Ombudsman complaint process
Find out more about how we manage complaints made to the Ombudsman
Learn more about how to make a complaint
Overview of the complaint process
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Step 1Assessing the complaint
We assess whether we can consider the concerns raised in the complaint before deciding the most appropriate way to address the concerns.
Key timeframes: We aim to acknowledge a complaint within 3 working days and connect the complainant with their case officer within 10 working days.
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Step 2Managing the complaint
We manage the complaint in line with our relevant policies based on our assessment of the most appropriate way to address the concerns. This may involve making an early resolution transfer, preliminary inquiries or investigating the complaint.
Key timeframes: We provide updates about the progress of a matter about every 6 weeks, or sooner if possible.
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Step 3Finalising the complaint
Our complaint outcomes are based on careful consideration of all relevant information. We may make suggestions or recommendations for improvement to the organisation that is the subject of the complaint or decide that no further action is necessary. We provide detailed explanations of our decisions.
Key timeframes: We aim to finalise basic complaints within 6 months and more complex complaints within 12 months.
Assessing the complaint
We aim to acknowledge receipt of a complaint within 3 working days.
When we receive a complaint, we first consider whether we can look into the issue being raised. We can assist with complaints about how the Australian Health Practitioner Regulation Agency (Ahpra), the National Boards, accreditation authorities and specialist medical colleges have handled a matter. Find out more about complaints we assist with.
We may suggest that a complaint could be better addressed by another organisation and provide the complainant with that organisation's contact details. Find out more about other health complaints.
The case officer carefully considers the most appropriate way to address the concerns raised in line with our Assessment Policy.
Managing the complaint
We manage complaints in line with our complaint management policies. This generally includes considering whether the handling of a matter was fair, reasonable, lawful and consistent with the organisation’s policies and procedures.
Once we have assessed a complaint, we may decide to:
- transfer the complaint directly to the organisation complained about for a response
- make preliminary inquiries
- start an investigation
- decide not to take any further action.
The relevant policy, or policies, we follow depend on the process we decide to follow based on our assessment of the complaint.
We generally provide complainants with a progress update every 6 weeks, or sooner if possible.
Transferring the complaint
With the complainant’s consent, we may decide to transfer the complaint to the organisation they are complaining about for a response. The complainant will have an opportunity to provide feedback on the response. We will also assess the response to ensure it is fair and reasonable. Once this occurs, we will decide the appropriate next steps, if any, for the complaint.
Find out more about the transfer process
Making preliminary inquiries
In some cases, we need further information to help us decide whether to investigate a complaint. We generally request this information from the organisation the complaint is about by making preliminary inquiries. We review this information alongside the information provided by the complainant to decide whether to investigate the complaint.
Download our Preliminary Inquiry Policy
Investigating the complaint
If we decide to investigate a complaint, we provide written notice to the complainant and the organisation that their complaint is about. This notice outlines the issues being investigated. We ask the organisation to provide our office with information about the complaint. This often involves requesting relevant documents it holds.
At the end of the investigation, we discuss our proposed findings with the complainant. This is an opportunity for any final comments before we make a final decision.
Find out more about the investigation process
Finalising the complaint
We aim to finalise most complaints within approximately 3 to 6 months and more complex complaints within 12 months. We provide the complainant with a detailed explanation of our decision.
In some cases, we may:
- provide (or suggest that the organisation the complaint is about provides) a better explanation of the decision or action being complained about
- speed up the processing of a delayed matter
- suggest that the organisation being complained about:
– offers an apology
– reviews or changes a process
– reconsiders a decision.
Sometimes these outcomes are achieved before we finalise a complaint. For example, an organisation may provide a further explanation or apology to a complainant during our early resolution transfer process. An organisation may also agree to review a policy or process in response to our preliminary inquiries or investigation into a complaint.
If we believe an organisation has adequately addressed the complaint, or we find that the handling of a matter was fair and reasonable, we may finalise the complaint without taking any further action.
The Ombudsman does not have the power to force Ahpra, a National Board, an accreditation authority or a specialist medical college to change a decision they have made.
However, when appropriate, the Ombudsman can make formal comments, suggestions for improvement or recommendations to the organisation that is the subject of the complaint.
Find out more about complaint outcomes
Feedback and review of our decisions
If a complainant is dissatisfied with their complaint outcome, we ask that they first contact the person who managed their matter. This gives us the chance to address their concerns and/or provide further explanation of our decision. If this does not resolve their concerns, the complainant is welcome to provide feedback about our service delivery and/or apply for an internal review of our office’s decision regarding their complaint.
Learn more about how to provide feedback on our service delivery and the review processes available for our complaint decisions.
Withdrawing a complaint
Complaints can be withdrawn at any stage. When this happens, we generally notify the organisation that the complaint is about that the complaint has been withdrawn without taking further action. However, in exceptional circumstances, we may decide to take action to prevent a serious risk of harm.