TORONTO — Many patients, their families and caregivers worry filing a complaint about their health care could lead to reprisal, says Ontario’s Patient Ombudsman, and there is still work to do to combat that perception.

In her first ever annual report, which will be released Thursday, Patient Ombudsman Christine Elliott says her office received approximately 2,000 complaints from patients, their families and caregivers between 2016 and 2017. But many of those same people also expressed reservations about lodging the complaint.

“There is that fear of reprisal on the part of some people that if they make a complaint or speak out, that the care of their loved one will suffer,” she says. “I’ve told people I consider that very unlikely to happen, but I can’t guarantee that it won’t happen.”

In the report — called Fearless: Listening, Learning, Leading — Elliott encourages patients and their families to continue to come forward to her office with their concerns. She also asks hospitals, home-care agencies and long-term care homes to embrace the complaints process, which she says will lead to improvements in Ontario’s health-care system.

“People are making these complaints for the right reasons,” she says. “They want assistance with their own complaint, but they also want to make the system better, too.”

The Ontario government created the Patient Ombudsman office in 2014 and the agency took its first complaint in July 2016. Elliott said in its first year of operation her office resolved 70 per cent of complaints, but consistent themes also emerged in the messages from patients and their families.

The report says that majority of the complaints fielded by the office, 70 per cent, related to Ontario’s hospitals, 20 per cent related to home care and 10 per cent were related to long-term care.

The top five issues flagged to the ombudsman were inappropriate discharge, miscommunication or lack of communication, difficulty accessing service, poor care, and understanding and improving policies and procedures.

Elliott says about two-thirds of complaints involve some element of a breakdown in communications. Health-care agencies need to continue to work toward a “patient-first” approach, which relieves the anxiety people often feel when they’re receiving care.

“Essentially, what people are telling us is they don’t want to feel like a body with a disease or an illness,” Elliott says. “They’re a person and they deserve a measure of respect and dignity.”

Elliott says symptoms of the province-wide problem with so-called alternate level of care patients — patients who are ready to be moved from hospital to another setting but can’t be discharged because they have no place to go — are also surfacing in complaints to her office. While the province grapples with ways to make more space in long-term care homes, it could take some simple steps to avoid complaints related to discharge planning, she says.

“We hear a lot from people that they hear 24 hours or less that their mother or father is going to be moved out and they don’t have time to make good decisions,” she says. “I think there’s work that could be done on that point that could help relieve concern that patients are feeling.”

Health Minister Eric Hoskins says Elliot’s work “has provided a valuable opportunity for Ontario’s patients to be heard.”

“Our health-care system is at its best when patients are as integrated as possible in decisions about their care,” he says in statement.

Elliott says her office will continue to act as a conduit between patients and the government as it starts its second year. It also intends to dive deeper into some systemic issues to determine if there is enough evidence to warrant full investigation, she says.

“It’s not a finger-pointing exercise. It’s not to catch somebody out making a mistake,” Elliot says. “It’s for everybody to work together to try and resolve individual complaints, but also to try and make recommendations … (that) can be imposed that will help strengthen our health-care system.”