Reference Framework for Exercising the Functions Assumed by Members of User s Committees and In-Patients Committees. June 2006

Transcription

1 Reference Framework for Exercising the Functions Assumed by Members of User s Committees and In-Patients Committees June 2006

2 Implementation of the Act to amend the Act respecting health services and social services and other legislative provisions (2005, c.32) (Bill 83) Reference Framework for Exercising the Functions Assumed by Members of User s Committees and In-Patients Committees June 2006

3 Produced by: Direction des communications, ministère de la Santé et des Services sociaux This document is only available in an electronic format. Documentation section, under Publications. Masculine pronouns are used generically in this document. Legal deposit Bibliothèque et Archives nationales du Québec, 2006 National Library of Canada, 2006 ISBN (version PDF) ISBN (version PDF) This document may be reproduced in whole or in part as long as the source is given. Gouvernement du Québec, 2006

4 Acknowledgments This reference framework draws on, among other things, documents from the Montérégie, Laval and Montréal health and social services agencies 1. We are grateful to the agencies for allowing us to use the original texts. The Direction de la qualité also wishes to thank everyone who contributed to the preparation of this reference framework for the users' committees and in-patients' committees of Québec's health and social services institutions. Writers : Susy Landreville, nurse, B.Sc., LL.M., health law attorney Réjean Tardif, Direction de la qualité, Ministère de la Santé et des Services sociaux Participants in the consultation : MSSS : Patricia Caris, Direction générale de la planification stratégique, de l évaluation et de la gestion de l information Patrick Huot, Direction générale de la planification stratégique, de l évaluation et de la gestion de l information Daniel Tremblay, Direction de la jeunesse et de la toxicomanie Dr. André Delorme, Direction de la santé mentale Users' committees : Mtre. Bianca Laliberté, Conseil pour la protection des malades Mtre. Martin Roy, Conseil pour la protection des malades André Poirier, Regroupement provincial des comités des usagers Claude Ménard, Regroupement provincial des comités des usagers Associations : Mtre. Sonia Amziane, Association québécoise d établissements de santé et de services sociaux Jacques Couillard, Association québécoise d établissements de santé et de services sociaux Luc Demers, Association des centres jeunesse du Québec Yves Neveu, Fédération québécoise des centres de réadaptation pour personnes alcooliques et autres toxicomanies Gilles Bourgeault, Association des établissements de réadaptation en déficience physique Public Curator : Jacques Maheu Lucie Plante 1. Laval regional health and social services board, working group presided by Rita Proulx, Des réponses à vos questions, 1995; Montérégie regional health and social services board, Stratèges Idées, La Trousse, March 1997; Montréal-Centre regional health and social services board, Guide sur la création et le fonctionnement d un comité des usagers dans un établissement de santé et de services sociaux, 2001.

5 Manon Anctil Francine Périard Claude Painchaud Health and social services agencies : Serge Beauchamp, Mauricie and Centre-du-Québec health and social services agency Louise-Anne Clément, Laurentides health and social services agency Nicole Demers, Côte-Nord health and social services agency René Dumont, Bas-Saint-Laurent health and social services agency Michel Lachapelle, Gaspésie Îles-de-la-Madeleine health and social services agency Lucie Lagacé, Saguenay Lac-Saint-Jean health and social services agency Odette Leduc, Montérégie health and social services agency Gilles Patry, Chaudière-Appalaches health and social services agency Julie Pelletier, James Bay regional health and social services centre Claude Piché, Lanaudière health and social services agency Suzanne Rompré, Capitale-Nationale health and social services agency Christiane Rouleau, Montréal health and social services agency Denise Stewart, Abitibi-Témiscamingue health and social services agency Martin St-Louis, Outaouais health and social services agency Yves St-Onge, Laval health and social services agency Johanne Turgeon, Estrie health and social services agency Translation : Les Publications du Québec, Service de traduction Layout : Sylvie Boutin, Direction de la qualité, Ministère de la Santé et des Services sociaux Marie-Christine Gilet, Direction des ententes de gestion, Ministère de la Santé et des Services sociaux

6 Contents Preamble...7 Introduction Reference framework Objectives Legal basis The Charter of human rights and freedoms and the Civil Code of Québec set forth the fundamental human rights : The Act respecting health services and social services Guiding principles Responsibilities of the various players Health and social services agencies Boards of directors Executive directors Local service quality and complaints commissioners Mandate of the users' committee and in-patients' committees Mandate Composition of the users' committee and in-patients' committees Composition of the users' committee Composition of in-patients' committees The legal functions of the committees The five functions of the users' committee The three functions of in-patients' committees The means available to the committees for carrying out their mandate A resource person : why not? Prerequisites for the proper operation of a committee First function : to inform Second function : to foster and assess To assess client satisfaction Third function : to defend rights Fourth function : to accompany and assist Fifth function : to ensure proper operation Other responsibilities Appointments to the board of directors Appointments to the institution's various committees Operating rules : s. 212, AHSSS Reporting by the committees The users' committee's activity report Budget management and financial report Eligible expenses Ineligible expenses Conclusion Bibliography... 39

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8 Preamble Users' committees have been in existence for a number of years, in such institutions as residential and long-term care centres, rehabilitation centres, youth centres and psychiatric hospital centres. The various reforms of the health and social services network vastly changed the mandate of users' committees. In 1991, the former beneficiaries' committees became users' committees with a role focused more on the defence of user rights and the promotion of better-quality services. Bill 83's recent amendments to the Act respecting health services and social services build on past gains and reflect the legislator's will to ensure that : Each institution sets up a users' committee representative of all users served by the institution, regardless of the institution's mission or the nature of the services required by the users, be they in-patients or not. A group of people concentrates specifically on user rights and the ongoing improvement of living conditions at each facility of an institution where there are inpatients, taking into account the realities specific to users who must be in-patients in order to receive the services required by their condition. These amendments apply to the institutions in the health and social services network and all their users. 2 Further to the passage of Bill 83 in November 2005 and the release of the document Un défi de solidarité, les services aux aînés en perte d autonomie, plan d action (a solidarity challenge, services for elderly persons losing their autonomy, action plan) 3, the Direction de la qualité of the Ministère de la Santé et des Services sociaux was entrusted with the mandate of drawing up a reference framework for exercising the functions conferred by law on users' committees and in-patients' committees. This reference framework is intended primarily for the men and women who sit on these committees. 2. Act to amend the Act respecting health services and social services and other legislative provisions, S.Q., 2005, c Ministère de la Santé et des Services sociaux, Direction des communications (Québec, 2005). 7

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10 Introduction 4 With the passage of Bill 25, Minister of Health and Social Services Philippe Couillard reorganized Québec's health system. Local networks were set up, along with 95 health and social services centres. Thus, a major step was taken, with a view to bringing services closer to the general public and making it easier for people to move through the health and social services network 5. Mr. Couillard made the following statement when Bill 83 was tabled before the National Assembly in the fall of 2005 : [TRANSLATION] The quality of health care and social services necessarily goes hand in hand with the enforcement of user rights. But, to that end, people must know their rights and have easy access to effective recourse 6. On that occasion, he announced the obligation for all health and social services institutions to set up a users' committee and, where applicable, in-patients' committees. In so doing, he confirmed the importance of the role played by the men and women on these committees with regard to the enforcement of user rights and the promotion of improved health services and social services. The 2004 report on quality living environments for people in residential and long-term care centres (CHSLDs) noted that, in most of these institutions, the users' committee had difficulty [TRANSLATION] " assuming its role, primarily because of a lack of comprehension of its mandate, a high turnover rate among members, and a lack of support and means 7 ". The report recommended that terms and conditions be established for the functioning of users' committees so that the committees [TRANSLATION] " represent users well and constitute a key interlocutor of general management and the board of directors ". Moreover, the working group that studied complaint examination mechanisms in June 2004 acknowledged that [TRANSLATION] " users' committees are essential mechanisms 4. Act respecting local health and social services network development agencies, R.S.Q., c. A Philippe Couillard, Mise à jour du cadre législatif en santé et services sociaux Des mesures pour mieux garantir la qualité des services, (Québec : Gouvernement du Québec, December 2004). 6. Ministère de la Santé et des Services sociaux, L'intégration des services de santé et des services sociaux, Le projet organisationnel et clinique et les balises associées à la mise en œuvre des réseaux locaux de services de santé et de services sociaux (Québec, February 2004), 26 p. 7. Ministère de la Santé et des Services sociaux, Direction des communications, Un milieu de vie de qualité pour les personnes hébergées en CHSLD, Visites d appréciation de la qualité des services (Québec, 2004), p

11 8 for enabling direct participation by users in the management of institutions ". The group was of the opinion [TRANSLATION] " that not only must such mechanisms be systematically introduced, but, in addition, their ability to influence the management of institutions must be ensured 9 ". This reference framework is for all people sitting on a users' committee or an in-patients' committee, and is intended as a tool to help them better understand their role and functions, as well as the scope of their actions in carrying out the mandate entrusted to them under the Act respecting health services and social services. It is also for the managers of health and social services institutions, who must form these committees and see that they function well. The first chapter of the document sets forth the objectives, legal basis and guiding principles underlying the action of the committees. The other chapters explain the committees' legal functions and responsibilities. Lastly, the document discusses the cooperative relationship that must be forged with the various departments within an institution and the other partners in the network, and concludes with reporting by means of activity reports and financial results. 8. Ministère de la Santé et des Services sociaux, Direction générale de la planification stratégique, de l évaluation et de la gestion de l information Rapport du groupe de travail sur les mécanismes d examen des plaintes (Québec, June 2004), p Ibid. 10

12 1 Reference framework 1.1 Objectives The objectives of this reference framework are to define the terms and conditions of application of the provisions of the Act respecting health services and social services 10 that govern the functions of users' committees and in-patients' committees, and to make the provisions more readily understandable. More specifically, the framework proposes to : 1. Help the women and men on users' committees and in-patients' committees better understand their mandate. 2. Establish the guiding principles of their actions. 3. Explain the AHSSS provisions governing their functions. 4. Delimit their scope of action so that they can fully play the role expected of them. 5. Clarify their responsibilities with regard to reporting (submission of activity reports and financial results). 1.2 Legal basis The legal basis of this reference framework is comprised primarily of the Charter of human rights and freedoms, the Civil Code of Québec and the Act respecting health services and social services. All of these laws contain provisions enshrining human rights, and in the case of the AHSSS, more specifically, user rights The Charter of human rights and freedoms and the Civil Code of Québec set forth the fundamental human rights : The right to life and personal inviolability (s. 1, Charter) (a. 3, C.C.Q.). The right to the safeguard of one's dignity (s. 4, Charter). The right to the respect of one's privacy (s. 5, Charter) (a. 3, C.C.Q.). The right to the respect of one's name and reputation (s. 4, Charter) (a. 3, C.C.Q.). The right to non-disclosure of confidential information (s. 9, Charter). The right to the inviolability and integrity of one's person (aa. 3 and 10, C.C.Q.). The right to autonomy and self-determination (a. 11, C.C.Q.). The right to equality (s. 10, Charter). The right to protection against exploitation (s. 48, Charter). The right to assistance when one's life is in peril (s. 2, Charter) (a. 13, C.C.Q). 10. For simplification purposes, the Act is referred to as the "AHSSS". 11. R.S.Q., c. C S.Q. 1991, c

13 1.2.2 The Act respecting health services and social services The AHSSS defines user rights at health institutions on the basis of these fundamental rights. Section 1 : Object of the Act " The health services and social services plan established by this Act aims to maintain and improve the physical, mental and social capacity of persons to act in their community and to carry out the roles they intend to assume in a manner which is acceptable to themselves and to the groups to which they belong ". Section 2 : Subparagraph 8 To foster effective and efficient provision of health services and social services and respect for the rights of the users of such services. Section 3 : Guidelines of the AHSSS 1. The person requiring services is the reason for the very existence of those services. 2. Respect for the user and recognition of the user's rights and freedoms must inspire every act performed in his or her regard. 3. The user must be treated, in every intervention, with courtesy, fairness and understanding, and with respect for his or her dignity, autonomy, needs and safety. 4. The user must, as far as possible, play an active role in the care and services which concern him or her. 5. The user must be encouraged, through the provision of adequate information, to use services in a judicious manner. Sections 4 to 28 and sections 34 et seq. concern the rights of users : The right to information (s. 4, AHSSS). The right to services (ss. 5, 13 and 100, AHSSS). The right to choose a professional and an institution (ss. 6 and 13, AHSSS). The right to receive the care required by one's condition (s. 7, AHSSS). The right to consent to or refuse care (s. 9, AHSSS). The right to participate in decisions (s. 10, AHSSS). The right to be accompanied, assisted and represented (ss. 11 and 12, AHSSS). The right to be lodged by an institution (s. 14, AHSSS). The right to receive services in English (s. 15, AHSSS). The right of access to one's user's record (ss. 17 to 28, AHSSS). The right to the confidentiality of one's user's record (s. 19, AHSSS). The right to file a complaint (ss. 34, 44, 53, 60 and 73, AHSSS). 1.3 Guiding principles An institution's users' committee and in-patients' committees must follow guiding principles in order to take quality, efficient action centred on users. 12

14 The interest of users must drive all decisions and actions of the users' committee and in-patients' committees. The representation of all of the institution's clienteles without discrimination based on race, colour, sex, age, religion, handicap or any other ground is fundamental to respecting the institution's users as a whole, be they in-patients or not. Respect and cooperation based on trust between the members of the users' committee, the members of the in-patients' committees, the institution's managers and all other people involved is essential to effective, concerted action on behalf of users. The autonomy of the users' committee and in-patients' committees is crucial in carrying out their mandate and functions. The committees determine their objectives and priorities for action. However, their autonomy is not absolute, as certain parameters must be taken into account. The committees are accountable for their actions to the users they represent, and, since they are committees of the institution, they also answer to the institution's board of directors. Partnership with the various departments within an institution must be fostered so as to develop a genuine synergy in enforcing user rights and improving the quality of services in the institution. Respect for confidentiality is imperative within the users' committee and inpatients' committees. Members must see it as a duty and take all steps necessary to ensure that the personal information to which they have access remains confidential. To that end, the members of the committees should take an oath of confidentiality. 1.4 Responsibilities of the various players Several players in the health and social services network in particular, health and social services agencies, and the board of directors, general management and service quality and complaints commissioners of the institutions are responsible for ensuring that the rights of users are enforced and quality services are provided Health and social services agencies Health and social services agencies have the following responsibilities : Ensure public participation in the management of the public network of health services and social services and ensure that users' rights are protected (s. 340, subpara. 1, AHSSS). Establish procedures and mechanisms to inform the general public and involve people in the organization of services, and to ascertain their level of satisfaction with the results obtained (s. 340, subpara. 7.7, AHSSS). Develop mechanisms for the protection of users and for user rights advocacy (s. 340, subpara. 7.8, AHSSS). See that mechanisms for public participation provided for in this Act, such as users' committees, are implemented (s. 343, AHSSS). 13

15 Inform the users in its territory of the health and social services available to them and of their rights, recourses and obligations in that respect (s. 344, AHSSS). Request a report of the users' committee's activities, as necessary (s. 212, second para., AHSSS). Ensure that the special budget for the users' committee is allocated by the institution and is in keeping with the budgetary rules in effect (ss. 350 and 351, AHSSS) Boards of directors An institution's board of directors manages the affairs of every institution under its administration, and establishes priorities and orientations for the institutions and sees to it that they are observed (ss. 170 and 171, AHSSS). Boards of directors have the following responsibilities : Ensure the pertinence, quality, safety and effectiveness of the services provided (s. 172, AHSSS). Ensure respect for users' rights and promptness in processing users' complaints (s. 172, AHSSS). Create a watchdog committee to ensure that the board of directors fulfils its service quality responsibilities effectively (ss to , AHSSS). Ensure that all necessary steps are taken to set up a committee for the users of an institution's services and an in-patients' committee in each facility where in-patient services are offered, according to transparent and democratic rules that encourage the participation of users or their representatives (s. 209, AHSSS). Determine the composition of the users' committee and the in-patients' committees (s. 209, AHSSS). Allocate to the institution's users committee the special budget provided for that purpose in the institution s operating budget (s. 209, AHSSS) Executive directors Under the AHSSS, an institution's executive director is responsible for ensuring the proper functioning of the users' committee and in-patients' committees. The executive director is the leader who must see that reasonable means are implemented to facilitate the work of these committees. Executive directors have the following responsibilities : Foster the proper functioning of the users committee and in-patients' committees. Make a room available for the committees activities. Make it possible for the committees' records to be kept confidential. Inform, in writing, every user of the existence of the users' committee and inpatients' committees. 14

16 To foster the proper functioning of the committees, an institution's executive director must encourage openness and transparency toward, and cooperation with, the committees. The executive director can meet this obligation by : promoting the existence of the users' committee and in-patients' committees among the institution's professionals; encouraging the members of the users' committee to undergo training so that they develop the skills required to fulfil their role; consulting the committees before adopting or revising documents concerning users and the enforcement of their rights and obligations (e.g. code of ethics, guide for welcoming users); soliciting the participation of the committees whenever user representation is relevant; taking into consideration recommendations made by the users' committee and inpatients' committees; providing the necessary material resources, such as a telephone line, a photocopier, the Internet, a courier service, a locked filing cabinet; helping resolve, as necessary, any conflicts that arise; designating a respondent, as necessary, to liaise with the committees and the institution. Making an adequate room available to the users' committee and in-patients' committees and making it possible for the committees' records to be kept confidential are concrete means advocated by the legislator for ensuring that the committees have the basic conditions needed to carry out their activities. The purpose of informing users in writing of the existence of the users' committee and inpatients' committees is to enable users to contact the committees and use their services as needed. An institution's executive director can meet this obligation by : including the committees' contact information in the guide for welcoming in-patients or in any other documentation given to users; posting the contact information for the users' committee and in-patients' committees at strategic locations in the institution; posting the information concerning the users' committee and in-patients' committees on the institution's Website Local service quality and complaints commissioners An institution's local service quality and complaints commissioner is a key person for seeing that user rights are enforced. The commissioner reports directly to the board of directors and carries out his or her functions on an exclusive basis. Local service quality and complaints commissioners assume the following functions : Answer to the board of directors for the enforcement of user rights and for the diligent handling of user complaints (s. 33, AHSSS). Apply the complaint examination procedure in keeping with the rights of users (s. 33, subpara. 1, AHSSS). 15

17 Promote the independent nature of their role (s. 33, subpara. 2, AHSSS). Distribute information to increase understanding of the rights and obligations of users and the code of ethics (s. 33, subpara. 2, AHSSS). Promote the complaint examination process and publish the procedure (s. 33, subpara. 2, AHSSS). Give assistance or see to it that assistance is given to users who require assistance for the formulation of a complaint or for any further step related to the complaint (s. 33, subpara. 3, AHSSS). Take action on his or her own initiative when apprised of the facts and when there are reasonable grounds to believe that the rights of a user or group of users are not being enforced (s. 33, subpara. 7, AHSSS). Give advice on any matter within their purview submitted by the board of directors or any other committee of the institution, including the users' committee (s. 33, subpara. 8, AHSSS). In some respects, certain functions of the local service quality and complaints commissioner are complementary to those of the committees, in particular the functions of informing users and of assisting and accompanying them. In these areas, consultation and collaboration are essential factors in optimizing the impact of the actions taken. However, because the local service quality and complaints commissioner's functions are exclusive, he or she cannot be in charge of users' committees or in-patients' committees. 16

18 2 Mandate of the users' committee and in-patients' committees Section 209, AHSSS states the following : " Each institution must set up a committee for the users of its services and, in the case of a public institution or of a private institution which is a party to an agreement under section 475, allocate to it the special budget provided for that purpose in its operating budget or, in the case of a private institution which is not a party to an agreement, the amount paid for that purpose by the Minister. If the institution operates a centre offering in-patient services, it must set up an inpatients' committee in each of the centre's facilities. " 2.1 Mandate The mandate of the users' committee and in-patients' committees is to safeguard the rights of users. The committees must see to it that the dignity of users is respected and that their rights and freedoms are recognized. The committees are one of the key spokespersons for users when dealing with an institution's authorities. Enforcement of user rights, service quality and client satisfaction are the cornerstones of the committees' actions. The committees must pay particular attention to the most vulnerable clienteles and work to promote improved living conditions for in-patients Composition of the users' committee and in-patients' committees The composition of an institution's users' committee and in-patients' committees is determined by the institution Composition of the users' committee " The users' committee is composed of at least five members elected by the users of the institution and of a representative designated by and from among the in-patients' committees set up under the second paragraph 13. " " The majority of the members must be users. However, if it is not possible to have a majority of users on the committee, the users may elect another person of their choice, provided that the person does not work for the institution or practise a profession in a centre operated by the institution 13. " 13. Section 209, subparagraph 1, AHSSS. 17

19 2.1.3 Composition of in-patients' committees " An in-patients' committee is composed of at least three members elected by the inpatients of the facility in conformity with the conditions set out in the fourth paragraphe 13. " 18

20 3 The legal functions of the committees Section 212 of the Act respecting health services and social services sets forth the functions of an institution's users' committee and in-patients' committees. The legislator introduced a single users' committee for all the users of an institution, in addition to an in-patients' committee in each facility where users reside. The users' committee is responsible for reporting to the board of directors on all its own activities and those of the in-patients' committees. The users' committee and in-patients' committees each have a very important role to play in the enforcement of rights and the promotion of service quality : Institution Users' committee Facility In-patients' committee The users' committee exercises the five functions specified in section 212, AHSSS, for the institution's users as a whole. The in-patients' committee exercises the first three functions listed in section 212 AHSSS, only for the in-patients of the facility in which the committee was created. 3.1 The five functions of the users' committee Under section 212, AHSSS, the functions of the users' committee are as follows : 1. To inform users of their rights and obligations. 2. To foster the improvement of the quality of the living conditions of users and assess the degree of satisfaction of users with regard to the services obtained from the institution. 3. To defend the common rights and interests of users or, at the request of a user, his or her rights and interests as a user before the institution or any competent authority. 4. To accompany and assist a user, on request, in any action he or she undertakes, including the filing of a complaint in accordance with Divisions I, II and III of Chapter III of Title II of this Act or the Act respecting the Health and Social Services Ombudsman (chapter P-31.1). 19

21 5. To ensure the proper operation of each of the in-patients' committees, if applicable, and see that they have the resources necessary to exercise their functions. 3.2 The three functions of in-patients' committees Under section 212, AHSSS, the functions of the in-patients' committees are as follows : 1. To inform users of their rights and obligations. 2. To foster the improvement of the quality of the living conditions of users and assess the degree of satisfaction of users with regard to the services obtained from the institution. 3. To defend the common rights and interests of users or, at the request of a user, his or her rights and interests as a user before the institution or any competent authority. 20

22 4 The means available to the committees for carrying out their mandate This reference framework presents various alternatives or suggestions for users' committees and in-patients' committees to help them carry out their mandate on a daily basis. 4.1 A resource person : why not? Hiring the services of a qualified person to coordinate the activities of the users' committee is an effective means for the committee to ensure efficient, coherent action on its part. In so doing, the users' committee ensures a resource person is available as necessary, thereby contributing to the proper operation of both the users' committee and the in-patients' committees. 4.2 Prerequisites for the proper operation of a committee To ensure that it operates properly, a committee must first : find out about the operation of the institution, and the institution's organization chart, organization plan and clinical plan; learn the characteristics of the people served by the institution; prepare a code of conduct to be used as a guide to intervention and interaction with the other partners in the institution; identify the resources in the sector and the community partners that work with users of the health and social services network; draft operating rules. The reference framework will now discuss in greater detail the various functions of users' committees and in-patients' committees. It specifies their respective respon-sebilities while circumscribing the scope of their actions. The following means are indicated for information purposes only, and do not constitute an exhaustive list of the activities that can be engaged in by the committees in assuming their functions. Other activities can be added or may better reflect the particular needs of users. These suggestions must be adapted to the specific reality of a users' committee or an inpatients' committee in a health and social services centre, a youth centre, a residential and long-term care centre or a hospital centre. 21

23 4.3 First function : to inform For the users' committee and in-patients' committees, this involves knowing and promoting the rights of users in the institution or its facilities. The No. 1 function of these committees is to see that users of health services are adequately informed of their rights and obligations. TO INFORM USERS OF THEIR RIGHTS AND OBLIGATIONS Responsibilities of the committees Know the rights and obligations of users. Read the various documents on the rights and obligations of users. Know the institution's complaints examination procedure. Know the role of the Public Protector. Inform users of the role and functions of the users' committee and in-patients' committees. Means proposed Organize training sessions for all members of the users' committee and in-patients' committees : invite specialists in the field (lawyers, community resources, rights advocacy groups, etc.). Obtain the following documents, in particular : the institution's code of ethics; excerpts from the AHSSS, the Charter of human rights and freedoms and the Civil Code of Québec; the text of the complaints examination procedure; the texts of the various departmental policies and directions, as needed. Invite the local service quality and complaints commissioner to explain the complaints examination procedure. Invite a Public Protector staff member or the institution's local service quality and complaints commissioner to explain his or her mandate and role. Prepare an explanatory leaflet on the role of the users' committee and in-patients' committees, to be given to users upon their admittance and displayed at strategic locations in the institution. Post the contact information for the users' committee and in-patients' committees at the entrance to the institution or its facilities. Visit users who are not mobile or contact them by telephone. Use promotional items : pens, bookmarks, logo, etc. 22

24 TO INFORM USERS OF THEIR RIGHTS AND OBLIGATIONS Responsibilities of the committees Ensure that written information on the users' committee and in-patients' committees is distributed to the users. Means proposed Ask the institution about the terms and conditions for disseminating information to users. Consult the documentation given to users by the institution. Plan information activities for users on their rights and obligations. Work with the local service quality and complaints commissioner to optimize the committee's interventions. Organize information sessions and invite a speaker. Write articles for the institution's information bulletin or for local newspapers. Disseminate information on the rights of users : for example, draw up a calendar, prepare a folder, etc. Set up discussion meetings with in-patients and their families. Organize theme weeks on such subjects as respect or quality. IMPORTANT Notify the institution in advance of the activities that the users' committee or in-patients' committees wish to organize, and obtain the necessary authorizations. The institution should keep the committees informed of the events it organizes that are likely to concern them. 23

25 4.4 Second function : to foster and assess For the users' committee and in-patients' committees, this involves observing and bringing to the institution's attention the situations or points to be corrected in order to improve the quality of the living conditions of users. TO FOSTER THE IMPROVEMENT OF THE QUALITY OF THE LIVING CONDITIONS OF USERS Responsibilities of the committees Communicate to the institution the observations of the members of the users' committee and in-patients' committees on the quality of services and the living conditions of users. Give the executive director or the local service quality and complaints commissioner opinions on situations requiring changes. Participate in the steps taken by the institution that may impact on improving the quality of services and the living conditions of users. Means proposed Observe : the physical environment : the cleanliness of the premises (rooms, washrooms, dining room, etc.), and security; the human environment : attitudes toward users, respect for confidentiality and privacy, etc.; schedules : meals, visits, wake-up times, bedtime, activities, personal care, treatments, etc.; food : quality, quantity, variety, temperature, etc.; complementary services : canteen, cafeteria, pastoral services, laundry, hairstyling, etc.; recreational and sports activities : type, frequency, place, equipment, etc. Submit proposed corrective measures in writing. Request a meeting with the department concerned. Designate representatives to sit on those committees where the participation of users is solicited and relevant. Be proactive and inform general manage-ment of the committee's interest in parti-cipating in the various steps taken, in order to represent the users' point of view. 24

26 TO FOSTER THE IMPROVEMENT OF THE QUALITY OF THE LIVING CONDITIONS OF USERS Responsibilities of the committees Bring the individual and group needs of users to the institution's attention. Means proposed Point out needs regarding the improvement of services. Point out needs regarding premises, materials, equipment, etc. Point out needs regarding activities. IMPORTANT It is not up to the committee itself to correct the problem situations noted. It must ensure that the institution or people in positions of authority take the remedial measures necessary. The committee may propose measures to improve the quality of living conditions, but at no time may it purchase equipment for users or fund recreational activities. Members of the users' committee and in-patients' committees must never take direct action in regard to employees. At no time may they take the place of the various departments of the institution. 25

27 4.5 To assess client satisfaction TO ASSESS THE DEGREE OF SATISFACTION OF USERS WITH REGARD TO THE SERVICES OBTAINED FROM THE INSTITUTION Responsibilities of the committees Find out how users and their families perceive the quality of the services received, and so inform the local service quality and complaints commissioner or general management. Become familiar with the institution's client satisfaction assessments. Means suggested Install suggestion boxes in strategic places at the institution or facility. Use questionnaires to conduct surveys on specific subjects determined by the users' committee or in-patients' committees. Set up meetings with users and their families. Receive users or their families individually at the committee's room in order to listen to their dissatisfactions and suggestions. Upon request, participate in assessments conducted by the institution. Ask for the results of the surveys conducted by the institution. IMPORTANT Assessing the degree of satisfaction of users with regard to the services obtained from the institution does not means that the users' committee and in-patients' committees are responsible for conducting client satisfaction surveys on behalf of the institution, or surveys provided for in certain certification procedures. 26

28 4.6 Third function : to defend rights For the users' committee and in-patients' committees, this involves defending the rights of users and making the necessary representations to the institution, the local service quality and complaints commissioner or any other authority. Defending the rights of users is a function for which committee members must develop skills. Rights are defended at the request of a user or a group of users of the institution, or at the request of the institution's users as a whole, or on the committee's initiative. TO DEFEND THE COMMON RIGHTS AND INTERESTS OF USERS OR, AT THE REQUEST OF A USER, HIS OR HER RIGHTS AND INTERESTS AS A USER BEFORE THE INSTITUTION OR ANY OTHER AUTHORITY Responsibilities of the committees Receive and assess requests submitted to the users' committee or in-patients' committees by users concerning the violation of their rights. Inform users of how to file a complaint or express dissatisfaction. Bring to the institution's attention situations that the committee finds unacceptable or contrary to the rights of users. Means proposed Draw up a schedule indicating when a resource person will be on duty in the room, and post it so that users and their families can meet with members of the committee if they wish. Meet with users or their families individually, or contact them by phone. Make various means of communication available to users : forms, a mailbox near the room, a telephone line with an answering machine, ing, etc. Ensure rapid follow-up of any requests and inform the user. Explain the complaints procedure to users and give them the procedure in writing. Refer users to the institution's local service quality and complaints commissioner, or to the complaint assistance and accompani-ment centre (CAAP). Direct the user to the public curator, where applicable. Inform the local service quality and complaints commissioner of any violation of user rights noted by the committee. Substantiate the committee's observations on the institution's code of ethics. 27

29 TO DEFEND THE COMMON RIGHTS AND INTERESTS OF USERS OR, AT THE REQUEST OF A USER, HIS OR HER RIGHTS AND INTERESTS AS A USER BEFORE THE INSTITUTION OR ANY OTHER AUTHORITY Responsibilities of the committees Means suggested Request the assistance of professionals in Consult specialists : ethicists, outside rights complex cases or cases raising ethical questions. advocacy groups, attorneys, etc. Analyse the complaints received to deter-mine whether the problem is individual in nature or affects a group of users. At a meeting of the committee, discuss the problem raised. Decide whether it is an individual or group problem, and which steps should be taken. IMPORTANT Bear in mind that it is users who file complaints, and that the committees cannot file a complaint on behalf of a user. Confidentiality must be respected at all times, even outside the institution and even after a person has left the committee. To defend the rights of users is to report a reality considered to be problematic, while cooperating with the institution in correcting the situation. Committee members must avoid putting themselves in a situation of conflict of interest. They must not use the committee for personal purposes. The reference framework will now discuss the two functions specific to an institution's users' committee. 4.7 Fourth function : to accompany and assist The users' committee shares the duty of accompanying and assisting users with the institution's local service quality and complaints commissioner, as well as with regional community organizations created under section 76.6, AHSSS and mandated to provide assistance and accompaniment during the complaints procedure (CAAPs). Thus, users have several players to choose from when they need help formulating a complaint or need to be accompanied throughout the procedure. 28

30 TO ACCOMPANY AND ASSIST A USER, ON REQUEST, IN ANY ACTION HE OR SHE UNDERTAKES Responsibilities of the committees Facilitate access to information on the rights and obligations of users, and inform them of recourse options. Help users formulate complaints verbally or in writing. Means proposed Give users contact information for the available resources in particular, the public curator, the complaint assistance and accompaniment centre (CAAP), community rights advocacy groups or documentation on these resources. Designate one or more committee members who have the skills required to formulate verbal or written complaints. Where applicable, entrust the task to the resource person employed by the committee. Refer users to the local service quality and complaints commissioner or to the regional complaint assistance and accompaniment centre. Refer to the public curator any users under the public curator's jurisdiction. Forge ties with the local service quality and complaints commissioner and the regional complaint assistance and accompaniment centre in order to coordinate the action of the various people involved. Accompany users, on request, in any step they take, including the filing of a complaint. Provide the relevant information to users who take steps. Refer users to the resources in the sector, as necessary. Accompany users when they meet with the institution's authorities. IMPORTANT A person who accompanies and assists a user must play a supporting role, not act in the user's stead. 29

31 4.8 Fifth function : to ensure proper operation Users' committees are responsible for one final function ensuring the proper operation of the in-patients' committees. TO ENSURE THE PROPER OPERATION OF EACH OF THE IN-PATIENTS' COMMITTEES, IF APPLICABLE, AND SEE THAT THEY HAVE THE RESOURCES NECESSARY TO EXERCISE THEIR FUNCTIONS Responsibilities of the committees Plan support for the in-patients' committees. See that they have the financial resources necessary for their operation. Work in close collaboration with the inpatients' committees so as to create a synergy to facilitate concerted, effective action. Incorporate the activity reports of the inpatients' committees into the users' committee's annual activity report. Means proposed Assist the in-patients' committees in drafting their operating rules. Ensure that the in-patients' committees have an adequate room and the equipment necessary to their operation. In collaboration with the in-patients' committees, the users' committee determines the amount of money to be allocated to them, taking into account the overall budget. In collaboration with the in-patients' committees, the users' committee determines how the allocation will be granted. Consult and inform the in-patients' committees about all matters relating to the rights of users. Set up occasional meetings with all members of the committees. Assist the in-patients' committees in drafting their activity reports, as necessary. IMPORTANT The users' committee and the in-patients' committees must work jointly in the interests of the users of the institution. 30

32 5 Other responsibilities The users' committee and in-patients' committees have responsibilities over and above their actual functions. This section presents the various additional duties. 5.1 Appointments to the board of directors The users' committee must, by resolution, appoint two people as administrators to the institution's board of directors. The committee must comply with the directives sent to it by the regional health and social services agency when the election to the board of directors is held. The appointees do not necessarily have to be members of the users' committee or of an in-patients' committee, but they do have to be of full age 14. In turn, the institution's board of directors will appoint one of these people to its watchdog committee. 5.2 Appointments to the institution's various committees The users' committee and in-patients' committees must sit on the working committees set up to improve the quality of the institution's services. It is important for them to take advantage of this opportunity afforded them by management to play their role as user representatives Operating rules : s. 212, AHSSS Once it has been created, a users' committee must immediately establish its operating rules, as well as those of the in-patients committees 16. It is an opportunity for the committee members to define rules in keeping with their reality. Apart from the composition of the committees 17 and the members' term of office 18, the users' committee has free reign in determining the rules that will govern it. The rules must contain elements that influence the operation of the committee. For example, they should define the role and functions of each of the members, structure meetings, facilitate decision-making, guide members through conflicts and so forth. They are not meant to make it difficult for people to do their work; rather, they are intended to guarantee the democratic operation of the committees and avoid arbitrariness. 14. Section 150, AHSSS. 15. Section , AHSSS. 16. Act to amend the Act respecting health services and social services and other legislative provisions, Le comité des usagers et les comités de résidents, Lignes directrices (Québec : Ministère de la Santé et des Services sociaux, Direction de la qualité, February 8, 2006), p Section 209, AHSSS. 18. Section 209.1, AHSSS. 31

33 POSSIBLE ELEMENTS Composition of the committee. Term of office. Functions and responsibilities of the users' committee and in-patients' committees. Resignation and destitution. Vacancies replacement procedure. Role of the resource person, if there is one. Meetings and how to run them, including quorum and voting. Election of officials. Powers and duties of administrators. General meetings, including quorum and voting. Minutes and the keeping of documents. Budget and reporting. Procedure for electing committee members. Oath of confidentiality. Conflict of interest. IMPORTANT The operating rules must be adopted by the users' committee and approved at the users' annual meeting. The operating rules need not be approved by the board of directors, but they may be tabled before the board for information purposes. 32

34 6 Reporting by the committees Each year, the users' committee must submit to the institution's board of directors an activity report that includes a financial report. On request, a copy of the activity report must be sent to the health and social services agency. 6.1 The users' committee's activity report The users' committee's activity report must present the specific activities carried out in relation to each of the committee's functions. The financial report must state the amounts invested to ensure the exercise of the functions. The reports of the in-patients' committees must be incorporated into the activity report. The users' committee or an in-patients' committee should take advantage of the annual general meeting to present its activity report and financial report in order to inform the attendees of the work accomplished further to its mandate. The institutions' fiscal year ends on March 31. It would be appropriate for the users' committee to adopt the same year end-date and submit its report to the board of directors no later than May 31. Here are a few suggestions for the information that could be included in the report. INFORMATION SUGGESTIONS Composition of the committee. Meetings held (number and date). The committee's action plan. A report on individual and group complaints. Activities carried out during the year. Activity reports of the in-patients' committees. Financial results and budget forecast. Objectives for the coming year. Recommendations. 33

35 6.2 Budget management and financial report The users' committees of public institutions and of private institutions under agreement receive from the institution's board of directors or its general management the special budget provided for that purpose in the institution's operating budget. The users' committee of self-financing private institutions receives the amount earmarked for that purpose by the Minister. The committees must follow certain principles when making decisions about the management of their budget. BUDGETARY PRINCIPLES The users' committee and in-patients' committees must not defray the cost of equipment or furniture for users in the institution's stead. Moreover, they are not to assume expenses for recreational activities that are the responsibility of the institution. Expenses are fixed on an annual basis and should not engage amounts provided for in the budget for the following year. The users' committee and in-patients' committees manage their budget autonomously and cannot be obliged to make a disbursement for an expense imposed by the institution. The users' committee and in-patients' committee should avoid recurring expenses or habits that would oblige them to invest amounts regularly in activities or purchases. The users' committee keeps any amounts not spent at the end of each fiscal year of the institution; however, it must not accumulate amounts unduly. IMPORTANT Each year, the committee must ensure that it receives the planned amount from the institution for its activities. The users' committee may address any question about obtaining a budget to the institution's general management or department of finance, or to the regional health and social services agency. The users' committee manages its budget autonomously. It decides on its own how the budget will be used and it is not required to obtain authorization from the institution. The committee is also free to decide whether it will opt for a separate bank account or use the institution's accounting services. Even though the users' committee retains its spending autonomy, it can nonetheless reach an agreement with the institution concerning the use of the administrative infrastructure in place, and thereby reduce the costs and accounting associated with such tasks. If the committee decides to manage its affairs separately, it must keep close track of all expenses incurred. It must introduce an accounting system that ensures good reporting. 34

36 All accounting documents needed to produce its annual financial report must be kept confidential in a safe place. The users' committee must adopt guidelines for properly using its budget. To ensure sound management, it must introduce rules for authorizing expenses. Under section 212, AHSSS, the users' committee must "ensure the proper operation of each of the in-patients' committees, if applicable, and see that they have the resources necessary to exercise their functions". The users' committee must therefore set aside amounts in its budget for the operation of the in-patients' committees. Accordingly, it must decide, in collaboration with the inpatients' committees, the operating terms and conditions it intends to adopt to give all inpatients' committees a measure of free reign at their respective facilities. However, the in-patients' committees must report on the expenses incurred and submit supporting documents to the users' committee. The budget is entrusted to the users' committee to support it in carrying out its five functions. It has an obligation to spend judiciously. This obligation of sound management applies also to the in-patients' committees. An institution's board of directors manages the affairs and exercises all the powers of the institution 19. This responsibility includes the affairs of the users' committee. The members of the board of directors may call into question the contents of the report. Thus, a users' committee that used amounts for purposes other than those under its mandate, or that allowed amounts to be so used, could be accountable to the board of directors. 6.3 Eligible expenses The committees must incur only expenses related to their functions. EXAMPLES OF ELIGIBLE EXPENSES Salaries or fees of the resource people hired by the users' committee. Travel expenses : meals, transportation and accommodation to attend committee meetings or participate in a convention, conference, training session, symposium or any other activity related to the committee's functions, etc. Costs to produce promotional material for the committee's activities : suggestion box, poster, leaflet, rights calendar, etc. Expenses incurred to draft and print the annual report. Materials needed to support the committee's work : photocopies, long-distance calls, photographs, stamps, pencils, paper, bulletin board, computer, furniture, etc. Expenses to organize activities related to the committee's functions : conferences, theme weeks, etc. 19. Section 170, AHSSS. 35

37 Costs to produce and disseminate a committee information bulletin. Expenses to design tools needed to carry out functions. Consultation fees, dues, magazine subscription fees. IMPORTANT The users' committee and in-patients' committees must follow the rules applicable in the health and social services network, in particular with regard to travel expenses. 6.4 Ineligible expenses The committees must not assume certain expenses that are the institution's responsibility. EXAMPLES OF INELIGIBLE EXPENSES User-related capital expenditures : swing, bus, television, micro-wave oven, water fountain, air conditioning, gifts, etc. Expenses related to the recreational activities or well-being of users : outings such as to a sugar shack, the hiring of a singer, holiday camps, massage therapy, music therapy, zoo therapy, etc. Costs incurred to provide user rights training to the institution's staff. Expenses incurred for the election of committee members : information and promotional documents, mailings, elected assembly, special user meetings, etc. Amounts related to the use of a room : rent, upkeep, electricity, telephone and painting. Costs related to keeping documents (e.g. a filing cabinet). Expenses incurred to publish and disseminate the code of ethics and the complaints examination procedure. INELIGIBLE EXPENSES Financial compensation paid to members for participating in committee meetings. 36

38 Conclusion The existence and vitality of users' committees and in-patients' committees can be somewhat problematic in that the men and women who sit on these committees do so on a volunteer basis. These people who give of their time and work hard on behalf of the enforcement of rights and the improvement of the quality of services need the assistance and support of the board of directors and the general management of the institutions. It is a prerequisite for the proper operation of the committees. Effort must also be put into helping committee members to clearly understand their role and functions, and to subsequently develop the skills required to take effective action. The committees must become major partners and play a role that is recognized within the institutions. This reference framework is intended as a tool for the men and women on these committees. It is a guide to which they can refer to organize their action and intervention on a daily basis. 37

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40 Bibliography Legislation Act respecting health services and social services, R.S.Q., c. S-4.2. Act respecting local health and social services network development agencies, R.S.Q., c. A-8.1. Act to amend the Act respecting health services and social services and other legislative provisions, S.Q., 2005, c. 32. Charter of human rights and freedoms, R.S.Q., c. C-12. Civil Code of Québec, S.Q., 1991, c. 64. Publications Couillard, Philippe, Mise à jour du cadre législatif en santé et services sociaux Des mesures pour mieux garantir la qualité des services (Québec : Gouvernement du Québec press release, December 2004). Laval regional health and social services board, working group presided by Rita Proulx, Des réponses à vos questions, Ministère de la Santé et des Services sociaux, L intégration des services de santé et des services sociaux, Le projet organisationnel et clinique et les balises associées à la mise en œuvre des réseaux locaux de services de santé et de services sociaux (Québec, February 2004). Ministère de la Santé et des Services sociaux, Direction de la qualité, Bill 83, Act to amend the Act respecting health services and social services and other legislative provisions, Users' Committee and In-Patients' Committees, Guidelines (Québec, February 8, 2006). Ministère de la Santé et des Services sociaux, Direction des communications, Un défi de solidarité, les aînés en perte d autonomie, plan d action (Québec, 2005). Ministère de la Santé et des Services sociaux, Direction des communications, Un milieu de vie de qualité pour les personnes hébergées en CHSLD, Visites d appréciation de qualité des services (Québec, 2004). Ministère de la Santé et des Services sociaux, Direction générale de la planification stratégique, de l évaluation et de la gestion de l information, Rapport du groupe de travail sur les mécanismes d examen des plaintes (Québec, June 2004). Montréal-Centre regional health and social services board, Guide sur la création et le fonctionnement d un comité des usagers dans un établissement de santé et de services sociaux, Montérégie regional health and social services board, Stratèges idées, La Trousse, March

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