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Patient Ombudsman’s Blog

 

January 31st, 2024

Why does Patient Ombudsman launch formal investigations?

 

Most of the complaints that Patient Ombudsman receives are resolved through the work of our Early Resolution Specialists – the frontline staff who work closely with both the person making the complaint and the health organization to find a fair resolution.

There are times, however, when Patient Ombudsman may decide its appropriate to launch an investigation. There are typically two kinds of investigations that Patient Ombudsman carries out: an investigation based on a complaint or an own motion investigation.

A complaint-based investigation may happen when an early resolution to a complaint cannot be achieved or if there are disputes about the facts.

An own motion investigation is typically about a systemic issue or a matter of high public interest that comes to Patient Ombudsman’s attention. This kind of investigation can be initiated without a complaint.


What to expect when an investigation is launched?

When Patient Ombudsman launches an investigation, everyone involved is notified and receives information about what to expect throughout the investigation process. An investigator will reach out to the complainant (if there is one) and to the health organization to collect relevant information. This may include speaking with people within the organization who have information related to the investigation. It is important to note that officers, directors, employees, shareholders, and other members of the health organization are required to cooperate with the investigation and provide information and documents relevant to the investigation.

Investigations are carried out in private, which means that during our investigations, we only provide specific details needed to collect evidence. We also expect that those we speak to or collect information from keep their involvement confidential. We might take steps to shield the identity of witnesses and maintain the anonymity of whistleblowers in some cases.

After gathering information and conducting interviews, investigators will draft a report of their findings and make recommendations. This report is sent to the health organization or other parties who may have potentially adverse findings, and they will be given an opportunity to respond to the findings. After the report is finalized, Patient Ombudsman follows up with the health organization on how it is addressing the formal recommendations. A summary of the report findings, including full recommendations, is made available to the public on our website.  

In 2023, Patient Ombudsman published three investigation summaries that touched on issues related to billing for uninsured services, chronic care co-payment, and reprisal and access to care.

Investigations are an important part of our work and the resulting recommendations are intended to push for systemic change and improvement in our health system.

 

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