Methods used by health ombudsman in their system improvement role: A comparison of two international health ombudsman in their system improvement role and the response of Scottish health boards to the system improvement activities of the SPSO

Abstract

Academics and ombudsman claim that a key role for ombudsman is to contribute to the improvement of the system over which they have oversight. However, there is limited research to support this claim and, much of what exists, is equivocal. This research examines the thesis that health ombudsman make a significant contribution to the improvement of the healthcare system as a result of the roles and activities that they undertake together with the way that they work with bodies in jurisdiction. In conducting this research, an international comparative case study was undertaken, using the Office of the Health Ombudsman, Queensland (OHOQ) and the Scottish Public Services Ombudsman (SPSO) as cases. In addition, three Scottish health boards participated in the research. The OHOQ was found not to be an ombudsman but to be a health complaint entity which principally focused on the prosecution of health professionals that it considers have conducted serious professional misconduct. The SPSO is an ombudsman, which principally tries to contribute to system improvement through compliance from health boards with recommendations arising from upheld complaints. In its approach to complaint investigations, the SPSO adopts the positions of an accountability institutional logic and coercive model of administrative control. These positions adversely affect the relationship between the SPSO and health boards with health board participants complaining about the nature of the communication between themselves and the SPSO, the quality of the clinical advice relied upon by the SPSO in reaching its decisions, and the inability to challenge either the advice or the decision. Consequently, in many cases, compliance with SPSO recommendations was due to a fear of sanction rather than commitment. In implementing recommendations, health boards use a dominant informational mode of organisational learning. Together, these factors explain why learning is unsustained leading to repeated complaints about the same issue.