A formal complaint about hospital care is not just an exercise in expressing dissatisfaction. The Ontario complaint and disclosure framework places a number of substantive obligations on hospitals: to define and disclose critical incidents, to analyze them and develop plans to prevent recurrence, and to report aggregated data to a quality committee. The complaints that patients and families bring are part of how the framework operates. Understanding how the framework works, what hospitals are obligated to do, and how to make an effective complaint can substantially affect what comes out of the process.
This guide is a hospital-specific complement to the broader A Patient’s Guide to Making Complaints About Health Care in Ontario, which covers the full range of complaint and review pathways available to Ontario patients. The focus here is on hospitals: the legislative framework that governs them, the complaint pathways specific to hospital care, and how to make a complaint that gets a substantive response.
The complaint pathways for hospital care
Three pathways are relevant to most concerns about hospital care.
Hospital patient relations. Each Ontario hospital is required to have a patient relations process. This is typically the first stop for any concern about hospital care. The patient relations office is part of the hospital itself, and its role is to help resolve complaints internally where possible, and to escalate them where appropriate.
Patient Ombudsman. Patient Ombudsman is an independent office that investigates complaints about Ontario’s public hospitals, long-term care homes, and home and community care support services. It is the body to escalate to where a hospital’s own patient relations process has not resolved the concern. Patient Ombudsman was established under the Excellent Care for All Act, 2010, which is the same statute that creates the broader hospital quality framework discussed below.
The regulatory colleges. Where the concern is about the conduct of an individual healthcare professional rather than the hospital as an institution, the appropriate body is the regulator for that profession: the College of Physicians and Surgeons of Ontario (CPSO) for physicians, the College of Nurses of Ontario (CNO) for nurses, and the analogous colleges for other regulated professions. The colleges have a complaint process and can take disciplinary action where the conduct meets the relevant thresholds. For more on the CPSO complaints process specifically, see Should I File a CPSO Complaint Against My Doctor?.
The pathways are not mutually exclusive. A patient who has concerns about both the hospital’s institutional conduct and an individual professional’s conduct can pursue both, and in serious cases often should.
The hospital, physician, and nurse distinction
A point that complicates hospital complaints, and that patients are sometimes unaware of: physicians at most Ontario hospitals are not employees of the hospital. They are independent contractors who hold privileges to practise at the hospital. Nurses typically are employees of the hospital, but physicians typically are not.
This affects the complaint analysis in two ways.
First, the hospital is generally vicariously liable for the conduct of its employees (including nurses), but not for the independent professional conduct of its credentialed physicians. A hospital-level complaint can reach institutional and nursing concerns; concerns specifically about a physician’s clinical judgment usually need to go to the CPSO.
Second, the hospital nonetheless has institutional responsibilities even for events involving credentialed physicians: the credentialing process itself, the supervision of physicians within hospital roles, the systems and protocols within which physicians work, and the response to incidents. Even a concern that arises from a physician’s conduct can, in many cases, also raise hospital-level questions about the institutional context in which the conduct occurred. The British Columbia decision in Sheoran v Interior Health Authority illustrates the point: the hospital’s duty of care extends to the systems within which clinical care happens, not only to its direct employees.
Hospital patient relations
Each hospital has its own patient relations process, accessible through the patient relations office. The process is non-adversarial and informal. It typically begins with a conversation, either by phone or in person, in which the patient or family describes the concern. From there, the patient relations office may:
- Contact the staff or department involved to obtain their account of what happened
- Arrange a meeting between the patient or family and the relevant staff
- Coordinate a review of the events by the relevant clinical leadership
- Provide a formal written response
- Refer the matter to an internal critical incident review process where the events meet the threshold
The patient relations process is not designed to compensate. It cannot order the hospital to pay damages or to discipline a staff member. What it can do is provide an explanation of what happened, an opportunity to be heard, and (in many cases) commitments by the hospital to address the underlying issues. Where the events meet the definition of a critical incident under Regulation 965 of the Public Hospitals Act, it can also trigger formal disclosure and review obligations.
A patient relations process is also typically the gatekeeper for the next escalation: Patient Ombudsman generally requires patients to have first raised the concern with the hospital before accepting a complaint.
Patient Ombudsman
Patient Ombudsman is an independent office that handles complaints about Ontario public hospitals, long-term care homes, and home and community care support services. The office cannot accept complaints about regulated health professionals as such (those go to the colleges) or about private clinics that operate independently of hospitals (though it can sometimes redirect such complaints).
The complaint process at Patient Ombudsman is structured. A complainant fills out a complaint form and is then contacted by an Early Resolution Specialist who assesses whether the complaint falls within Patient Ombudsman’s mandate, identifies what the complainant is seeking, and engages the health sector organization in an attempt at resolution. Where resolution is unsuccessful, Patient Ombudsman can move the complaint to a formal investigation, which can result in findings and recommendations to the institution.
Patient Ombudsman’s mandate, set out in the Excellent Care for All Act, 2010, includes the receipt, review, investigation, and resolution of patient complaints beyond the scope of an institution’s internal processes. The office does not have the power to award compensation, but it does have the power to investigate, to require institutional responses, and to make public reports.
The legislative framework: ECFAA, Regulation 965, and QCIPA
The Ontario hospital quality framework rests on three interlocking pieces of legislation.
The Excellent Care for All Act, 2010 (ECFAA) is the umbrella statute. It requires Ontario hospitals to establish a Quality Committee that reports to the hospital board, to develop annual Quality Improvement Plans, to implement patient and employee satisfaction surveys, to maintain a patient relations process, and to make declarations of values. ECFAA also established Patient Ombudsman.
Regulation 965 (Hospital Management) under the Public Hospitals Act addresses critical incidents. The regulation defines a “critical incident” as any unintended event that occurs when a patient receives treatment in the hospital that results in death or serious disability, injury, or harm to the patient, and that does not result primarily from the patient’s underlying medical condition or a known risk inherent in providing the treatment. Where a critical incident occurs, the regulation requires:
- Disclosure to the affected patient (or substitute decision-maker), the hospital’s Medical Advisory Committee, and the hospital administrator, as soon as is practicable after the incident
- A formal analysis of the incident, with development of a plan including systemic steps to avoid or reduce the risk of similar incidents
- Provision of aggregated critical incident data to the hospital’s Quality Committee at least twice per year
- Reporting of medication and intravenous fluid critical incidents through the National System of Incident Reporting within 30 days of disclosure
The first of these is the most directly relevant to patients: where a critical incident has occurred, you have a statutory right to be told. This includes both the fact of the incident and, in many cases, an account of its causes and the steps the hospital is taking to prevent recurrence.
The Quality of Care Information Protection Act, 2004 (QCIPA) is the third piece. QCIPA protects quality-of-care information shared within a hospital’s quality of care committee from disclosure in legal and regulatory proceedings. The protection is intended to allow clinical staff to discuss errors and near-misses candidly, in the interest of system improvement, without those discussions being used against them in court or college proceedings. The QCIPA protection does not extend to patient health records or to factual information about what happened; it covers only the quality-of-care committee deliberations themselves.
The practical effect of these three statutes operating together is that:
- The patient is entitled to be told the facts about what happened (a critical incident disclosure under Regulation 965)
- The patient is entitled to be told about the systemic steps the hospital is taking to prevent recurrence
- The patient is not entitled to access the deliberations of the quality-of-care committee that conducted the systemic review
- The patient’s medical records remain accessible (subject to the Personal Health Information Protection Act, 2004) and form the substantive evidentiary basis for any subsequent legal proceeding
Understanding what you can and cannot expect to learn from the disclosure process is important for managing expectations.
When to make a hospital complaint
The general advice is to raise concerns as soon as you reasonably can. Hospital memories are short, staff turnover is high, and the institutional capacity to respond meaningfully to a concern that is raised six months later is much lower than the capacity to respond to a concern raised within days or weeks.
There are two important caveats.
Coordinate with any potential legal claim. Where the incident is one in which there may be a viable medical malpractice claim, there are some considerations about what to disclose, when, and to whom that are worth thinking through with a lawyer before engaging deeply with the hospital’s complaint process. Anything you say to the hospital can be obtained in a subsequent legal proceeding; the hospital’s response can be useful to you, but it can also constrain your position. For more on the malpractice analysis generally, see Suing for Medical Malpractice in Ontario: What You Need to Know and Can I Sue for Medical Malpractice?
Watch the limitations clock. The limitations period for a medical malpractice claim is two years from when you knew or ought to have known the relevant facts. The complaint process can take months. Where there is a possibility of a malpractice claim, the complaint process should run alongside any legal investigation, not delay it. A common mistake is to spend a year on the complaint process and then discover that the limitations clock has been running the whole time.
How to make an effective hospital complaint
A few practical points improve the chances that a complaint produces a substantive response.
Be specific. A complaint that identifies dates, times, names of staff (where you have them), and specific events is more useful than a general statement of dissatisfaction.
Be focused. Address the specific events you want addressed. A complaint that lists fifteen grievances will get less attention to any one of them than a complaint that focuses on the two or three issues that most matter.
Get the records. Request your hospital records (or your loved one’s records, if you are the substitute decision-maker) early. The records are often the substantive basis for evaluating what happened. Patient relations responses are often more substantive when the patient has the records and can ask specific questions about them. For more on getting records, see How to Get Your Medical Records in Ontario.
Write it down. A written complaint is preferable to a verbal one. It is on the record, it is harder to misunderstand, and it forces the hospital to respond in a similarly considered way.
Identify what you want. A complaint is more likely to produce a useful response if it identifies what you are looking for. Sometimes that is an apology and an explanation; sometimes it is changes to a protocol; sometimes it is a referral to a critical incident review. Telling the hospital what you want allows them to respond directly to it.
Why this matters
For patients and families. The complaint process is not just an outlet for dissatisfaction. It triggers substantive institutional obligations under ECFAA and Regulation 965, including (where the events meet the threshold) formal disclosure and analysis of a critical incident. Patients who understand the framework and engage with it deliberately get more out of it than those who treat it as informal feedback.
For hospitals. The complaint process is part of the institutional quality system. Hospitals that take complaints seriously, respond to them substantively, and use them to drive system improvement reduce the risk of subsequent litigation and improve the experience of patients and families. Hospitals that treat complaints as a customer-service issue, separate from the quality system, miss the value of the framework.
For lawyers advising patients and families. The complaint process and the malpractice analysis run alongside each other. A patient who is contemplating both should think about the timing and the sequencing carefully: when to engage with the hospital, what to disclose, when to get the records, and how to manage the limitations period that runs in the background. A lawyer involved early can help ensure that the complaint process produces the most useful information and does not constrain the legal options.
For the broader landscape of complaints and reviews available to Ontario patients (including the regulatory colleges and the Office of the Chief Coroner), see A Patient’s Guide to Making Complaints About Health Care in Ontario. For an overview of how malpractice claims are evaluated, see Suing for Medical Malpractice in Ontario: What You Need to Know.
