Enterprise Risk Management (ERM) Legal & Regulatory

Stop, Listen and Empathize When Responding to Patient Complaints

Healthcare worker consoling women

Patient complaints range from minor, easily resolved at the point-of-care, to major, also known by CMS as grievances (CMS, 2016). One thing they all have in common is they take additional time to resolve. Working with patients and their families to address their concerns as quickly as possible is time well spent, because unresolved complaints and grievances are associated with an increased risk of malpractice claims and lawsuits (ECRI, 2016). In addition, marketing studies indicate that only 50 percent of unhappy customers complain to the service provider, but 96 percent will tell at least nine or 10 other people about their negative experience (AHRQ, 2015). Whether the issue seems legitimate or not, best practice dictates that patient complaints be taken seriously and the circumstances reviewed.

Online Complaints

Vanguard Communications, a marketing and public relations firm for specialty medical practices, conducted a national survey of online reviews of physicians and found that poor customer service precipitates the majority of patient complaints (Gooch, 2016). Only one in 24 complaints related to a misdiagnosis, unsatisfactory treatment or poor outcome (Gooch, 2016).

Ron Harmon King, co-author of the study and CEO of Vanguard Communications said, “The nearly unanimous consensus is that in terms of impact on patient satisfaction, the waiting room trumps the exam room (Vanguard Communications, 2016).”

Proactive Steps

Many customer service issues are relatively simple and almost never result in a lawsuit. But small issues can escalate, especially when patients feel their complaints have not been heard or resolved (ECRI, 2016). The Vanguard Communications study indicates that by focusing on common customer service issues, healthcare facilities can significantly reduce the number of patient complaints they receive. Proactive steps to avert patient complaints include:

  • Implementing scheduling practices that make it easier to see patients on time. Double and triple booking patients often results in significant patient wait times and leaves the physician, advanced healthcare professional and staff feeling rushed.
  • Educating staff regarding how to apologize for service lapses. Encourage them to resist becoming defensive when the patient complains and instead try taking the patient’s side.
  • Engaging employees with patients and families to set a positive tone for the entire visit. A friendly smile and making eye contact do not require additional time or money to incorporate into every encounter.
  • Informing every employee about how to handle patient complaints or concerns. Empower staff to promptly respond to patients’ concerns as ignoring a seemingly minor complaint will likely require extra time and attention to resolve later.
  • Training so that even if a complaint may be presented as a concern tangential to the medical care provided, staff can recognize when the nature of the complaint exceeds their expertise or authority to resolve. Provide staff with guidelines regarding when a complaint should be brought to the attention of the practice administrator, physician or advanced healthcare professional.

What about the more significant formal complaints or grievances that involve a quality of care issue or adverse outcome? These types of grievances can come directly from the patient or a family member, health insurers, licensing boards and in the form of a demand letter from an attorney. If left unaddressed, these grievances represent a significant risk for the physician and advanced healthcare professional. They should give serious consideration regarding how to best respond. In addition, staff should be instructed not to withhold information about a serious grievance in an effort to protect the physician.

Inform MPL Carrier

If presented with a quality of care concern or adverse outcome, the physician or advanced healthcare professional should contact their medical professional liability (MPL) carrier and, as a precaution, report receipt of a formal complaint or grievance. Your MPL carrier may offer additional resources to assist with your response.

Often, the first reaction to receiving a grievance is to become defensive or angry. It is important to resist the impulse to respond without taking ample time to objectively think through the best approach. The response should be professional, factual and avoid questionable assumptions. Pointing fingers or shifting blame to others is ineffective and often precipitates additional controversy.

If the complaint or grievance was sent to you by the patient or family member, it is important to timely communicate with them to acknowledge the concern was received, will be given your serious consideration and will be responded to within a specific timeframe. This lets the patient know you are listening. It does not require an immediate and final response, only an acknowledgment of receipt. Once the grievance and the related circumstances have been reviewed, an objective, factual response can be communicated to the patient or family member as appropriate. HIPAA requirements necessitate you confirm a family member’s authority to receive the patient’s protected health information before you release any medical information, even when responding to a complaint or grievance.

A frequent question is whether the response to a complaint or grievance should be communicated verbally or in writing. A verbal response is generally sufficient if a simple complaint is verbally communicated to the staff, physician or advanced healthcare professional. When a minor or informal complaint is communicated in writing, the circumstances surrounding the complaint may need to be considered before deciding whether to respond verbally or in writing. A formal complaint or grievance from a licensing board, health insurer, or other official agency will require a written response in a specified time frame. Compliance within the time frame is important. If it is not possible to meet the deadline for a response, an extension should be requested.

Take Away Points

  • Use complaints and grievances as an opportunity to utilize patient feedback to identify system failures, performance problems and implement quality improvement.
  • Establish a process to track and trend patient complaints and grievances should be established.
  • Develop a complaint response policy that addresses the range of complaints from informal to complex formal grievances.
  • Educate physicians, advanced healthcare professionals and staff regarding the importance of responding appropriately and in a timely manner to patient complaints and grievances.

References

Agency for Healthcare Research and Quality (AHRQ). (2015). Service recovery programs. Retrieved from http://www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/customer-service/straegy6p-service-recovery.html

Centers for Medicare and Medicaid Services (CMS). (2016). Grievances. Retrieved from https://www.cms.gov/medicare/appeals-and-grievances/mmcag/grievances.html

ECRI Institute (ECRI). (2016) Managing patient complaints and grievances. Retrieved from https://www.ecri.org/components/HRC/Pages/PtSup1.aspx

Gooch, K. (2016, April 26). Patients’ No. 1 complaint? Front-desk staff. Becker Hospital Review. Retrieved from http://www.beckershospitalreview.com/hospital-management-administration/patients-no-1-complaint-front-desk-staff.html

Vanguard Communications, Communications. (2016, April 25). Study 96 percent of online complaints about doctors fault customer service, not quality of care [Press release]. Retrieved from https://vanguardcommunications.net/online-patient-complaints-about-customer-service/

 

KarenWright-head-shot-100x100-2014

Karen Wright RN, BSN, ARM, CPHRM is a senior risk management consultant for the Mutual Insurance Company of Arizona (MICA). A member of the American Society of Healthcare Risk Management, she is a past president of the Arizona Chapter. With more than 25 years of risk management experience, she has provided a wide range of risk management education and consulting services to hospitals and out-patient facilities, as well as office staff, practice administrators and physicians. 

 

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