to meet employee and supplier

obligations as they fall due. This is achieved by ensuring that minimum levels of cash are held within the various bank

accounts so as to match the expected duration of the various employee and supplier liabilities.




(d) Liquidity Risk (contd)

The following table sets out the liquidity risk of fi nancial liabilities held by the Commission. It represents the

contractual maturity of fi nancial liabilities, calculated based on undiscounted cash fl ows relating to the liabilities at

reporting date. The undiscounted cash fl ows in these tables differ from the amounts included in the Statement of

Financial Position that are based on discounted cash fl ows.

2010 Payables in Total

<1 year 1-5 years >5 years

Note $ $ $ $


Payables 13 1,041,004 - - 1,041,004

Total 1,041,004 - - 1,041,004

2009 Payables in Total

<1 year 1-5 years >5 years

Note $ $ $ $


Payables 13 777,919 - - 777,919

Total 777,919 - - 777,919

(e) Market Risk

The Commission does not trade in foreign currency and is not materially exposed to commodity price changes. The

Commission is only exposed to interest rate risk through cash deposits in interest bearing accounts. The Commission

does not undertake any hedging in relation to interest risk and manages its risk as per the liquidity risk management

strategy.

(f) Interest Rate Sensitivity Analysis

The following interest rate sensitivity analysis is based on a report similar to that provided to management, depicting

the outcome on profi t and loss if interest rates would change by +/-1% from the year-end rates applicable to the

Commission’s fi nancial assets and liabilities. With all other variables held constant, the Commission would have a

surplus and equity increase/(decrease) of $10,136 (2009: $11,087). This is attributable to the Commission’s exposure

to variable interest rates on interest bearing cash deposits.

2010 Interest Rate Risk

-1% + 1%

Financial Instruments Carrying Amount Profi t Equity Profi t Equity

Cash 1,013,628 (10,136) (10,136) 10,136 10,136

Potential Impact (10,136) (10,136) 10,136 10,136




(f) Interest Rate Sensitivity Analysis (contd)

2009 Interest Rate Risk

-1% + 1%

Financial Instruments Carrying Amount Profi t Equity Profi t Equity

Cash 1,108,655 (11,087) (11,087) 11,087 11,087

Potential Impact (11,087) (11,087) 11,087 11,087

(g) Fair Value

The Commission does not recognise any fi nancial assets or fi nancial liabilities at fair value.

The fair value of receivables and payables are assumed to approximate the value of the original transaction, less any

provision for impairment.

The Commission does not hold any available for sale fi nancial assets.



Certifi cate of the Health Quality and Complaints CommissionThese general purpose fi nancial statements have been prepared pursuant to section 62(1) of the Financial Accountability Act 2009 (the Act), relevant sections of the9 Financial and Performance Management Standard 2009 and other prescribed9requirements. In accordance with section 62(1)(b) of the Act we certify that in our opinion:

(a) the prescribed requirements for establishing and keeping the accounts have been complied with in all material respects:

and

(b) the statements have been drawn up to present a true and fair view, in accordance with prescribed accounting standards,

of the transactions of the Health Quality and Complaints Commission for the fi nancial year ended 30 June 2010 and of the

fi nancial position of the entity at the end of that year.

Professor Michael Ward Mrs Cheryl HerbertCommissioner Chief Executive Offi cer

Date: 5 August 2010 Date: 5 August 2010


To the Commission of the Health Quality and Complaints Commission

Matters Relating to the Electronic Presentation of the Audited Financial ReportThe auditor’s report relates to the fi nancial report of the Health Quality and Complaints Commission for the fi nancial yearended 30 June 2010 included on the Health Quality and Complaints Commission’s website. The Commission is responsiblefor the integrity of the Health Quality and Complaints Commission website. I have not been engaged to report on the integrityof the Health Quality and Complaints Commission website. The auditor’s report refers only to the statements.

These matters also relate to the presentation of the audited fi nancial report in other electronic media including CD Rom.

Report on the Financial ReportI have audited the accompanying fi nancial report of the Health Quality and Complaints Commission which comprises thestatement of fi nancial position as at 30 June 2010, and the statement of comprehensive income, statement of changesin equity and statement of cash fl ows for the year ended on that date, a summary of signifi cant accounting policies, otherexplanatory notes and certifi cates given by the Commissioner and Chief Executive Offi cer.

The Commission’s Responsibility for the Financial ReportThe Commission is responsible for the preparation and fair presentation of the fi nancial report in accordance withprescribed accounting requirements identifi ed in the Financial Accountability Act 2009 and the9 Financial and Performance Management Standard 2009, including compliance with Australian Accounting Standards (including the Australian AccountingInterpretations). This responsibility includes establishing and maintaining internal controls relevant to the preparation andfair presentation of the fi nancial report that is free from material misstatement, whether due to fraud or error; selecting andapplying appropriate accounting policies; and making accounting estimates that are reasonable in the circumstances.

Auditor’s ResponsibilityMy responsibility is to express an opinion on the fi nancial report based on the audit. The audit was conducted in accordancewith the Auditor-General of Queensland Auditing Standards, which incorporate the Australian Auditing Standards. Theseauditing standards require compliance with relevant ethical requirements relating to audit engagements and that the audit isplanned and performed to obtain reasonable assurance whether the fi nancial report is free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the fi nancial report.The procedures selected depend on the auditor’s judgement, including the assessment of risks of material misstatement inthe fi nancial report, whether due to fraud or error. In making those risk assessments, the auditor considers internal controlrelevant to the entity’s preparation and fair presentation of the fi nancial report in order to design audit procedures that areappropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internalcontrol, other than in expressing an opinion on compliance with prescribed requirements. An audit also includes evaluating theappropriateness of accounting policies and the reasonableness of accounting estimates made by the Commission, as well asevaluating the overall presentation of the fi nancial report including any mandatory fi nancial reporting requirements as approvedby the Treasurer for application in Queensland.

I believe that the audit evidence obtained is suffi cient and appropriate to provide a basis for my audit opinion.

IndependenceThe Auditor-General Act 2009 promotes the independence of the Auditor General and all authorised auditors. The Auditor-9General is the auditor of all Queensland public sector entities and can only be removed by Parliament.

The Auditor-General may conduct an audit in any way considered appropriate and is not subject to direction by any person about the way in which audit powers are to be exercised. The Auditor-General has for the purposes of conducting an audit, access to all documents and property and can report to Parliament matters which in the Auditor-General’s opinion are signifi cant.

Auditor’s OpinionIn accordance with s.40 of the Auditor-General Act 2009 –9

(a) I have received all the information and explanations which I have required; and

(b) in my opinion –

(i) the prescribed requirements in respect of the establishment and keeping of accounts have been complied with in all material respects; and

rawn up so as to present a true and fair view, in accordance with the prescribed (ii) the fi nancial report has been dansactions of the Health Quality and Complaints Commission for the fi nancial year 1 Julyaccounting standards of the trahe fi nancial position as at the end of that year.2009 to 30 June 2010 and of t y

Queensland Audit Offi ceP BRAHMAN CPA f Queensland BrisbaneAs Delegate of the Auditor General of


Independent Auditor’s Report


AAccountability 62

Annual Health Check 44

Audit and Risk Governance

Committee 66,68

Auditor’s report 101

Australian Charter of

Healthcare Rights 41

BBundaberg Special Process 22

Bundaberg Show Cause report 46

CClient Experience Survey 28

Clinical Advisory Committee 66,69

Clinical Governance Reference

Group 50

Clinical opinion 22,27

Code of Conduct 58

Commission – role and biographies 64

Communication objective –

about this report inside front cover

Community engagement 40

Complaints 18

Complaints – complaints about us 29

Complaints Management Policy 29

Complaint Governance

Committee 66,68

Conciliation 21,27

Consumer Advisory Committee 66,70

Corporate governance 60

Credentialing investigation 39

Cultural Broker Group 58

Cultural survey 57

E Executive team –

roles and biographies 72

FFeedback inside front cover

Financial snapshot 5

Financial report 74

GGoal 2

Governance 60

Governance committees 66,68

H Health Practitioner Regulation

National Law 53,63

Highlights 4

Hospital profi les 15

I Independence 2

Independent auditor’s report 101

Indigenous engagement 41

Individual practitioner profi les 10,14

Information management 52

Information privacy 29

Internal audit plan 67

Interpreter services 29,41

Innovations Committee 59

K Knowledge and Research

Governance Committee 66,68

Knowledge management 52

L Learning and development 57

Legislation 2,53,63

Letter of compliance inside front cover

MMinister for Health 62

OOnline complaint form 28

Online strategy 52

Organisational chart 62,64,72

Overseas travel 41

PParliamentary Select

Committee review 63

Performance report card 8

Positive Workplace Committee 58

Public interest disclosures 32

Q Quality improvement initiatives 48

Quality monitoring 44

Queensland Ombudsman 29

RRecording technology 27

Records management 53

Reporting structure 62

Research framework 53

Responsive regulation 3

Reviews – complaint decisions 29

Right to information 29

Risk identifi cation and

intervention strategy 6,13

Risk management 67

Role 2

Root Cause Analysis reports 13

SService 28

Staff profi le 56

Stakeholder Engagement Plan 40

Stakeholder Engagement

Governance Committee 66,69

Stakeholders 2

Standards and quality 42

Standards review 50

StaRT 47

Strategic plan – targets and

performance 8

Sustainability reporting 59

TTranslation services 29,41

UUniversity partnerships 53

VValues 2

Verifi cation 47

Vision 2

WWebsite 52

Whistleblowers 32

Work and life balance 57

Workplace health and safety 58

Index


Preventing Harm, Improving Quality | Addendum

Addendum to the Health Quality and Complaints Commission Annual Report 2009-10 Caring for carers

We recognise and support the role of carers in our community.

As part of our commitment to the Carers (Recognition) Act 2008 and the Carers Charter, the following initiatives were undertaken in 2009-10:

we ensured access to our healthcare complaint service for carers and promoted our service through community and healthcare industry organisations

we acknowledged the important role of carers in our definition of a healthcare consumer - ‘A healthcare consumer is an individual who receives or uses a health service, and may also include families, carers and substitute decision-makers’

we promoted the Australian Charter of Healthcare Rights through consumer and community networks

our CEO met with carers in Rockhampton to discuss healthcare concerns (October 2009)

we supported the involvement of carers on our Consumer Advisory Committee

we offered a range of flexible work arrangements to staff with carer responsibilities and provided access to carer facilities at work.

Carers often raise healthcare safety and quality concerns through our complaints service. Of the 2241 healthcare complaints we received this year, 565 were made on behalf of a healthcare consumer.

Complainant breakdown 2009-10

Complaint made by

Number ofcomplaint

s

Consumer 1676 Family member 192 Parent 169 Partner 80 Spouse 49 Other 31 Enduring power of attorney 16 Unknown 15 Legal representative 6 Guardian 5 Statutory health attorney 2

The Australian Charter

of Healthcare Rights

(available in 17

community languages)

It’s OK to complain

(available in 15

community languages)

If you would like copies of any of the above resources, phone (07) 3120 5999 or

email your postal address and the quantity you require to [email protected]

Indigenous information cards

Brochures: Your guide to making a complaint,

Better healthcare for Queenslanders

Level 17 53 Albert Street Brisbane Qld 4000Mail GPO Box 3089 Brisbane Qld 4001Phone (07) 3120 5999 or 1800 077 308 (toll free)TTY 3120 5997 Fax (07) 3120 5998Email [email protected]

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