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Whether you own a business, work as an employee, or are a student, there may be risk in the actions you take. These risk articles are designed to help you and your business mitigate some of the risks associated with your industry.
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We know, insurance can be tricky to understand. Unfortunately, it's not as clear as 1s and 0s when working out what cover you need to ensure you're meeting your professional and contractual requirements. That's why our partner Guild Insurance has provided some insight into the importance of having the right insurance policy by developing common scenarios based on claims trends for the IT consultant profession below:
Scenario one – Expectations can be hard to meet
Despite best efforts, sometimes things don't end the way intended. Whether that's due to expectation management, perceived skill or capability, or it's just a bad day, there's a range of reasons that an employer can feel they've been left exposed, feeling vulnerable or worse, have experienced a financial loss. In this case, they may seek retribution by way of seeking compensatory damages.
Scenario two – Differences in scope of work after commencement of contract
It is not uncommon for claims to arise due to cost variation involving a contract. The variation could occur for a range of reasons, including but not limited to the contract taking longer than initially planned, or the discovery that the project is far larger and more complicated than first anticipated. If this results in a dispute of work/cost, things can and often do get messy if not communicated well.
Scenario three – Mistakes in high risk industries
Developing software for aerospace applications can come with challenges. Even the smallest mistake in this sector could have enormous consequences. Like the aerospace industry, segments such as health, utilities, medical or defence, among others, can come with significant risk if an accident occurs, and can result in major claims.
Scenario four – Proof of insurance and maintaining cover
Employers may ask for evidence of professional indemnity and public liability insurance as a condition for working for them. However, it is imperative to maintain your professional indemnity insurance policy after the contract ends, as claims may arise days, weeks, months even years after the services were performed. If you don't have a current policy, then you may be left exposed for claims or allegations made against you.
The ITPA partners with Guild Insurance to ensure the unique needs of your profession are covered. And they do this by providing a policy that bundles professional indemnity, products and public liability all in one.
To learn more about the features and benefits of Guild Insurance's IT consultant policy, visit guildinsurance.com.au or call 1800 810 213.
Implants: a step in the tooth life cycle, not the end.
Media and consumer interest have heightened demand and expectations for implants as a solution to tooth loss. As a result there are an increasing number of implants being placed but, with less than satisfactory treatment planning and case assessment there are also increasing complaints about failures. When an implant fails it usually means that the super structure also fails, making any substantiated claims costly to the PI insurer and therefore to everyone via increased premiums. By not adequately assessing and planning cases dentists are not acting to protect their own interests or those of the profession.
Emerging issues in implant complaints:
There are two emerging issues (leaving aside the issue of implants placed overseas for another article): firstly, patient driven treatment, where the patient refuses a removable option yet is biologically unsuitable for fixtures, can lead to placement of implants without adequate risk analysis and therefore a higher risk of failure. Secondly, a number of practitioners and most patients believe the treatment to be permanent and at low risk of failure. This is not the case according to dental literature.
Failure risks can be considered as restorative and surgical/periodontal. The prosthetic part of the treatment must be governed by first principles of occlusion and load, and because of the ease of machined components it is more predictable and if the occlusion is right, there is less risk of mechanical failure that conventional crowns and bridges. When implants fail, they are less amenable to treatment than natural teeth. There is reference in the literature to "failing" and "ailing" implants and it is recognised that there will always be implants which fail in the short term, but with time it is expected [and demonstrated in the literature] there will be more biological and technical issues resulting in increasing loss of implants.
Risk of failure
It appears that an increasing number of implants are being placed with no heed to the biological risks of failure. There is already (as well as emerging) published literature on this point but many dentists continue to place implants in cases which, given evidence based research, are at high risk of failure. As dentists we are used considering a risk hierarchy of factors for periodontal disease and caries. There are also risk factors to be considered when planning implants. There is well regarded literature which shows increasing loss or failure over time, and some cases of "spontaneous" failure with no known risk factors.
Emphasis in many planning cases is on the type of fixture and restoration and not on basic triage of suitability. In overlooking this foundation of treatment planning the result is increasing failures, complaints and therefore costs to the profession and the insurer.
In summary
Every dentist should know the limitations and complications which arise from implant placement and advise the patients of these. The dentist should conduct a risk assessment on the likelihood of failure and add this to the general discussion of implant treatment. Expectations of patients should be aligned with this risk profile prior to embarking on treatment.
Although this is a now ageing article, I recommend the excellent review article by Drs Gary Greenstein and John Cavallaro: JADA 145(8) August 2014. In this article they cite the following recommendations to help reduce failures.
Performing and recording a risk analysis and then informing patients of any heightened risk of failure is good risk management for you, not to do so is potentially negligent and can give rise to a basis for an expensive claim, usually involving a costly remedial treatment plan. Disregard for considering evidence based research would also result in a potential unprofessional conduct finding if the matter was taken to AHPRA, as would practicing beyond the scope of an individual's formal training.
Dr Eryn Agnew
Community Relations Manager/ Professional Consultant
Dental Implants - Success or Failure pdf
Chiropractors regularly deal with challenging situations and are continually required to make difficult decisions. However, these decisions don't always relate solely to the clinical care they're providing their patients. Unfortunately, sometimes chiropractors will face other difficult situations with their patients and knowing how to manage these isn't always easy or obvious.
The information below highlights three challenging scenarios, which are not uncommon in chiropractic, with tips on how they could be managed.
Patient requesting specific treatment
Some patients will attend their chiropractic appointment with what they believe is an understanding of their condition and how they should be treated. These patients will often request, maybe even demand, a particular type of treatment. This information may be based on how they've been treated by a chiropractor in the past. Sometimes it will be based on information non-clinically trained people, such as friends, have shared with them or even information they've read online.
Chiropractors must be sure all patients are assessed thoroughly regardless of what the patient tells them about their condition; the chiropractor as the health professional needs to be sure. Following the assessment, the chiropractor may determine that the treatment being requested isn't appropriate for that patient based on their current clinical situation.
When the treatment the patient has requested isn't ideal for them, they may not be happy with the decision to not provide this. This requires the chiropractor to explain to the patient what treatment is recommended and why. Chiropractors must be sure they don't allow themselves to be coerced into providing treatment against their better judgement and they need to be sure all treatment they provide is clinically justified. If there is a poor outcome following treatment and the choice of treatment is questioned, stating that the patient demanded that treatment isn't a justification for it being provided.
In many cases, the patient will accept the chiropractor's treatment recommendation. However, chiropractors need to be prepared for the possibility that some patients won't agree with this recommendation and may leave the appointment disappointed. Unfortunately, it's not possible to please all patients.
If the situation above occurs, it's vital that the patient's request is noted in the clinical record so there is a full history not just of what treatment was provided but of all conversations regarding the treatment.
Patients seeing multiple practitioners
Some patients will choose to visit multiple practitioners for the one condition. A common reason for this that they aren't satisfied with the treatment outcome from one practitioner, so they try others hoping for a different result. They may choose to see different chiropractors, or they might see different types of practitioners such as osteopaths and physiotherapists as well as a chiropractor.
In most cases, a patient seeking a different opinion shouldn't be cause for concern. However sometimes a patient who has seen numerous practitioners and has been unhappy with them all may be a patient who's difficult to please and chiropractors should be mindful of how they manage this situation.
In cases where a patient presents criticising the treatment provided by another practitioner, it's important that chiropractor doesn't also criticise this treatment. The chiropractor doesn't have the full story of how the patient presented to the other practitioners, what treatment was provided and why. Criticising the work of other practitioners is not only unprofessional, it can also encourage, even if unintended, the patient to make a formal complaint about that practitioner.
Quite often patients are unhappy with their treatment outcome due to them having unrealistic expectations. Assisting a patient to form realistic expectations about treatment requires effective communication before treatment starts. Therefore, be sure that with all patients the likely and realistic treatment outcomes are discussed with them prior to any treatment being performed. And this conversation needs to be had using language they'll understand so avoid clinical jargon.
If a chiropractor has a very uneasy feeling about a patient due to it appearing difficult to meet their needs, the chiropractor can decline to provide treatment. However, the chiropractor needs to acknowledge that not providing treatment could upset the patient. Therefore, this discussion needs to be planned and worded in a way unlikely to cause offence. Exactly what is said will vary depending on the situation, however it would be reasonable to let the patient know that due to the patient not getting benefit from previous treatment similar to what would be provided, the chiropractor may not be the most appropriate person to provide further treatment. The patient could be advised to see another health professional such as a medical practitioner.
Blurred boundaries
The relationship between a patient and chiropractor is a professional relationship. However, at times the behaviour of patients and chiropractors can blur the boundaries of this relationship and it can start to seem more of a personal relationship which isn't appropriate.
Chiropractors need to remember that their patients are just that, patients. They aren't friends and shouldn't become friends. There are a couple of simple rules to follow to avoid this change of relationship.
Chiropractors should avoid socialising with patients. Sometimes a chiropractor will treat a patient and their family for many years which leads to them getting to know each other quite well. This can lead to chiropractors being invited to family birthdays and other events. While it may seem impolite to decline these invitations, accepting them can complicate the professional relationship.
With the continually increasing use of social media, there can be a temptation to connect on social media with a large number of people. If a chiropractor has a professional social media account, only used for professional communications, it's okay to connect with patients through this account. However, chiropractors shouldn't connect with patients on a personal social media account.
Chatting to patients during consultations is a great way to seem more personable and make patients feel relaxed. However, if there is too much personal chatting the chiropractor is possibly not spending enough time discussing the treatment being provided. Also, there have been occasions when personal conversations have been misinterpreted by the patient and they've felt uncomfortable with the chiropractor discussing information not related to treatment.
Unfortunately, keeping clear boundaries can be a little challenging for those chiropractors practicing and living in small towns or communities where many people know each other. In these situations, the chiropractor needs to ensure that if they are treating someone they know, they maintain their professional standards during consultations and not treat these patients differently to others.
Managing difficult chiropractic situations
Receiving a complaint is often an unexpected part of running any business, including a dental practice. No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are. There can be a tendency to see a complaint as a personal criticism rather than constructive feedback. However there can be positive outcomes when the situation is managed appropriately.
Why do people complain?
There are many reasons why patients might complain about your practice and the treatment and service they've received. Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise. Having an understanding of why people may complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints. The following are some of the reasons why people may feel the need to complain.
High expectations – consumer expectations are increasingly high when engaging professional services. Patients pay what some may see as a lot of money for your service and will most likely see you as a highly trained and qualified professional. This view can influence their expectations about the service and outcomes they anticipate.
Unrealistic expectations – it's possible that patients may have unrealistic expectations about what they can reasonably expect from dental treatment. It's important to remember that most patients will not have the clinical knowledge you do and what's obvious or common sense to you may not be to them. A dentist and their staff must assist patients to be clear and fully informed about the treatment being provided and the outcomes they can realistically expect. This requires ongoing discussions with patients and, where possible, written information to assist their understanding.
To inform and be heard – patients may wish to make a complaint about an incident or poor outcome simply so they are sure you and your staff are aware of what has occurred and how they feel. They may wish to complain simply to be listened to and acknowledged, especially if they have been adversely impacted. Not all complaints will lead to a formal demand for compensation.
Belief that someone is responsible – when something goes wrong we often try to determine who's responsible. Sometimes someone is obviously responsible, sometimes it's hard to determine who's responsible and other times there is no one person responsible but it's just an unfortunate set of circumstances. However if a patient thought something had gone wrong and this led to them being harmed, it's quite possible they may complain with the intention of holding someone responsible and possibly liable.
Aesthetic factor – dental treatment provides many clinical benefits for patients as well as aesthetic benefits. These aesthetic benefits may at times add an extra level of expectation for some patients; they may not just want their teeth to be healthy, but want them to look good too. If a patient's teeth don't have the aesthetic look they expected or hoped for, they may consider complaining.
Perceived discretionary spend – unfortunately some patients may view dental treatment as optional or an expensive discretionary spend. This is possibly because they don't understand the importance of good oral health. Therefore if a patient has spent money on something they don't see as a necessity or that they could have done without, they may be particularly disappointed if the treatment didn't go according to plan.
The importance of managing complaints
There may sometimes be a temptation to ignore a complaint and hope it'll just go away. Maybe the patient won't follow up. Maybe the incident won't occur again. This is a very short-sighted way to run any business as there are clear benefits to appropriately managing complaints.
Patients will generally expect to see their complaint dealt with quickly and fairly. When this doesn't happen it's possible that further complaints will follow and the issue or concern could become a much greater one. Complaints may also escalate to AHPRA or another regulatory body.
Managing complaints should be seen as good 'customer service'. You rely on patients to keep your business afloat. When patients are unhappy with a service they've received, they can talk with their feet by not returning to the practice. Keeping patients happy and satisfied is more likely to see them continue to use your service and recommend your practice to others.
Complaints can provide a practice with an opportunity to review and improve their service. Receiving a complaint may highlight an issue which the practice had not been aware of. When investigating and dealing with the complaint, the practice may wish to consider a change in a procedure to avoid that issue arising again in the future.
How to manage complaints
It's advisable that every dental practice has a complaints policy. This means that the practice will have an agreed-to process which allows for all complaints to be dealt with in a fair and consistent manner. It also means staff know what to do which is important as managing complaints can be challenging.
A key aspect in dealing with any complaint is listening to the person. Where possible, make time to sit down in a quiet space and give them time to express their concerns. Make the effort to hear what they have to say and take on board what they've told you. You may not agree with all they're saying, however it helps if you can try to understand the situation from their perspective. You may wish to ask them to document their concerns so you both have an accurate record of the matter. Avoid being defensive or taking the complaint personally as this may inflame the situation.
With low level complaints you may be able to offer a solution there and then. However this won't always be the case. With more serious complaints you should provide the person with an assurance that you'll investigate the matter and get back to them with a response at a later date.
Guild Insurance and the Australian Dental Association (ADA) expects those insured with us not to admit liability (or name someone else as being at fault), or to offer any compensation without phoning the ADA first. However this doesn't prevent you from apologising or showing sympathy for any pain or inconvenience the person may be experiencing. Contact your local ADA branch as soon as you've received a complaint; don't wait till it escalates to a claim for compensation. We will provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation. This support can be the difference between sorting a problem quickly and it escalating to a serious claim.
Managing complaints in dentistry
There has been a steady increase in errors reported to Guild Insurance involving the wrong route of administration. These errors occur when a pharmacist dispenses a medication that has been manufactured for administration via a different route. For example, the pharmacist dispensed ear drops instead of eye drops, or the patient was prescribed injections, but was given tablets. Errors also include pharmacists directing customers to take the correct medication, but via the wrong route. For example, a customer was prescribed oral capsules, but the pharmacist labelled the medication to be used as a suppository.
These errors can and do happen, even to experienced pharmacists who've never made a mistake before. They can happen to you and they can have serious consequences for you and your customers.
An infant was prescribed Egozite scalp lotion to treat a skin condition. On the same script, it was recommended her parents also obtain Infacol drops to help treat infant colic. However, during the dispensing process, the labels were transposed and as a result, the Egozite lotion was given orally and the Infacol drops used topically.
A pharmacist inadvertently dispensed Ciloxan ear drops instead of Ciloxan eye drops. While the customer didn't suffer harm, the same error with a different medication may have resulted in serious consequences.
Reduce the risk of dispensing errors
Dispensing errors – wrong route of administration
There are an increasing number of dental services available which are direct to the consumer, meaning the consumer hasn't consulted directly with a registered dental practitioner. While the convenience of these services is obvious, they aren't without risk for both the consumer and any registered dental practitioner involved.
These direct services are available for several dental treatment areas such as orthodontic aligners, splints and sleep appliances. These services can be initiated by the consumer creating their own impression using materials and information provided to them. In other cases, the patient may have a digital scan carried out by the service provider at a designated location (shopfront or pharmacy), often by someone who is not a registered dental practitioner. Following this, a treatment plan is developed and the device(s) required will then be provided to the patient for use. Some of these services also offer mechanisms for remote supervision of treatment progress by a dental professional.
One of the concerns with this type of treatment model is that other dental issues, not directly related to the appliance, may not be detected due to the patient not being regularly assessed and treated in-person by an appropriately registered dental practitioner. There are also concerns about how patient suitability (or standard of care case selection) is determined. While some companies providing these services do have a process of assessing the suitability of the appliance for each patient, this is often done by the patient completing an online assessment form themselves; therefore, there is no assessment for suitability by a registered dental practitioner.
There may be occasions where a dentist, who isn't involved in this treatment model, has a patient ask them about their views on it or asks them for support in completing forms required to purchase one of these devices. Dentists should be aware that if they provide clinical advice, they are involved in the treatment. It's therefore recommended that dentists contact their ADA Peer Advisor (NSW/ACT) or Community Relations Officer (Victoria, South Australia and Tasmania) if they find themselves in this situation so they can obtain advice on how to best manage this situation.
Dentists who choose to participate in these treatment models need to understand and appreciate their level of responsibility and possible liability. Regardless of whether or not a dentist has seen or consulted with the patient themselves directly, involvement in design of such appliances or other aspects of their provision and use may be deemed by regulatory bodies to be provision of a dental service. Registered practitioners, when providing a dental service, must ensure their professional obligations are always being met.
If a consumer is dissatisfied with the outcomes of their treatment and they're aware of a registered dental practitioner who was involved in their treatment in some capacity, they have the same rights as other patients to formally complain to regulatory authorities or make civil claims about the treatment provided by this practitioner. To defend against allegations of wrong-doing, this practitioner would need to show that:
Most of us spend a considerable amount of our waking hours at work. We may spend more time with our work colleagues and customers than with our own families and loved ones. Therefore, our workplace relationships are a significant part of our lives.
Building healthy and effective relationships at work is not about making best friends. We can work well with people we aren't friends with. However, just like our personal relationships, building and maintaining work relationships is not easy. Yet when we manage to do so, there are many benefits.
Important relationships in early learning
For an educator within an early learning service, there are three important relationships they need to build and nurture.
1. Colleagues
Working in an early learning service can be quite a demanding and busy job. For the service to function effectively it's necessary that all staff, not just the educators, work well together.
2. Parents and other family members
The parents of children are a very important element of an early learning service. They decide which service they will have their child attend and how often. A positive relationship with parents may make them more comfortable with leaving their children with the service.
3. Children
Obviously children are a key relationship for any early learning staff member. Whilst the children may not make the decision to attend the service, their happiness and contentment when at the service will be very important to their parents.
Why building relationships can be difficult
A relationship is defined as a connection between two or more people. However sometimes the connection isn't by choice. For those of us who are not responsible for staff recruitment, we're expected to work with, and therefore spend a great deal of time with, people we have not chosen to have a connection with. Our work connections are forced connections and sometimes there is little more than work in common.
Some of these relationships can easily turn into meaningful and enjoyable relationships when we find ourselves getting along well with someone in the workplace. However this isn't always the case. Unfortunately, sometimes we just don't 'click' with the people we interact with at work.
Relationships in the workplace can also be challenging as we are often so busy when at work. We aren't there to primarily work on a relationship; we're there to do our jobs. And sometimes the pressures and demands of a busy job can add a strain to these relationships. We're also rarely taught how to build a relationship. While it is something we can learn informally through life experiences, we usually only receive little, if any, formal training about the importance of relationships and how to develop them.
Why effective workplace relationships are important
Effective workplace relationships serve a number of purposes. The more we get along with someone, the more we're likely to work well with them. Our teamwork and support for each other will improve and this can lead to our work being more productive and successful. Working well with someone is also likely to lead to us enjoying our work more. And when we're enjoying being at work, our performance and productivity can improve.
From a work health and safety perspective, respectful relationships in the workplace are related to greater job satisfaction, effective teamwork as well as reduced sick leave and staff turnover. Respectful relationships help prevent bullying and other negative behaviours in the workplace. An early learning service that is characterised as respectful creates a positive atmosphere for workers, parents and children.
Even when there is a great working relationship with colleagues, we can still encounter problems or conflicts in the workplace. This is a normal part of any workplace; we can't expect to always agree and get along. However, having a sound relationship where staff feel they can be open and honest with each other will assist when trying to deal with issues. Guild Insurance sees many claims every year that relate to workplace issues. In some of these cases it appears that the staff members involved have not been able to, or tried to, sit down together to discuss the matter, understand the different perspectives and come to an agreement before taking it further.
Relationships with children who attend your service and their parents are vital to the success of your business as they're your customers; without them you don't have a business. Developing a relationship with both children and parents assists to develop their trust in and respect for you, something needed when leaving a child in the care of another person. It's also possible that good relationships between parents and staff may assist when there is an issue or problem at the service, such as a child injuring them self. The better the relationship, the more likely parents may be understanding if there was an incident involving their child.
How to build effective relationships
There are many things which can contribute to building an effective relationship in the workplace. Most of us will agree that any relationship requires trust, honesty, open communication and support. Additionally, constructive feedback, positive role models, reliability, the promotion of diversity and equality, recognition of contributions, an agreement of shared goals and collaboration all contribute to positive working relationships.
However, these things don't just happen. People need to be committed to making time to develop and nurture their workplace relationships. This can be done in formal ways such as team meetings or staff development programs on topics such as teamwork or communication. It can also be done informally, such as by taking the time to chat to colleagues about non-work matters and getting to know each other better.
To build an effective relationship it's important to understand and appreciate each person for who they are. We know we're all different in so many ways, yet sometimes in our busy lives this can be forgotten. We can become frustrated when people don't see things the way we do. However, if we use these differences as a positive by recognising and utilising our different strengths and ideas, we can become much more productive when working together. Differing opinions or disagreements within a working relationship doesn't have to be a bad thing. If used well it can become a positive for the relationship and the workplace.
Active listening is vital in your relationships with colleagues, families and children. Active listening is about not just hearing what the other person is saying but really understanding everything they're saying. You need to show the person that you're hearing them (use eye contact whilst they're talking, don't look away) and respond to them in ways that show you've heard them. You don't have to say you agree with them however by repeating what you've heard shows the person that you've understood them. This is particularly beneficial in situations where there is conflict or other type of challenging conversation.
And finally, don't take your workplace relationships for granted. Like any relationship, they need to be valued, nurtured and repaired if there are problems. Remember that when all is going well in the relationship, there can be significant benefits for you and your workplace.
Building workplace relationships in early learning
Bullying in the workplace is a serious work health and safety issue which affects all workplaces, including early learning centres. Guild Insurance regularly manages workers compensation claims where there are allegations of staff members being bullied. Bullying negatively impacts both employees as well as the business they work for; therefore, it's something all businesses should be aware of and be consciously working towards eradicating
What is and isn't bullying?
Bullying is repeated unreasonable behaviour directed towards workers. Bullying can occur in many forms; it may be physical or psychological, it can be direct and obvious or indirect and subtle. Examples of bullying are:
Sometimes workers believe any behaviour or action in the workplace which makes them feel uncomfortable is bullying. However, this isn't the case. Actions carried out by management, such as disciplinary action or feedback about poor performance, isn't bullying when done reasonably. Disagreements are also generally not bullying when they're handled reasonably. There are other workplace behaviours, such as discrimination and sexual harassment, which while completely unacceptable, won't necessarily be considered bullying depending on the circumstances.
Bullying doesn't just occur in a face to face physical setting. More and more cases are being reported of bullying occurring online using social media. This online behaviour can be easier to hide and often won't occur during work hours, yet the consequences for employees and employers are just as severe.
Consequences of workplace bullying
There can be many consequences, both for individuals and the workplace, when bullying is taking place.
Firstly, it is the responsibility of all employees to create and maintain a safe work environment. If a workplace isn't taking reasonable steps to prevent and manage bullying, this may be seen as a breach of WHS laws.
Bullying can lead to serious physical and psychological harm with people suffering from depression, stress, anxiety and emotional exhaustion. It is well recognised that workers suffering from physical or psychological harm are more likely to take sick days and not be as productive as they would hope to be when at work. Bullying can also lead to a level of staff resignations.
Preventing and dealing with bullying
There are numerous ways employees, employers and workplaces can reduce the likelihood of bullying occurring. There are also many resources available to support this.
1. Workplace culture
To create and maintain a workplace where bullying doesn't exist, it's important to start by addressing the culture of that early learning centre. Managers and senior staff need to be sure they're leading by example in the behaviour they demonstrate and expect of their staff. All staff should be expected to treat their colleagues fairly and with respect, and this behaviour must start with those most senior.
It is also vital that a culture is created where staff feel comfortable speaking up if there is something they're unhappy about. If a staff member feels they're being bullied by a colleague, it's ideal that they speak to their manager first before considering making a formal complaint against the centre. Yet for this to happen, this openness and willingness to discuss concerns needs to be supported and encouraged.
A key step an early learning centre should take to prevent bullying occurring is to be sure no one thinks it won't happen in their workplace. Bullying behaviour unfortunately can occur in any workplace. However, if a manager thinks their centre is immune, it's possible they won't put in place the necessary process to prevent this which could place them at greater risk.
2. Business policies
Early learning centres all have an extensive list of policies for their business. There are many policies which are required from a regulatory perspective. However, all centres should consider what other areas they should develop policies for beyond those required; bullying is an example of this. A policy on workplace bullying should include information about what a staff member should do if they're experiencing bullying and how the centre will respond to this. Workplaces should also have a social media policy which sets out appropriate social media behaviour for both personal and professional use.
The benefit of having a policy, rather than just stating what's required, is that it formally sets the standard that all staff are expected to abide by and can be continually referred to. However, for policies to be effective they need to be known about and be accessible for all staff. This means centres need a process for making sure staff are aware of the policies they need to adhere to.
3. Performance management processes
Performance management discussions can unfortunately lead to staff confusing feedback with bullying. This confusion can often occur due to the way the performance appraisal is delivered. It's incredibly important that managers are undertaking their role in a reasonable manner so that it doesn't cross that line and become bullying.
Addressing poor performance shouldn't be put off until an official staff feedback or review discussion. Doing this means that a staff member's poor performance will continue for some time without them being aware. Receiving this unexpected feedback only at review time can be viewed as unfair and unreasonable by staff members.
When discussions are had regarding performance issues, staff should be encouraged to have a support person there with them. This person can provide them with moral support during the meeting as well as afterwards. A record of these discussions should be made so there is a history of what was said by all parties and what was agreed to.
The Fairwork Ombudsman provides resources to assist with managing underperforming staff members, this information can be found at www.fairwork.gov.au/how-we-will-help/templates-and-guides/best-practice-guides/managing-underperformance.
4. Additional resources
Preventing and managing bullying is not easy; therefore there are resources available to assist workplaces with this challenge. For assistance with understanding what bullying is, how to prevent it and what both employees and employers should do if it does occur, refer to the follow sites:
Workplace bullying in early learning
It may surprise you to know that complaints about orthoses are a common source of podiatry claims to Guild Insurance.
Common allegations include:
Any claim against you, whether substantiated or not, can be distressing. Your good reputation may be damaged leading to undue criticism from other healthcare providers and reduced client referrals. Furthermore, complaints to agencies such as AHPRA may take many months to resolve resulting in a prolonged period of uncertainty.
Managing client expectations through effective communication is central to avoiding claims against you. Key issues to discuss with clients include, but are not limited to:
Finally, remember to clearly document your discussion and the outcomes in the client's clinical notes. Good clinical notes are invaluable in the event of a complaint against you.
Orthoses - Managing Expectations
Incidents involving pharmacists selecting the wrong medication or the wrong strength are the most common dispensing errors reported to Guild Insurance. Not surprisingly, a number of these errors involve look-alike, sound-alike medications.
Despite awareness raising campaigns, errors still occur. While a person could suffer harm if given any medication in error, the likelihood of serious clinical effects increases significantly when the medication involved has a narrow therapeutic index. These errors can and do happen, even to experienced pharmacists who've never made a mistake before. They can happen to you and they can be fatal to your customers.
A patient was admitted to hospital with unexplained abdominal bleeding. On investigation he was found to have an abnormally high INR, even though he had never been prescribed anticoagulant therapy. His elevated INR was eventually attributed to a dispensing error. The pharmacist had inadvertently made a selection error and dispensed 5mg Coumadin instead of 5 mg Coversyl as prescribed.
Due to a pharmacist's selection error, the cytotoxic medication Hydrea was dispensed instead of the prescribed antihypertensive Hydopa. The young woman happened to be pregnant and claimed the error resulted in her suffering a miscarriage.
A customer successfully claimed for 'loss of income' when she was unable to work for an extended period after a dispensing error. Although the customer had been prescribed Lamictal 25mg, the pharmacist inadvertently dispensed 200mg tablets. The customer subsequently took the higher dose for a number of months and suffered liver damage. While the pharmacist said she usually used 'barcode scanning', she failed to do so on this occasion.
Reduce the risk of dispensing errors
Pharmacy Dispensing Wrong Medication or Strength
Receiving a complaint is often an unexpected part of running any business, including a chiropractic practice. No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are. There can be a tendency to see a complaint as a personal criticism rather than constructive feedback. However, there can be positive outcomes when the situation is managed appropriately.
Why do people complain?
There are many reasons why patients might complain about your practice and the treatment or service they've received. Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise. Understanding why people may complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints. The following are some of the reasons why people may feel the need to complain.
High expectations – consumer expectations are increasingly high when engaging professional services. Your patients pay for your service and will most likely see you as a highly trained and qualified professional. This view can influence their expectations about the service and outcomes they anticipate.
Unrealistic expectations – it's possible that patients may have unrealistic expectations about what they can reasonably expect from chiropractic treatment. Their high expectations may at times surprise you. It's therefore important to remember that most patients will not have the clinical knowledge you do and what's obvious or common sense to you may not be to them. A practice must assist patients to be clear and fully informed about the treatment being provided and the outcomes they can realistically expect. This requires ongoing discussions with patients and, where possible, written information to assist their understanding.
To inform and be heard – patients may wish to make a complaint about an incident or poor outcome just so they are sure you and your staff are aware of what's occurred and how they feel. They may wish to complain simply to be listened to and acknowledged, especially if they have been adversely impacted. Not all complaints will lead to a formal demand for compensation.
Belief that someone is responsible – when something goes wrong we often try to determine who's responsible. Sometimes someone is obviously responsible, sometimes it's hard to determine who's responsible and other times there is no one person responsible but it's just an unfortunate set of circumstances. If a patient thought something had gone wrong and this led to them being harmed, it's quite possible they may complain with the intention of holding someone responsible and possibly liable.
The importance of managing complaints
There may sometimes be a temptation to ignore a complaint and hope it'll just go away. Maybe the patient won't follow up. Maybe the incident won't occur again. This is a very short-sighted way to run any business as there are clear benefits when complaints are managed appropriately.
How to manage complaints
It's advisable that every chiropractic practice has a complaints policy. This means that the practice will have an agreed-to process which allows for all complaints to be dealt with in a fair and consistent manner. It also means staff know what to do which is important as managing complaints can be challenging.
A key aspect in dealing with any complaint is listening to the person. Where possible, make time to sit down in a quiet space and give them time to express their concerns. Make the effort to hear what they have to say and take on board what they have told you. You may not agree with all they are saying, however it helps if you can try to understand the situation from their perspective. You may wish to ask them to document their concerns so you both have an accurate record of the matter. Avoid being defensive or taking the complaint personally as this may inflame the situation.
With low level complaints you may be able to offer a solution there and then. However, this won't always be the case. With more serious complaints you should provide the person with an assurance that you'll investigate the matter and get back to them with a response at a later date.
Guild Insurance expects those insured with us not to admit liability (or name someone else as being at fault), or to offer any compensation without contacting us first. However, this doesn't prevent you from apologising or showing sympathy for any pain or inconvenience the person may be experiencing. Contact Guild Insurance on 1800 810 213 as soon as you've received a complaint; don't wait till it escalates to a claim for compensation. We will provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation. This support can be the difference between sorting a problem quickly and it escalating to a serious claim.
Managing complaints in Chiropractic
Guild Insurance regularly analyses claims information to understand factors which may contribute to claims and complaints occurring. This analysis has highlighted a trend where claims involve treatment by at least two dentists.
Evaluating another dentist's work
All dentists will at times treat a patient who's had dental work carried out by another practitioner. And you may have questions about that treatment, such as when:
Dentists must be very mindful of how they handle these situations and what they say to or in front of the patient. It's understandable that to provide treatment the dentist will want a complete understanding of prior treatment. However, conversations about another practitioner's treatment, if not conducted appropriately, may contribute to the patient lodging a complaint against that other dentist.
What can go wrong?
Not all situations where a dentist questions previous treatment will lead to issues arising. However, the following case examples highlight how easily complaints can occur.
A patient had received many years of dental treatment from Dentist A. Whilst happy with the treatment provided, the patient began seeing Dentist B when she moved to a new house. During a consultation, Dentist B commented on the file fragments which had been left in her tooth, assuming she was aware. When she appeared surprised, Dentist B explained that he had detected small fragments of a file which had been left in a tooth following RCT. Dentist B was openly critical of Dentist A for what he described as 'sloppy treatment' and told the patient she should have been informed at the time when the file broke.
Whilst away for a weekend, a patient felt a tooth break whilst eating. He decided to see a local dentist who was available to provide emergency treatment. When he returned home he went to see his regular dentist to receive further treatment to that tooth. His regular dentist was quite surprised with and critical of the treatment provided by the other dentist. She informed the patient that due to the poor work she was going to have to replace what was done, therefore costing the patient more than he had anticipated.
Impact of comments made
Making negative comments about the work of another dentist can reflect poorly not just on that dentist but the dental profession. If the entire situation surrounding treatment is not understood, the comments may be incorrect and presumptuous. This can unfairly damage the reputation of a dentist as well as cause unnecessary frustration for the patient.
It's therefore very important that when dentists find themselves in a situation where they have questions about the work of another dentist, this is handled appropriately.
Tips for managing these situations
Guild Insurance (Guild) undertakes regular reviews of the claims managed by them to understand trends and themes within those claims. Recently Guild has identified an increase in the frequency and severity of fitness related claims being reported. The nature of the incidents which lead to these claims suggest that some fitness professionals are not recognising the risks within their work, or they aren't being proactive enough to properly manage those risks.
The following information will assist fitness professionals in understanding the risks they face in their day to day work and what they need to do to reduce the likelihood of these risks becoming a reality.
Don't underestimate the importance of communication
Guild's claims experience shows us that poor communication is a factor in almost all complaints from fitness clients. In some cases, clients will allege the communication from the fitness professional was poor and this led to an incident, such as the explanation for how to perform an exercise was too brief and this resulted in the client injuring themselves. In other cases, the client may not mention anything about communication when lodging their complaint, yet when the incident is investigated it's found there has been a communication breakdown between the fitness professional and the client. Fitness professionals need to focus not only on their technical knowledge but also their communication skills when communicating any information to clients.
Don't underestimate the risk of poor exercise selection and prescription
Exercise has the potential to provide a great deal of enjoyment whilst also providing health and fitness benefits. However, Guild's experience in managing fitness claims provides evidence that there are also significant risks attached to exercise; clients can suffer life changing injuries. Yet this doesn't mean we should stop exercising, it means we need to pay closer attention to the risks of exercise and put in place risk mitigation strategies to reduce the likelihood of these injuries occurring. Hoping a client won't be injured isn't enough. The risk of exercise needs to be understood and mitigated.
Work within your scope of practice
Fitness professionals need to be sure they understand, and work within, their scope of practice. This means knowing what they've been trained to do and are competent in. Giving advice outside this scope will potentially be creating a risk for the client which in turn becomes a risk for the professional. Fitness professionals need to be sure that regardless of what information or program the client has requested, they only plan and deliver exercise programs within their scope. If the client's needs or requests are outside of this, the professional needs to seek assistance or refer the client to someone else. Fitness professionals need to remember they're responsible for all professional advice and guidance they provide, so they should never allow themselves to be coerced into doing something they know they shouldn't.
Keep records of sessions
It's important to keep a record of your sessions with clients. This means maintaining an accurate and detailed history of what exercises your client has performed and the specifics of those exercises in terms of weight, height, sets, repetitions etc. It also means you have details of how successfully the client performed those exercises and if there were any issues such as injuries.
Records of your sessions with clients serve two key purposes:
Balance encouragement and pushing too far
It's quite common to hear clients allege their trainer pushed them too hard when they had told the trainer the exercise was beyond their capability and this led to them suffering an injury. But where is the line between encouraging a client to challenge and improve their fitness and pushing too far that it becomes a risk? Unfortunately, this line isn't always obvious. Therefore, fitness professionals need to be sure they're tailoring all they do to each individual client and watch for signs that the client is struggling to a point of potential harm.
Balance creativity and risky
Like all good business people, fitness professionals are continually looking for new and different offerings for their clients and ways to set themselves apart from their competitors. However, this ingenuity can create new risks for the business. The risks of any new offerings need to be carefully considered before being put into place; think about what can go wrong before it does. Guild has seen many claims where clients have been seriously injured undertaking an activity where it could be argued that the risks of the activity outweigh the likely benefits.
Be proactive with managing risks
Guild has seen numerous cases where the fitness professional has identified a potential risk or hazard, such as a pothole where clients are jogging, or weights being left on the floor rather than on racks, yet they've put in very little, if any, effort to manage that risk. Warning clients to avoid a pothole whilst running is not proactively managing a risk. Moving the clients away from the area where there is a pothole is going to be much more effective in preventing an injury. When a risk assessment is done, and this leads to risks being identified, fitness professionals need to be sure they're taking the necessary steps to reduce the likelihood of that risk eventuating. Hoping it won't happen isn't enough.
And finally…
Don't think it won't happen to you. No fitness professional is immune from the risks involved in training clients. The more aware a professional is of what could possibly go wrong, the more equipped they are to prevent it.
Fitness professionals and their risks
Guild Insurance is a leading insurer of early learning centres in NSW. The responsible service of alcohol at meetings, fundraising events or social gatherings is something our clients frequently enquire about.
The following information highlights the risks faced by centre managers, committee members and staff when making decisions about the service of alcohol at events. However, if you are unsure about anything to do with the service of alcohol, you should seek legal advice.
Serving alcohol at events held by child care centres
What if people bring their own alcohol to events?
Guild also recommends you prohibit committee members, parents or visitors from bringing any alcohol to events that have been organised by the centre.
While it might seem a safer option for people to bring along their own alcohol, it certainly does not remove the risk of legal liability attaching to the centre or members of the committee. If a committee member, volunteer or staff member was to be injured, or cause injury to someone else after consuming alcohol, a court may deem the staff and / or committee partly responsible. The court may also see the centre as encouraging a culture of drinking at such an event, or the centre and its committee not taking reasonable steps to avoid the incident giving rise to the injury. Therefore, Guild strongly recommends that you prohibit all alcohol consumption at any centre events, both in and out of business hours.
Early Learning Centres and Alcohol Consumption NSW
It's well recognised that patients don't necessarily complain simply based on their clinical outcome. Most dentists will have heard of or seen situations where a patient has experienced an outcome which wasn't ideal yet wasn't particularly poor, however the patient has been quite annoyed with the outcome and has lodged a complaint. On the other hand, there are many cases of patients who have experienced quite poor outcomes yet have chosen to not complain.
There are many reasons why the above may occur, some which are easier to identify than others. All patients are different and human behaviour isn't always predictable. Good communication and the relationship between the patient and dentist will greatly influence the likelihood of a complaint. One other very important factor is the expectations of patients.
Patient expectations
Many patients will go into dental appointments with some level of expectation regarding their likely outcome. They may have a very clear and detailed outcome in mind or it may be more broad and open. Most importantly, some of these expectations will be realistic, however others won't be.
Unrealistic patient expectations pose very real challenges for dentists. If a patient undergoes treatment which they have unrealistic expectations about, it's unlikely those expectations are going to be met simply due to them being unrealistic. If a patient's expectations haven't been met, it's likely the patient is going to be unhappy or dissatisfied with the treatment. Those unhappy and dissatisfied patients are the ones more likely to complain about the treatment and expect further corrective treatment or compensation. It's therefore vital that dentists do all they can to help the patient fully understand treatment and the likely and possible treatment outcomes before treatment begins.
Creating realistic expectations
A key step in making sure a patient has realistic outcomes regarding treatment is to have an open and honest conversation with them. This will not only provide the patient with information about their treatment, it will also give the dentist a clearer understanding of the patient's expectations. A dentist's clinical skills are vital to what they do, however effective communication goes a long way in providing positive outcomes.
To assist a patient to have realistic expectations, dentists must ensure they explain the treatment and outcomes using simple, clear terms. Technical clinical language should be avoided as many patients won't understand this. Dentists should also consider how they tailor their language and the information for each individual patient. For example, a person with language or literacy challenges may need information presented in a more detailed manner than other patients. Dentists should also consider using diagrams, pictures or models to assist with understanding where appropriate.
When discussing treatment with a patient, it's important that dentists don't make assumptions about what the patient will or won't understand. It's easy for dentists to become so familiar with what they do and know that they sometimes forget how foreign that knowledge can be to other people. Patients will have varying degrees of knowledge and experience regarding dental treatment. Therefore, what they understand about their treatment will also vary.
When a patient attends a dental practice and requests a particular type of treatment, this is an occasion when a dentist should be especially mindful of the patient's expected outcome. When a patient has requested a type of treatment, the patient has clearly formed a decision regarding what treatment they need to get the outcome they desire. What they're requesting and expecting may be reasonable and realistic, however in some cases it may not be. When presented with this situation, dentists need to be sure they don't rush into providing the patient with the requested treatment. As with all patients, there needs to be a thorough assessment and diagnosis process. Then the patient is to be provided with their treatment options, as well as the risks and benefits of those options. There may be treatment options which are more suitable which the patient isn't aware of. The patient also needs to be made aware of the likely treatment outcomes for each of those treatment options.
The dentist needs to be sure the patient has all required information before consenting to treatment and this includes understanding the likely outcomes. A patient's request for particular treatment doesn't alter this required process. And dentists need to remember that they're always responsible for the treatment they've provided, regardless of whether it was requested by a patient.
In summary…
Dentists should be doing all they realistically can to improve the outcomes for their patients and reduce the likelihood of poor outcomes and complaints. An important step in this process is making sure patients have realistic expectations regarding treatment outcomes. Dentists have a very important role in using their clinical knowledge in conjunction with practical terminology to assist patients to develop realistic expectations. Dentists need to remember this is of great benefit to both themselves and their patients.
Managing Patient Expectations in Dentistry
Dispensing errors can have an enormous impact on both the customer and the pharmacist. Imagine how you would feel if a simple mistake caused serious harm to someone? Unfortunately, we see firsthand how distressing these events can be.
It may seem unnecessary or over the top, to have a step by step dispensing procedure in your pharmacy. After all, dispensing is at the very heart of what it means to be a pharmacist. You do it every day and you've developed your own routine. It works for you – you don't make mistakes.
Yet dispensing errors reported to Guild Insurance tell a different story. They remind us that mistakes happen every day. Pharmacists are increasingly under pressure. Customers can be impatient if asked to wait for more than a few minutes. There are frequent interruptions during dispensing and pharmacists are expected to make greater efficiencies in tough financial times. Gaining customer loyalty is also a daily challenge due to fierce competition. As such, many pharmacies are carrying a wider range of stock to cater to different needs. Needless to say, pharmacists are experiencing unprecedented workload pressures. Coupled with fatigue and personal stresses, the risk of making a serious dispensing error cannot be ignored. It really can happen to you.
Getting into the habit of following a thorough, systematic dispensing procedure for every script can help protect you against an unthinkable error. Developing a good routine reduces your reliance on simply being vigilant, particularly when you are tired or working long hours. It helps reduce the chance of human error. However, it does take time for a set routine to become second nature. Success requires commitment to following the same steps every time, even when processing the easiest of scripts. The more you get into a habit, the easier it should become. Furthermore, it also helps you to identify barriers and improvements to dispensing practices. Sometimes, we don't realise that our workflows are inefficient and adding to our difficulties until a serious error happens.
Despite this, some pharmacists still believe that risk reduction strategies, such as barcode scanning, can place unrealistic demands on their already busy workloads; "It slows me down at the very time I need to be more efficient". However, embedding safe dispensing practices before an error or crisis occurs can lead to greater efficiencies. But it does take some planning and teamwork.
Reducing the risk of dispensing errors
All early learning centres would be well aware of the expectation and legal requirement for them to provide a safe environment. But what does this actually mean? How can anyone be sure their business really is safe? And what would it mean if your business wasn't and an incident occurred?
Guild Insurance has been insuring early learning businesses for many years and this experience has provided us with a great understanding about the risks faced when an environment isn't safe. Unfortunately, this experience also tells us that despite best efforts, many early learning centres aren't as safe as they could or should be.
What is a safe environment?
When many of us think about an early learning centre being safe, the first thought is often around the physical environment for children. There are many obvious physical risks for children and Guild Insurance unfortunately sees numerous claims where children have been physically harmed. But this is just one piece of the safety puzzle.
All businesses need to be free from dangers and hazards for all people who attend or use the business. This means that early learning centres have an obligation to children, staff and anyone else who attends, such as parents. And safety extends beyond physical.
Children need a centre where the likelihood of them being physically injured is low. They also need to feel happy and nurtured. They need to be able to learn and develop as they move through their childhood and develop social skills. They need to feel respected as an individual whilst learning to respect and appreciate others as individuals too. They need an environment where they can thrive as young people.
Staff also need an environment which is physically safe. With the physical work required in early learning, injuries to staff are unfortunately not uncommon. Staff also need a workplace which is supportive and enables them to perform their best. They need opportunities to develop and grow as a professional and to feel that their contribution to the workplace is valued and appreciated.
It may come as a surprise to learn that visitors, such as parents, have been injured whilst at a centre. Therefore, a safe physical environment is important to them as well. Parents will also want to be sure that the centre is a safe and secure environment for their child. They need to feel confident that their child is going to be well cared for and educated.
To be able to create a safe environment, you need to start by understanding what can make it unsafe. This means you need to identify the possible risks and think about what could go wrong before it does. Below are examples of what can go wrong as seen in claims managed by Guild Insurance.
Why do things go wrong?
When trying to understand why an incident has occurred, at Guild Insurance we focus on 'contributing factors'. This is because there's rarely one main cause for an incident but more likely many factors which have contributed to it occurring. Addressing these factors can assist in reducing the likelihood of incidents occurring. Below is a list of the common contributing factors identified by Guild Insurance.
Unfortunately, all risks can never be eliminated from early learning centres. And we can't guarantee that the most effective risk efforts will mean an incident won't occur. However, there is a great deal which you and your staff can and must do to create a safe environment and reduce the likelihood of an incident in your centre.
Is your early learning centre a safe environment?
Imagine if…
You receive an angry email from the parent of one of your clients stating they aren't happy that you declined to provide therapy to their child and they're considering making a complaint alleging discrimination. You know you weren't the most suitably qualified speech pathologist to provide therapy to that child and did the right thing in referring to someone else. Therefore, you immediately reply to the parent informing them of your version of events. Some time after this you hear from the parent again claiming they have now lodged their discrimination complaint.
Guild Insurance's Liabilities policies state that as soon you, as the policy holder, experience a claim made against you or an incident which could give rise to a claim, you are required to notify Guild. However, Guild is aware that some clinicians respond to complaints on their own without first notifying Guild. This can have a number of consequences for these clinicians as they're not receiving the support or guidance their insurance policy may entitle them to. It can also mean the policy holder is not adhering to the conditions of the insurance policy.
Possible scenarios
The following scenarios are some examples of when you should notify Guild Insurance:
When to notify Guild
Clinicians are sometimes unsure whether a matter is serious enough to warrant notifying their insurance company. There are some occasions where notifying an insurance company is a must, such as when there is a request for client records from a solicitor or funding provider or when there is an allegation of the client suffering harm following therapy. However, when a client complains directly to you, this is when you need to use your judgement. If the client has simply informed you that they didn't respond as hoped to therapy provided previously yet doesn't seem annoyed or demanding, then this may be a matter which can be sorted by you alone. Yet if you're in doubt or concerned about the complaint or allegation from the client or their family, then you should notify Guild.
Will my premium go up if I notify Guild of a matter?
Guild's premium pricing is influenced by a number of factors. Notifying Guild of an incident is unlikely to be the cause of a premium increase the following year. However, as detailed below, not notifying Guild may lead to further stress and complications. Therefore, the cost of the premium should not be a factor in deciding whether or not to notify Guild.
Consequences of not notifying Guild
Facing an allegation or investigation of any sort can be an extremely stressful situation for a clinician. When a clinician handles a matter themselves without the support of Guild, that stress is compounded as the clinician will be dealing with a process they're unfamiliar with.
Guild has seen many cases where a clinician's own response has either not provided the required information, or a response has been written in a way which is likely to inflame or escalate the situation. This usually leads to further investigations being conducted and Guild being notified after the investigation has begun, inhibiting Guild's support and influence.
When a clinician doesn't notify Guild as soon as is reasonably possible of a claim made against them, they may be considered to not be complying with the conditions of the insurance policy. This can lead to cover under the policy being cancelled or the claim not being paid.
It's also important to understand that a clinician may leave themselves with out of pocket expenses by not notifying Guild at the beginning. This may occur if they engage their own legal counsel not approved by Guild and at a rate Guild believes to be exorbitant or if they have offered to settle a matter without Guild's consent.
The staff at Guild Insurance have a great deal of experience and expertise in managing allegations and investigations and are well aware of what is required when responding to them. For this reason, it's of benefit to everyone involved to notify Guild immediately and be sure the necessary support is provided and process is followed from the start.
How to contact Guild Insurance
To notify Guild of an incident, and therefore make a claim against your insurance policy, either call Guild on 1800 810 213 or go to guildinsurance.com.au/claims.
Notifying Guild of a claim - Speech Pathology
Too often people unfortunately seek comfort in the belief that 'it could never happen to me'. Yet claims reported to Guild Insurance tell us otherwise. They remind us that businesses suffer losses every day.
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subset: commoncrawl


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Continuity mistake: The Simpsons' bathroom has changed position. In 'Today I am Klown' it was opposite the top of the stairs, at the back of the house; in this episode it is at the front of the house. (00:00:35)jle
I, (Annoyed Grunt)-bot - S15-E9
Other mistake: When the bullies are riding around Bart and Milhouse there are problems with their water bottles. In some frames they vanish, in some others the bullies' far legs are drawn in front of the bottle. (00:01:40)jle
Continuity mistake: When Krusty ends up at his old neighbourhood, the street changes between shots. E.g. the "LLBeanie" sign appears above the door of the 2nd shop and the suit of the man reading the newspaper changes from grey to blue. (00:05:25)jle
Continuity mistake: After he takes a puppy from Bart, Snake's car appears from nowhere. (00:04:15)jle
Continuity mistake: Right at the very end scene, when Lisa and Maggie are sitting on the bed, you can see that there are 6 bricks on the bed. Yet when the shot changes there is only one behind Maggie, meaning two of them have just vanished. (00:20:30)Chaz1003
The Ziff Who Came to Dinner - S15-E14
Continuity mistake: In once scene, Artie walks past the Simpson's to Selma (or Patty). In the next shot he is shown walking past the Simpson's again.
I, (Annoyed Grunt)-bot - S15-E9
Continuity mistake: At one point in the cycle shop, Homer has his hand in his pocket in one shot, and it's suddenly out in the next one.David Mercier
Margical History Tour - S15-E11
Continuity mistake: Lisa empties a glass of red wine that she previously poisoned with sleeping potion. When she falls over sound asleep, her glass is shown on the ground next to spilled wine.Ral0618
Continuity mistake: When Lisa is explaining to Marge why she is unhappy, the door to her bedroom closes on its own. (00:07:10)jle
The Ziff Who Came to Dinner - S15-E14
Continuity mistake: When the Simpsons first see Artie Ziff in the attic, as he stands up, there's a theremin behind him (corresponding with Homer's comment that the "ghost" was playing his theremin). Artie puts a sign up above it. However, when Artie moves to the rafters, the sign he put up is still there, but the theremin isn't.Moose
Continuity mistake: The coathanger is too small to reach the medicine cabinet.Dr Wilson
Continuity mistake: Throughout the whole of this episode, the clock on Mr. Burns' desk keeps appearing and disappearing.Chaz1003
Diatribe of a Mad Housewife - S15-E10
Continuity mistake: After the clown balloon that rips at the car dealership there is a bit of material left over and there is also a cord attached to the wooden platform where the balloon was. After a reaction shot, it cuts back and the material and the cord have both disappeared.Lummie
Continuity mistake: In the scene where Homer is going down the escalator, in the Costington's Centre, after he gets on two men follow him, then a woman, yet when the shot changes, it's a man then a woman then the other man. (00:00:45)Chaz1003
Factual error: The tongue Lisa sleeps on in the museum isn't anatomically correct. It shows the bitter and sweet taste buds as being side by side on the surface of the tongue. In reality, different taste buds are not in specific places on the tongue. I wouldn't normally complain, but this is supposed to be in a museum.David Mercier
Marge vs. Singles, Seniors, Childless Couples and Teens, and Gays - S15-E8
Continuity mistake: When we see the town at the meeting, Smithers is sitting in front of Selma. In the next shot, though, Smithers is suddenly on stage holding the 'SSCCATAGAPP' sign and Lenny is sitting in front of Selma. (00:08:50)jle
My Mother the Carjacker - S15-E2
Other mistake: In the scene where the prisoners are singing along with Mona, two inmates have the same Identity number.
Continuity mistake: When Lisa is standing outside the Kwik-E-Mart, the "open 24 hours" sign on the window changes position between shots. (00:13:00)jle
Treehouse of Horror XIV - S15-E1
Continuity mistake: When the younger Professor Frink is receiving and wearing his Nobel Prize, his father goes nuts and starts stealing people's brains. The younger Frink figures out that kicking the elder Frink in the crotch will stop him. When he does, and the elder Frink falls off the stage, he is wearing the Nobel Prize, not the younger. (00:15:00)Richard Welty
My Mother the Carjacker - S15-E2
Continuity mistake: At the end of the episode when Homer is looking for another message from his mom to find out if she's really alive, Marge and the kids enter the kitchen, Marge says that it's 2 in the morning. But the clock on the wall shows that it's 9 pm.Jane Doe


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RIO DE JANEIRO — Prosecutors on Monday filed new corruption charges arising out of the huge bribery scheme at Petrobras, the national oil company, against the treasurer of the ruling Workers Party — putting additional pressure on President Dilma Rousseff at a time when she is fighting calls for her ouster over the burgeoning scandal.
The charges against the treasurer, João Vaccari, moved the payoff scandal closer to Ms. Rousseff herself. A former executive at Petrobras testified earlier this month that he met with Mr. Vaccari to define how the party should receive bribes from contractors vying for business with the oil giant.
The former Petrobras executive, Pedro Barusco, who was also charged in the scheme on Monday, said that the Workers Party had received as much as $200 million in bribes. Mr. Barusco said that some of those payoffs were channeled to Ms. Rousseff's first presidential campaign, in 2010.
"Vaccari knew that the payments were actually bribes," Deltan Dallagnol, a prosecutor in the investigation, told reporters in the southern city of Curitiba.
The developments in the scandal have shaken Brazil's political establishment, with the Supreme Court authorizing investigations of powerful legislators in Ms. Rousseff's ruling coalition. Setting an important precedent in Brazil, corporate executives accused of paying the bribes have spent months in jail as investigators examine the charges.
No testimony has emerged suggesting that Ms. Rousseff, who led the Petrobras board of directors during much of the time that the payoff scheme unfolded, personally profited from the scheme.
While political analysts say that her impeachment or resignation remain unlikely, Ms. Rousseff has been put on the defensive, grappling with plunging approval ratings and large antigovernment protests as the country's once hardy economy falters.
Responding to the latest developments in the scandal, Ms. Rousseff said Monday that the work by the prosecutors pointed to institutional independence in Brazil.
"If they want to investigate, then they're going to investigate, and those who are responsible will pay for what they've done," she said.
The Workers Party, which has held power since 2003, has repeatedly denied that it received illegal campaign donations. Mr. Vaccari has also denied wrongdoing.
In addition to Mr. Vaccari, prosecutors filed corruption charges on Monday against 26 others including Renato Duque, a former high-ranking Petrobras executive with close ties to powerful figures in the Workers Party.
The Federal Police took Mr. Duque into custody on Monday after investigators said they had found more than $20 million in accounts controlled by him in Monaco and other tax havens.
Sérgio Moro, the judge overseeing the investigation of the bribery scheme, said Mr. Duque had moved the money into the accounts last year in an attempt to hide it from the authorities.
The police on Monday also seized a vast art collection at Mr. Duque's home in Rio de Janeiro, including works by the painters Djanira da Motta e Silva and Alberto da Veiga Guignard.
Mr. Duque was previously detained by the police last year until a justice on the high court ordered his release. Alexandre Lopes, a lawyer for Mr. Duque, said his client denied having any involvement in illicit activities at Petrobras.


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Authentic Palestinian Cuisine? There's an App for That
"Palestine on a Plate" courts controversy in an effort to reclaim a culinary legacy.
Image via the Palestine on a Plate website.
A Palestinian-British app is the brains behind a new mobile that gives people access to the popular national dishes of Palestine. Chef Joudie Kalla, who's honed her craft Gordon Ramsay's Pengelly's, London-based Italian restaurant Daphne's, launched Palestine on a Plate to document and share over 50 of her mother's recipes and other recipes from her homeland. The app includes more recognizable dishes like hummus and labneh, but the most popular recipe right now is a lesser known dish called m'tabak, which is comprised of a flaky pastry, halloumi cheese, ricotta, and pistachios.
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Remember The First Day
I remember the first day we met
The very day you donned and adored me
I was without blemish like the dexterity of the Bonwire weaver
Memories so indelible like a nevus
You walked on the wards like Christ did on Bartimaeu's street
And yes, you willed and made others whole
I remember when my hem caught its first dirt
I do remember when my sleeves first soaked patients' sweat
I remember like you do remember your first successful CPR
Dirt after dirt; sweat after sweat
Soiled and fallen short of 'don-ment'
Wrinkle after wrinkle, I'm left to the paws of age
No notice of divorce
Not even a subpoena to the court
I hang on death's sickle without your remorse
I remember the first day we met
I remember the first day you left
Pain so gross like drenching night sweat
This poem was inspired by a white coat left that had been left hanging in the doctors' restroom for a long time.
Anthony Gyening-Yeboah, MD
Junior House officer, Cape Coast Teaching Hospital, Cape Coast, Ghana.
For The Love of Medicine
For the love of medicine
We thrive and thrive
For the love of what we do and who we are
We continue, hot on our pursuit
To be academically refined
Because at the end
It's not just to be found worthy in character and academics or
To understand the principles of our currency (Stuff)
It's for what we have to impart in this world!
It's for the dream we keep alive and give our all. 💛❤💜
Written by Dumebi Ofili
400 level Medical Student, University of Uyo, Nigeria.


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The Freeloader Classic is the new star of the solar mobile charging world. Sleek and robust it contains the most cutting edge electronics capable of powering the world's most popular devices including the iPad and the iPad2.
Covered in a hard wearing and stylish aluminium skin, Freeloader Classic now has super powerful solar panels and is capable of giving power to an iPod / iPhone for 18 hours, a smart phone for 44 hours, a PSP of DS for 2.5 hours and an iPad for 2 hours.
Classic's in built LCD data panel provides useful information about battery level, power input and connectivity.
Supplied with 9 connector's tips including the new "standard" micro USB and a USB socket, Freeloader Classic is ready for action, straight from the box!


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Music is 4 Lovers continue their Global Lovers compilation series this November. The third volume delivers a spice-filled palette of tunes from South America's hottest up-and-coming house and techno producers.
Electronic Groove spreads the love with Cristhian Balcazar's new tune "The Sides"
Artist: Various Artists, Cristhian Balcazar
Title: Global Lovers V3: South America
Label: Music Is 4 Lovers
Release Date: 2019-11-22
Turn it up & enjoy!


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Staff Profile
Publication details for Prof Jens BeckmannScherer, R. & Beckmann, J.F. (2014). The acquisition of problem solving competence: evidence from 41 countries that math and science education matters. Large-scale Assessments in Education 2(1): 10.
- Publication type: Journal Article
- DOI: 10.1186/s40536-014-0010-7
- Keywords: Capability under-utilisation, Math-science coherence, Math education, Problem solving competence, Science education.
- Further publication details on publisher web site
- Durham Research Online (DRO) - may include full text
Author(s) from Durham
On the basis of a 'problem solving as an educational outcome' point of view, we analyse the contribution of math and science competence to analytical problem-solving competence and link the acquisition of problem solving competence to the coherence between math and science education. We propose the concept of math-science coherence and explore whether society-, curriculum-, and school-related factors confound with its relation to problem solving.
By using the PISA 2003 data set of 41 countries, we apply multilevel regression and confounder analyses to investigate these effects for each country.
Our results show that (1) math and science competence significantly contribute to problem solving across countries; (2) math-science coherence is significantly related to problem solving competence; (3) country-specific characteristics confound this relation; (4) math-science coherence is linked to capability under-utilisation based on science performance but less on math performance.
In sum, low problem solving scores seem a result of an impeded transfer of subjectspecific knowledge and skills (i.e., under-utilisation of science capabilities in the acquisition of problem solving competence), which is characterised by low levels of math-science coherence.


text: Texas local Christopher North began his profession as a kid actor, dealing with Ron Howard and Burt Reynolds young. He became a talented multi-instrumentalist in this time around and after his stint with performing, he became an extremely efficient journeyman musician. Despite focusing on his very own material, he'd use …Read More »


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Preparation time:
Cooking time:
Difficulty: Easy - for beginners
1/2 cup butter softened
1/4 cup sugar
2 eggs
3/4 cup flour
2 teaspoon orange extract
1 teaspoon vanilla
2-3 Tablespoons milk
Sugar coated Orange candy
Preheat oven to 375º F. Line a 12 cup muffin tin with baking paper cups. Put all the ingredients except for the milk into a food processor and blend until smooth.Pulse while adding the milk. scrape from the bowl and try to fill each cup equally. Bake for 12-18 minutes.
Orange Cream Cheese Icing
1/4 cup butter softened
8 oz softened Cream cheese
1 cup powdered sugar
2 tsp orange extract.
Mix the softened butter and cream cheese together in a mixer. Slowly add the sugar a little at a time then add the orange extract. Top with sugar candy oranges~Angela


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Chengdu magnesium smoke duct board pipe of various components and operation mechanism should be able to ensure the normal use function, installed to facilitate the operation of the site. Chengdu magnesium smoke duct plate parts and the whole common type magnesium duct connection mainly adopts flange connection, because the wind pipe flange width than the flange parts GB wide, so according to the parts connected with the wind pipe specifications flange and pipe flange enlarged, corresponding to the wind. At the same time, parts of the flange bolt hole size and spacing should be consistent and wind. The wind component and the inside diameter of the tube size have certain deviation, the scope of activities cannot fire valve, control valve and other parts of the moving parts than the flange edge, so as not to collide with the wind pipe. Chengdu magnesium smoke duct plate installation of each component should be located in a separate hanger, the weight can not bear by the wind pipe, and air pipe should be connected before operation test. The air is directly installed on the exhaust pipe, air inlet hole is less than 300mm * 300mm can take direct hole on the wind pipe; air holes larger than 300mm * 300mm at the same time forming and the wind pipe, forming a whole, not directly from the hole in the wind pipe; strengthening tuyere is arranged around the edge at the same time more than 50mm the width of the tube, the wind flange thickness according to the tuyere specifications refer to the same specifications. The air and the main air pipe through the tube connection, does not allow direct access to the hole on the wind pipe. In charge of production should be reserved for flanged plug three port end outlet short and the three port connection, the other end is connected with the outlet connection. Self tapping screws should be fixed by the air outlet and the galvanized products, before installation, should be clean air, the air outlet frame with tape, and pay attention to product protection.
The last one:Sichuan glassy magnesium anti exhaust air pipe board Next:Glassy magnesium anti exhaust wind pipe plate manufacturer


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Why chinalove.com was blocked?
I can not access chinalove.com
How to unblock chinalove.com please?
I can not open chinalove.com page.
Is site chinalove.com been blocked/banned?
This site can't be reached. chinalove.com took too long to respond.
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This site can't be reached chinalove.com took too long to respond. Try: Checking the connection
Display "ERR_CONNECTION_TIMED_OUT" when access chinalove.com
Display "ERR_CONNECTION_FAILED" when access chinalove.com on browser


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Cen·sure, v. i. [imp. & p. p. Censured p. pr. & vb. n. Censuring.]
1. To form or express a judgment in regard to; to estimate; to judge. [Obs.] "Should I say more, you might well censure me a flatterer."
2. To find fault with and condemn as wrong; to blame; to express disapprobation of.
I may be censured that nature thus gives way to loyalty. --Shak.
3. To condemn or reprimand by a judicial or ecclesiastical sentence.
Syn: -- To blame; reprove; rebuke; condemn; reprehend; reprimand.
adj 1: officially rebuked or found blameworthy; "the censured
senator did not run for another term"
2: officially and strongly disapproved; "the censured conflict
of interest"; "her condemned behavior" [syn: condemned]


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By Brian
February 8 2010
With the distaste of the Henry incident still lingering in our throats, we now have a reason to smile again. T... More >
June 3 2009
We look ahead to this weekends World Cup Qualifier match against the men from Bulgaria. A mixed bag of news is coming in from the camp ahead... More >
May 30 2009
Craven Cottage, home to Fulham F.C. was the arena for last nights International friendly between the ROI and Nigeria. The Irish manager deci... More >
May 18 2009
18th May, today Republic manager Trapattoni announced his 25 man squad for the two upcoming games. Firstly at Craven Cottage, home to Fulham... More >
May 16 2009
Republic of Ireland utility man, John O'Shea, added another medal to his collection today, winning the English Premier League Title with... More >
May 14 2009
Roy Keane has gotten himself involved in the Ireland vs Ireland saga lately. He was speaking about the situation regarding Ireland's con... More >
April 26 2009
The 29th of May will see the Republic Of Ireland take on Nigeria in what is only the third time the two nations have played each other. Held... More >
April 19 2009
In a recent interview, Republic Of Ireland assistant manager Marco Tardelli hailed the future of the young Crystal Palace starlet. At the te... More >
April 5 2009
The current Manchester City Goalkeeper and Ireland Number one, is the focus of our attention this week as we detail his career, with some hi... More >
April 3 2009
It seems that in the aftermath of the Republic's 1-1 draw with Italy, as the dust settled, one man has some unfinished business. Noel Hunt h... More >
PLAYER PROFILE : Robbie Keane (10)
Name : Robbie Keane
Born : 8th July 1980 Tallaght, Dublin
Height : 5ft 8in
Position : Striker
Current Club : Tottenham Hotspur (EPL)
Robbie Keane (above right) started his professional club career with Wolverhampton Wanderers in England. He scored twice on his debut at the tender age of 17 and was immediately noticed as a prospect for the future.
The next season, having cemented a place in the Wolves first team, he finished the year as the clubs top goalscorer. He made his international debut against the Czech Republic in March 1998 and proceeded to bag his first international goal against Malta in October of the same year.
On the club front he has been somewhat nomadic, having moved from club to club throughout his career and not really settling anywhere. He has played for the afore mentioned Wolves, Coventry City, Inter Milan, Leeds United, Tottenham Hotspur, Liverpool and is now back with Spurs again.
He is the countries captain and all time top international goal scorer sitting currently on 37 goals in 87 appearances. With a good bit left in the tank yet, we should se a few more goals added to that tally.


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Fresh Gluten-Free Chickpea Linguini - Organic (6-Pack)$49.99
Buy any two 6pks for Free Shipping!
Gluten Free | Kosher | Non GMO | Grain Free | Organic
Our fresh Chickpea Linguini is crafted to deliver on both taste and texture. Made with organic chickpea flour, this delicious pasta is gluten-free, grain-free and organic.
Because our chickpea linguini is freshly made, the pasta cooks perfectly al dente in only 2-3 minutes. Toss with your favorite sauce and enjoy!
Taste Republic is on a mission to revolutionize gluten-free food. Join the movement and exercise your right to ENJOY food, without limits.
Bring a pot of water to a rolling boil. We recommend 3 quarts of water per 9 oz. package of Taste Republic pasta. Gently loosen the bundle of pasta with your hands and carefully place the loosened pasta into the boiling water. Stir immediately to prevent the pasta from sticking together. Boil for 2-3 minutes or until preferred al dente texture. If frozen, place directly in the boiling water and stir to loosen the pasta. Immediately toss with desired sauce and serve.
Organic Chickpea Flour, Water, Organic Potato Starch, Organic Tapioca Starch, Organic Whole Egg, Organic Egg White, Contains 2% or less: Xanthan Gum, Salt, *Glucono-delta-lactone.
*Glucono-delta-lactone is a natural acidifier found in wine and honey
Customer Reviews
Best Pasta Ever!
I have been eating grain free for about 8 years and pretty much gave up on pasta. I recently found Taste Republic Grain Free Pastas and I have to say man these are game changing! Great texture and great taste. So glad to have pasta back in my life!
I have been using the Taste Republic Chickpea Linguine for a few years now. Since going gluten free my biggest concern was loosing my pasta- and my Italian roots. I adore this pasta! Most gluten free products lack taste, texture and become mushy during coking. This pasta however is wonderful! Form stays, taste is 100% and they stay firm and do not turn into mush. I typically make this Linguine with homemade Alfredo Sauce or with a Vodka Basil Tomato sauce with Spicy Italian Sausage. I could eat this every day!