Regulation on Complaints and Appeal

Considerations

• The NIAZ has the goal of contributing to the assurance and improvement of the quality of care in health care organisations.
• The NIAZ realises this by periodically investigating health care organisations, who have applied for this, via a fixed procedure on the basis of standards established in advance. Should the set requirements be met, the health care organisation in question will be granted an accreditation status.
• In this context, the NIAZ takes decisions which are important for health care organisations, possibly and to an increasing degree, for the business world too with, for example, care consumers, health care insurers, third-party insurers and Inspectorates.
• It is therefore important that a just and balanced regulation of disputes between the NIAZ and health care organisations should exist.
• A distinction is made between a complaint and an appeal.
• A complaint concerns dissatisfaction or expression of it in relation to, in principle, every aspect of how the NIAZ functions. The NIAZ regards a complaint primarily as an opportunity for improvement.
• An appeal concerns opposition to an official decision by the NIAZ in relation to the subjects which are stated in this regulation. In general, these are decisions which have legal consequences for the organisation.
• For an appeal, this regulation provides an official procedure, aimed at arriving at a binding judgement. Dealing with complaints is preferably carried out as unofficially and accommodatingly as possible, with the possibility of the dissatisfaction being resolved quickly. Dealing with a complaint is geared to maintaining relationships and quality improvement.
• If a complainant wishes to receive an official statement in relation to a complaint, the guiding principle is that this is dealt with by the Directorship in the case of complaints about the NIAZ and by the Board in the case of complaints about the Directorship or the Board.

Complaints

1. Complaints

1.1. A complaint is an expression of dissatisfaction in relation to, in principle, every aspect of how the NIAZ functions.

1.2. For submitting a complaint, the person who is authorized to do so is the legal representative of the care organisation or the person who has been authorized to do so, hereafter referred to as the ‘complainant’.

1.3. A complaint about the NIAZ should be submitted in writing, with the reasons for it, to the Directorship of the NIAZ. Should the complaint concern how the Directorship or the Board functions, than the complaint will also be submitted in the same way to the NIAZ Board

1.4. After the complaint has been received, the complainant will receive a receipt of submission by return post, in which it is stated when the complaint can be expected to be dealt with

1.5. Directly once the complaint has been received or as soon as possible thereafter, the body dealing with the complaint will take measures to resolve or limit the causes of the

Established by the NIAZ board dated 18 May 2006
complaint, or measures can be taken to completely or partially resolve any disadvantageous consequences.

1.6. The body dealing with the complaint, ensures that it is handled within a reasonable amount of time, in any case within three months after the complaint has been received.

1.7. Should it so be desired, the complainant will be given the opportunity to provide further information in writing about the complaint, and should it so be desired, be heard by the body which is handling the complaint.

1.8. The body at the NIAZ which the complaint concerns will be given the opportunity of putting forward a defence in writing.

1.9. The body dealing with the complaint ensures that there is a thorough investigation into the facts.

1.10. The complainant will receive a written conclusion from the body dealing with the complaint. In this it will be stated whether and the extent to which the complaint is considered to be justified. At the same time, in the case that the complaint is completely or partially declared justified, the NIAZ will state what it will undertake to prevent it happening again.

Appeal

2. Possibilities for appeal

2.1. An appeal can be lodged by the health care organisation, hereafter referred to as the ‘appellant’, whose interests have been directly affected, against

2.1.1. all the decisions of the NIAZ regarding the accreditation status of the health care organisation, including the conditions which they are subject to;
2.1.2. all the decisions which have been taken on the grounds of an accreditation agreement or Board decision.

2.2. Under a decision in the previous paragraph, it is also understood to be not taking a decision, not taking it on time or taking it incompletely on the grounds of a relevant provision.

2.3. Decisions subject to appeal are taken at the NIAZ by one of the bodies of the Foundation: the Board and Directorship. The body which decision is being challenged will be regarded as a party in the proceedings.

3. Committee of Appeal

3.1. The NIAZ Board proposes and appoints the members of the Committee of Appeal.

3.2. The members of the Committee of Appeal practise their tasks independently in relation to the Board and Directorship. The membership of the Committee of Appeal is incompatible with a person’s capacity as a member of the Board or the Directorship of the NIAZ.

3.3. The Committee of Appeal consists of at least three members and three substitute members. The chairperson, who preferably qualified as a Master in Law or has a comparable legal degree, is appointed as such by the Board.

3.4. The members and substitute members of the Committee of Appeal are appointed for a period of four years and may be reappointed immediately and repeatedly after the period of appointment has expired.

3.5. Before a member is appointed for the first time, the organisations which, pursuant to the NIAZ Charter, have the right to nominate members of the NIAZ Board, are given the opportunity of raising any possible objections to the candidature of a member in question.

3.6. The members or substitute members of the Committee of Appeal observe confidentiality about all they learn in performing their tasks regarding the health care organisation lodging the appeal and the NIAZ. This concerns all the information which is not legally accessible to the public and third parties. For this purpose they sign a declaration of confidentiality.

3.7. A position in the official secretariat of the Committee of Appeal is provided for by or on behalf of the Directorship of the NIAZ. The official in question is not part of the Committee of Appeal.

4. Lodging an appeal

4.1. Lodging an appeal can take place within thirty working days after the date that a decision has been made by the NIAZ. Saturdays, Sundays and generally recognised public holidays are not considered to be working days.

4.2. Lodging an appeal does not defer the operation of the NIAZ’s decision, unless it has been determined otherwise in the accreditation agreement or pursuant to a Board decision.

4.3. Lodging an appeal takes place by means of a substantiated appeal in writing, directed to the Committee of Appeal and sent by registered post.

4.4. After receiving the letter of appeal, the health care organisation as well as the body in question at the NIAZ will immediately be sent a letter of receipt from the official secretariat.

4.5. After receiving the letter of appeal, as quickly as possible in all reasonableness, the chairperson of the Committee of Appeal determines the place, date and time for the sitting for handling the appeal. As much as possible, this happens in consultation with the appellant and the NIAZ. The appellant and the body in question at the NIAZ will immediately be sent notification of this.

4.6. There are no costs for lodging an appeal for the appellant payable to the NIAZ. The appellant can be advised by a legal advisor. The costs for this are for the appellant’s account.

5. Handling the appeal

5.1. The Committee of Appeal handles the appeal within a reasonable period of time, in any case within three months after receiving the letter of appeal.

5.2. A court will handle the appeal, which consists of the chairperson and at least two members appointed by him/her. The court always consists of an uneven number of members, including the chairperson.

5.3. Should a mixture of interests be said to exist between any member of the Committee of Appeal with those of the appellant, before the procedure, this member will immediately withdraw in favour of another member. In view of this, both the appellant as well as the NIAZ can object to a member of the Committee of Appeal. The Committee of Appeal decides about the requested objection.

5.4. With regard to the appeal, as long as the Committee of Appeal has not reached a decision, at the substantiated request of the appellant and on the grounds that the implementation of the decision would cause disproportionate disadvantage in relation to interests served by the immediate implementation of that decision, for the purpose of the NIAZ providing a decision, the chairperson may completely or partially defer it or determine that a measure may be taken to prevent or limit such a disproportionate disadvantage.

5.5. In the case of paragraph 5.4 and after he/she has become acquainted with the arguments of both the appellant and the NIAZ, the chairperson of the Committee of Appeal will reach a substantiated decision as quickly as possible. If possible, the chairperson will consult with the court. The decision is binding for the appellant and the NIAZ. The decision will be confirmed in writing for the appellant and the NIAZ.

5.6. Both the appellant as well as the NIAZ have the right to inform the sitting of their arguments in writing in advance.

5.7. The appellant and the NIAZ are heard at the sitting of the Committee of Appeal. Each can be advised or represented by a legal advisor at the sitting. Each can also decide to reject the right to be heard.

5.8. All the members of staff at the NIAZ, including the auditors, as well as any possible external experts engaged for the accreditation process, are obliged to provide the Committee of Appeal with information if requested. For this purpose, the Committee of Appeal requests leave to inspect and receives copies of all, in all reasonableness, the relevant records in relation to the litigious decision.

5.9. The Committee of Appeal further has the authority to hear the witnesses, to consult experts and to take all other measures and make provisions, which includes holding a further sitting, if it in all reasonableness considers this to be necessary in the interests of reaching a good judgement.

5.10. The appellant and the NIAZ have the right to produce witnesses during the sitting, providing the names and addresses of the witnesses have been submitted in writing to the Committee of Appeal and the NIAZ or respectively the appellant least five working days before the sitting’s date.

6. Judgement

6.1. The Committee of Appeal ensures that its judgement is made known to the appellant and the NIAZ within a reasonable amount of time, at the most within two months from the completion of the sitting.

6.2. The judgement of the Committee of Appeal is binding for the NIAZ and the appellant.

6.3. The Committee of Appeal judges according to the principles of reasonableness and fairness. It should adhere to the relevant accreditation agreement for this and the regulations and rules established by the NIAZ for comparable organisations.

6.4. The Committee of Appeal decides through a majority of votes.

6.5. In declaring the appeal of the appellant justified, at the claim of the appellant the Committee of Appeal can

6.5.1. completely or partially withdraw or change the challenged decision by the NIAZ;
6.5.2. order the NIAZ to completely or partially withdraw or change the challenged decision;
6.5.3. order the NIAZ to not implement the challenged decision, or to discontinue its implementation;
6.5.4. order the NIAZ to carry out specific action.

6.6. The Committee of Appeal can determine that the decision it is authorized to make on the grounds of the previous paragraph is conveyed to the NIAZ as a recommendation.

6.7. The judgement of the Committee of Appeal is put into writing and signed by the chairperson and the other members. A copy of this is then sent to the appellant and the NIAZ.

6.8. The original version of the judgement is filed in the archives of the Committee of Appeal. Inspection by third parties will only be granted if permission is given in advance by the appellant as well as the NIAZ.

Other provisions

7. Unforeseen cases

7.1. In cases which are not provided for in this regulation regarding the handling of complaints then the NIAZ Board will reach a decision, heard by the Directorship.

7.2. In cases which are not provided for in this regulation regarding the handling of appeals then the Committee of Appeal will reach a decision, heard by the NIAZ Board.

8. Publicity

8.1. The NIAZ Board establishes, amongst other things in view of the annual report, the publication policy concerning the handling of appeals and complaints, taking into consideration the provisions in this regulation.