3. Guiding principles

There are 5 sections to our Complaints Handling Policy:

Overview
Aim of the Commission’s complaints function
Guiding principles
Complaints process
Personal and protected information

The Commission’s complaints processes are underpinned by a number of guiding principles, including:

3.1 Older person focus
3.2 Timely resolution
3.3 Keeping people informed
3.4 Transparency
3.5 Risk-based and proportionate response
3.6 Procedural fairness
3.7 Open disclosure
3.8 Outcome-focused approach
3.9 Early resolution approach

Our complaints process is consistent with the principles set out in the Better Practice Complaint Handling Guide by the Commonwealth Ombudsman. In line with the guide, our complaints service is designed and delivered in a way that:

is user-centred, simple to access and easy to use
supports early resolution
is integrated within the Commission's Regulatory Strategy
enables us to identify and report on insights from complaints
is supported by clear process guidance
ensures skilled staff who have the support they need to deliver better practice
is supported by robust quality assurance and review processes
is appropriately resourced.

3.1 Older person focus

Older people are at the centre of our complaints processes. To ensure this, older people can expect that we will:

listen to them to ensure we understand their values and what they want from both their aged care services and us at the Commission
always include them, or their representative, in the complaints process
share accurate information that is clear, straightforward and accessible
keep them informed throughout the complaints process and about any actions or decisions that affect them, and the reasons for those decisions.

3.2 Timely resolution

Resolving complaints in a timely fashion is a key principle of best practice complaints handling. We understand that people making complaints need their concerns addressed as quickly as possible and providers also need us to make timely decisions.

We will always assess and prioritise complaints based on the risk or harm to older people. This is because the safety, health and wellbeing of older people is our priority. It also ensures we take timely action to reduce serious risk and prevent harm to older people.

This can sometimes impact the timeliness for addressing concerns involving lower risk. However, we are committed to resolving all complaints within our published service standards.

3.3 Keeping people informed

We will keep the parties involved in the complaint up to date throughout the complaint process. This is another important aspect of good complaints handling and ensures parties are informed and empowered to actively participate in the complaints process. To ensure this, we will talk to complainants/older people about their preferences in terms of both method and frequency of communication. We will gain agreement from them about how they wish this to occur, and ensure all parties have clear expectations regarding frequency of communication.

3.4 Transparency

We want to build trust and confidence in the Commission through:

our willingness to publicly share information about our operations
application of good decision-making principles, consistency and fairness
open communication about the complaints process and ensuring people understand what it can and cannot do
our openness to external scrutiny.

We are transparent about:

how we regulate
our decisions and the reasons for them
how we perform.

In the complaints function, we openly share information about:

the aim of the complaints process
the principles behind the complaints process
the outcomes we aim to achieve in the complaints process
key steps in the complaints process
the decisions we make in the complaints process, the reasons for them and the decision-making principles we apply when making them
how we perform the complaints function as required under the Commission Act
each person’s rights and responsibilities in the complaints process
how we record, use and share protected information throughout the complaints process.

3.5 Risk-based and proportionate response

We base our decisions and actions on risk to the older person, and act in proportion to the level of identified risk. We use the right mix of regulatory tools to get the best results for older people, focussing on protecting and enhancing their safety, health and quality of life.

This approach underpins all the Commission’s regulatory actions, including when we handle complaints.

In managing complaints, this means:

we escalate risk as required to the appropriate areas of the Commission to ensure older people are safe
the way we manage the complaint is based on the nature of the risk or harm to the older person, and whether the provider is managing that risk or harm appropriately. This proportionate approach to regulation is demonstrated in our regulatory diamond, found in our Regulatory Strategy
we prioritise complaint matters to ensure people are safe
we consider the circumstances of each complaint and the outcomes being sought by the older person.

3.6 Procedural fairness

As decision-makers, under the law we must approach our decisions with procedural fairness. This means we give everyone involved in a complaint the right to:

be heard
be treated fairly and without bias
be informed of and respond to allegations
information regarding the status of a complaint.

The 3 main rules for procedural fairness are:

Hearing rule – We must tell a person or provider before we make a decision that may affect their interests. We must then hear and consider their response before making the decision. We will share the critical issues we seek to address, and any additional information that is credible, relevant and significant to the issues.
Bias rule – We must:
1. be impartial and unprejudiced
2. have no personal stake, interest or involvement in the case
3. have no actual bias or appearance of bias in the case or against the person or provider involved.
  Note: to prevent actual or potential bias within our complaints process, we follow a strict conflict of interest policy.
Evidence rule – We must make decisions for logical reasons based on the available evidence.

When we handle complaints and information about provider responsibilities, we make sure we provide procedural fairness to a person or provider whose rights or interests may be negatively affected by one of our decisions, including:

giving the person making the complaint the chance to respond to our findings before finalising the complaint
ensuring the older person's voice is heard and involving them or their representatives in decisions that affect them
allowing providers to respond before a decision is made that affects them, and affording them the opportunity to give information and evidence to inform the complaint process
keeping the person and provider informed of the progress and outcome of the complaint.

This makes sure we treat all parties fairly, keep them informed, and involve them in managing the complaint.

Further guidance regarding procedural fairness can be found on our website.

3.7 Open disclosure

Open disclosure is the open discussion that a provider has with the older person or the person making the complaint when something goes wrong. This may include their family or supporters if appropriate. It includes situations when something has harmed, or has the potential to cause harm, to people receiving aged care services.

Open disclosure can involve:

listening to the older person’s experience of what occurred and ensuring they feel heard
a factual explanation of what went wrong
explaining what steps parties will take to prevent it from happening again
an apology
ensuring the older person understands how their experience will inform service improvements.

Comprehensive guidance regarding open disclosure is available on our website.

In managing complaints, we:

require providers to meet their responsibilities to practice open disclosure under Aged Care Quality Standard 6 and Standard 8.3.c and 8.3.e in the Principles
make sure providers understand their responsibilities for open disclosure generally, as well as within the specific complaint
make sure that older people or people making the complaint understand providers’ obligations for open disclosure. We will also help them understand:
- how taking part in open disclosure can help them speak up about issues that affect them
- how they can be supported throughout these discussions.

3.8 Outcome-focused approach

We focus on helping older people achieve the outcomes they want to see from their complaint. This means we will listen carefully to the older person to understand the outcome(s) they are looking for. We will talk with them at the beginning of the complaint process about what is realistic to achieve. This is because we need to make sure complaint outcomes are proportionate and in line with provider’s responsibilities.

We help providers improve their services and each older person’s experience of aged care. We also monitor how effective our resolution approach is in improving the quality of care for older people.

We make sure, where possible, that providers:

remedy non-compliance – this means providers understand and fix what went wrong
restore older people’s trust in the care that they deliver – often through practicing open disclosure
take steps to prevent issues from happening again.

To ensure we focus on outcomes, we:

understand the outcome the older person is seeking for each issue they raised
make sure the complainant understands where outcomes are consistent with provider responsibilities
focus on addressing risk and ensuring people are safe
check that the complaints process has delivered the outcomes the older person is seeking, or explain when those outcomes are not possible
focus not only on outcomes related to the complaint issues, but also on outcomes related to restoring relationships and trust
ensure older people, their families and carers feel heard and respected throughout the complaints process.

3.9 Early resolution approach

The process of resolving complaints early, while adhering to the Rules and Aged Care Act, is a guiding principle of how the Commission handles complaints. A key step in our assessment process is identifying where the issues raised in a complaint are suitable for early resolution. Early resolution means identifying and implementing a proportionate and fit for purpose response to a complaint at the earliest point possible. It recognises that in many complaints there are different ways, other than formal investigation or other formal dispute resolution techniques, that allow for a prompt outcome to be reached.

Early resolution allows for efficient and effective complaint resolution and promotes expedient and effective use of public resources. It meets the expectations of the public and helps foster trust, confidence and satisfaction with our complaint handling. Our complaints management system is structured so that the option to resolve a complaint early is considered in most complaints. Consideration is given at all stages to the most appropriate complaint-handling option in the circumstance and managed accordingly.