The Ontario Patient Ombudsman

Although Craig Thompson has only been Patient Ombudsman since April, his four years as the executive director of the Ombudsman’s Office helped him hit the ground running — which is important, because the Ombudsman has never been busier.

Considering the COVID-19 pandemic is driving a record number of complaints to their office, two annual reports are in the works for November, they’re investigating how Ontario’s long-term care homes managed the pandemic, and they’re conducting a survey of long-term care residents, their caregivers, families and staff, Thompson’s team has a full plate.

“There’s a lot of work going on around us,” said Thompson, “all of which is important for our office to report. That is the power of an ombuds, the ability to take complaints, and then in their aggregate, make sure we are pulling out what it is that’s rising to the top in terms of issues or root causes, so that we can tell the system what we’ve heard and they can respond to it.”

Office of Last Resort

Ontario’s Patient Ombudsman was formed in 2016 with now Health Minister Christine Elliott being the first to serve in the role. It collects complaints about the health care experiences of patients, families and long-term care residents. The Ombudsman has jurisdiction over public hospitals, long-term care homes, and home and community care support services delivered formally by the government.

What the office does not have is jurisdiction over are clinical decisions and the conduct of health care workers.

In its third year of operations, Patient Ombudsman received a total of 2,419 complaints — a five percent increase over the previous year. As in its first two years, the majority (62 percent) of complaints about health sector organizations within Patient Ombudsman’s mandate were about public hospitals. This was followed by home and community care coordinated by Local Health Integration Networks (LHINs) (nine percent) and long-term care homes (eight percent).

Eighteen percent of complaints were about health care services and providers that are outside of Patient Ombudsman’s jurisdiction.

Complaints rarely fall neatly into one jurisdiction or another, said Thompson. But that doesn’t stop the Ombudsman from trying to help in every case.

Thompson’s staff does not stop people when they start describing a problem that is not in their area of authority. “At the boundaries of our responsibilities, we want to understand the full trajectory of a complaint. And then we will begin to break it down and unbundle it,” he said.

As an office of ‘last resort,’ the Ombudsman only deals with complaints that patients or their families have already tried to resolve somewhere else.

“We understand that when people come to our office, we need to recognize these are often not ideal situations for them, and people are under a lot of stress,” said Thompson.

The Patient Ombudsman team has been getting better at “unbundling” complaints quickly, working to resolve what’s in the Ombudsman’s authority and helping the complainant find the right place to go for issues out of their jurisdiction.

“And we always encourage people, ‘if you don’t know where to go, just give us a call’,” said Thompson. “Our team is really excellent at helping you to understand the system.”

COVID-19 and Long-Term Care

For the past 18 months, the Ombudsman’s office has been focused on complaints related to COVID-19, along with a parallel surge in complaints related to long-term care.

“[That] was the impetus for us to initiate a public call for complaints, which we’ve never done in our history,” said Thompson, “and also to initiate our own investigation, a formal investigation, into long-term care complaints and [long-term care homes’] response to the COVID-19 pandemic.”

Previous Ombudsman Cathy Fooks, who died unexpectedly late last year, released the first special report on long-term care and COVID-19 in October 2020. That report, which focused on the first wave of the pandemic, found a high level of concerns around COVID-19 safety measures in long-term care homes, including infection prevention and control, and adequate staffing.

The second report, which just came out at the end of August, deals with the second and third waves. Its focus is on visitation and isolation — crucial issues for residents and families.

In their effort to secure their residents against the risk of COVID-19 infection, administrators restricted the access of essential caregivers to residents.

“The investigation has also highlighted how the pandemic has been particularly hard on physicians and other care providers”

“I think we collectively forgot about the essential role caregivers provide to their loved ones or to the people they’re taking care of,” said Thompson, whose parents are both in long-term care.

He said separation from their essential caregivers can have negative consequences for the long-term health of residents. “They are essential to the care team… and that’s something that we point out in our report.”

Front Line Workers

The investigation has also highlighted how the pandemic has been particularly hard on physicians and other care providers, said Thompson.

“These folks have been at the front of this pandemic, dealing with very frightening and challenging situations with sometimes not a lot of information, sometimes with confusing information — and dealing with people who are also frustrated and under a lot of stress.”

The situation has been bad enough that the Ombudsman has begun to see complaints from hospital staff members.

“We began to see complaints from staff in the form of whistleblower complaints over the pandemic — and we typically didn’t see those kinds of complaints,” said Thompson. “That was because health care professionals were really trying to understand what was going on.”

Focus on Fairness, Deliver Better Care

Ultimately, the work of the Patient Ombudsman is intended to provide information to the health care system that it can use to deliver better care and avoid complaints altogether.

That’s an area that the Ombudsman and CPSO can collaborate on, said Thompson.

“The sharing of our insights, what we’re learning, I think is probably the next big opportunity for us,” he said. “And that runs both ways because it’s instructive to our team to understand what CPSO or the other colleges are hearing in terms of the complaints that come into their office, because those aren’t in isolation of the care experiences we’re dealing with [in the Ombudsman’s Office].”

Sharing those insights helps complete the picture of what is going on in the health care system, allowing caregivers and administrators to reduce complaints, focus on more difficult cases, and spend more time delivering excellent care.

“Proactive ombuds is all about not having a complaint to deal with because you’ve thought about fairness in the design of a program or the rollout of a clinical service,” said Thompson.