Using a Matrix to Revolutionise Consumer and Carer Satisfaction

Forensicare

Introduction

Forensicare, Victoria’s statewide forensic mental health service provider, implemented a structured complaints management model to improve the experience of consumers and carers and strengthen safety learning. Services span community programs, prisons and the 136-bed Thomas Embling Hospital.

The project introduced a Complaint Severity Matrix to standardise how complaints are assessed, prioritised and resolved. The aim was to ensure processes were consistent, timely, accessible, and effective, while reducing repeated or persistent complaints

By embedding consumer feedback into governance processes, the initiative positioned complaints as a proactive safety mechanism rather than a reactive administrative task. Early results show improved satisfaction, clearer staff guidance and more consistent resolution practices, supporting a culture where consumer voices directly inform safer care delivery.

Challenge

A 2024 review of Forensicare’s complaint processes identified significant inconsistencies in how concerns were managed across services. Consumers and carers reported dissatisfaction, repeated complaints and unresolved issues, often leading to strained relationships with staff and inefficient use of resources.

Clinical staff were frequently unclear about expectations when assigned complaints, and there was no structured method to assess severity or guide resolution actions. Importantly, no data was collected on complainant satisfaction or process effectiveness, limiting organisational learning.

Without a consistent framework, complaints risked becoming persistent and adversarial rather than constructive safety feedback. Forensicare required a standardised, evidence-informed approach that could guide staff responses, improve consumer experience and generate meaningful data to support quality improvement in forensic mental health settings.

Approach

Forensicare conducted a literature review and internal audit to identify best-practice complaint management models. The Healthcare Complaints Analysis Tool (HCAT) informed categorisation principles, while a retrospective audit of 77 complaints and staff consultations identified effective local responses.

These insights led to development of a Complaint Severity Matrix linking complaint severity to clear response actions and timeframes. Implemented in 2024-25, the matrix standardised expectations for staff managing complaints across services.

A structured feedback mechanism was introduced, asking complainants whether they felt heard, respected, informed, and supported. Responses generated satisfaction scores to evaluate process effectiveness. Findings were integrated into clinical governance reporting, enabling continuous monitoring and improvement. This practical, evidence-based model embedded consistency and accountability into complaint resolution across the organisation.

Achievements / Outcomes

Implementation of the Complaint Severity Matrix improved both consumer experience and staff confidence in complaint management. Staff reported clearer expectations, reduced resolution time, and greater organisational support when responding to concerns. Consumers indicated feeling more heard, better informed and more satisfied with outcomes. [APAC-CHS-2…orensicare | PDF]

Between November 2024 and October 2025, 103 complaints were managed under the new model. Of 37 complainants providing feedback, 73% reported full satisfaction and none reported zero satisfaction. Compliments and anecdotal feedback also highlighted improved communication and timeliness. [APAC-CHS-2…orensicare | PDF]

The process is now more consistent, accessible and effective, strengthening trust and encouraging earlier reporting of concerns. By generating measurable satisfaction data, the initiative has embedded complaints as a learning system to identify risks, improve services, and support safer forensic mental health care.

Lessons for Others

• Standardise complaint severity assessment
• Link severity to clear actions
• Measure complainant experience
• Embed feedback in governance
• Support staff with guidance tools
• Use complaints as safety data
• Start simple and iterate