REFORM MEDICAL SERVICE BY LEARNING THROUGH COMPLAINT
By Mitsuru Ikenaga,

The WHO method is becoming common practice for the Patients’ Rights Ombudsman Japan:
Three years has passed since Nonprofit Organization (NPO) Patients’ Rights Ombudsman Japan, founded in June 1999, started providing a service in July 1999.
Since its foundation, the aim of the organization has been to establish a Complaint Procedure in the medical and welfare field, which as suggested in ゛A Declaration on the Promotion of Patients’ Rights” (March 1994) adopted by the European Conference of the World Health Organization (WHO).

We have received complaints from patients and their families all over Japan. For the last three years up to June 2002, the use made of the consultation services which we provide were as follows. Telephone consultation 1,615 from all over Japan, interview consultation 689 mainly from Fukuoka Prefecture where the Patients’ Rights Ombudsman Japan office is located. The total is 2,304.
These consultation and support services were all provided by volunteer citizen consultation staff and expert consultation staff (in law and medical and welfare fields).
Five cases have been investigated by the Ombudsman Conference members (which consists of 15 members, who are experts in every field related to patients’ rights and volunteer staff) since these cases were not resolved by consultation and support activity and applied for complaint investigation.
This “Patients’ Rights Ombudsman Blue Book” is composed of two sections.

Section 1 consists of a concise outline of the interview consultation cases of past three years (about six hundred) classified according to the type of complaints.
The period of an each interview consultation is about 40 minutes. In the interview, the
content of each complaint is organized based on the relation to patients’ rights and consultation staff give advice to patients and their families so they can solve their problems. If it is necessary, further support and interview services are provided.

In Section 2, consists of reports of the Ombudsman Conference on five cases which have been presented in the last three years. Investigation and examination of the cases by the Ombudsman Conference is provided with the agreement and cooperation of the people who are involved in the cases in order to promote patients’ rights. Through these activities, it is expected that both parties will discuss further about their case referring to the opinion provided by Ombudsman Conference so as to solve their dispute with both parties’ understandings.
In principle, the investigation report is presented within 100 days after the petition is accepted.

Activities of the Nonprofit Organization (NPO) Patients’ Rights Ombudsman Japan are provided not only to solve each complaint but also with the aim of establishing a ‘Medical System which learns from complaints’.
In order to realize this aim, it is important to know precisely the content of each complaint which is presented by patients and their families and to clarify the condition of the infringement of patients’ rights and the problems of the medical and welfare services in detail through faithful dialogue.
We Ombudsmen (and women) provide these useful data widely to citizens and medical and welfare institutes on an anonymous basis by updating our homepage regularly, in order to promote patients’ rights to reform medical system and improve its quality. Volunteer staff in the Ombudsman office process these data daily.

Our Complaints Procedure clearly shows the present situation of medical practice
and how to reform it:

The complaints from patients and their families reported in this “Patients’ Rights Ombudsman Blue Book” reflect the real shape of medical practice in Japan and its problems that need to be solved from the medical and welfare service users’ point of view. Each interview is so serious that it affects the true nature of medical service. Thus, I hesitate to describe each case as merely a “Complaint”.
Of course, some complaints come from misunderstandings.
However, many serious complaints are to be found in daily medical service and most of the complaints arise from a lack of explanation from medically engaged people such as doctors to patients (that is to say, the internationally confirmed medical principle that every medical practice should be done after getting prior informed consent by patients is
not employed sufficiently).
It is remarkable that so many patients and their families have started to present their complaints to the Patients’ Rights Ombudsman which is an extrajudicial system.
Patients and their families are rarely unable to solve their complaints.
On the contrary, that they present their complaints shows their expectations.
If we can clarify the cause of complaints and solve them appropriately which then leads to
reform of the medical system, then an ideal state of ‘Complaint as Treasure’ will be realized.
Particularly, the five investigation reports described in Section 2 show that the tendency not to respect patients’ rights is still deeply rooted in the traditional medical structure and in the consciousness of doctors and medical providers, which is the cause and background of complaints.
Moreover, Section 2 clearly suggests the problems in the system which should be immediately overcome such as an insufficient prescription disclosure system in order to promote the sharing of medical information with patients.

Most of the medical institutes which were the objects of such investigations are expected to play an important role as the main regional hospitals in their societies.
So I think that measures for promoting patients’ rights should be drastically strengthened. Possible measures include for example, holding workshops regarding ‘Patients’ Rights’  which have become the international standard in medical and welfare service as adopted by the World Health Organization (WHO) and the General Assembly of World Medical Association, and to assign Patient Advocacy in every medical and welfare facilities.
In addition, Nonprofit Organization (NPO) Patients’ Rights Ombudsman Japan has opened a Tokyo Consultation Room to prepare for the establishment of an Ombudsman organization in Tokyo.
From January 2002, training workshops for citizen consultants have been held as well as providing interview consultation for patients and their families in Kanto region. Complaints which have been presented there are nearly the same type as the ones which we have dealt with by telephone consultation in Fukuoka from all over Japan.
This fact shows that the common circumstances and structural background which causes such complaints is inherent in the medical system of Japan.
I strongly hope that this “Patients’ Rights Ombudsman Blue Book” is fully utilized as a textbook to clarify and promote the problem of reforming medical practice from the viewpoint of enhancing patients’ rights and the quality of medical practice.

July 2002