Effective Strategies for Responding to Patient Complaints and Grievances

What qualifies as a patient grievance?

The CMS Conditions of Participation (CoPs) define a patient grievance as a “written or verbal complaint by a patient or the patient’s representative regarding (a) the patient’s care; (b) abuse or neglect; (c) the hospital’s compliance with CMS Conditions of Participation; or (d) a Medicare beneficiary billing complaint.”

Handling patient grievances can be challenging. However, addressing grievances effectively is crucial for maintaining trust and ensuring high-quality care at your facility. A well-handled grievance not only resolves the issue and satisfies the patient or their representative, but also enhances patient satisfaction and fosters a positive reputation for the healthcare provider.

Following is a guide that can help you respond properly and effectively when you receive a complaint or grievance.

Have a Policy and Process in Place

• Establish how complaints and grievances will be handled, including instructing a patient or their representative on whom to contact to file a grievance.
• Designate the person who will handle and address grievances within your organization.

Acknowledge the Issue Promptly

• Immediate attention to these matters is vital, so you should respond as soon as possible. Delays in responding can exacerbate frustration and dissatisfaction.
• Listen actively and give the patient or their representative your full attention. Show empathy and understanding, acknowledging their feelings and concerns.

Investigate Thoroughly

• Gather information and collect all relevant facts related to the complaint. This includes reviewing medical records, speaking with staff involved, and understanding the patient’s perspective.
• Assess the situation to determine whether the issue stems from a systemic problem, a specific incident or a misunderstanding.

Communicate Clearly

• Provide a transparent response. Once you have a full understanding, communicate your findings clearly. Explain what happened, how it was investigated, and any corrective actions taken.
• Offer an apology if appropriate but use caution to not accept blame or liability. A sincere apology can go a long way. It shows that you take the patient’s concerns seriously and are committed to resolving issues.
• Maintain professionalism. Avoid becoming angry, belittling the issue, or making excuses.

Implement Corrective Measures

• Take action. If the complaint highlights a valid issue, make necessary changes to prevent recurrence. This could involve staff training, procedural adjustments or improvements in communication.
• Follow up and check back with the patient to ensure they are satisfied with the resolution and that the issue has been effectively addressed.

Document and Learn

• Record the complaint in the complaint log according to your organization’s process. Keep detailed records of the complaint, investigation, follow-up and resolution process. This documentation is essential for tracking patterns and improving overall service.
• Review and improve by regularly analyzing complaint logs to identify trends and areas for performance improvement. Use this feedback to enhance patient care and prevent future issues.

Train Your Staff

• Your staff needs to know how to receive a complaint/grievance from a patient or family member without exacerbating the situation. It’s vital that they know how to show empathy and support, but at the same time, avoid accepting blame, liability or aggravating the issue.

Writing a Response Letter to the Grievance

Many complaints will neither be considered a grievance nor require a written response. For example, housekeeping issues, dietary complaints and many other minor issues can be handled immediately by staff present at the time the complaint is made – thus resolving the issue immediately.

However, more serious grievances received verbally or written must be addressed with a written response and resolved as soon as possible. A written response, with the hospital’s decision, is expected within seven days of the initial notification and should include the name of the hospital contact person, steps taken on behalf of the patient to investigate the issue, results of the grievance process and the date of completion.

On occasion, a grievance is complicated and may require longer than seven days to resolve. In these situations, the patient or representative must be informed that the hospital is working to resolve the grievance and will be following up with a written response within the number of days indicated within the organizational policy.

Here are some of the most important things to include in a grievance letter:

1. Expression of empathy, including an apology for any trouble that the situation may have caused.
2. Name and contact information of the person at your facility who is handling the grievance investigation.
3. Your facility’s decision regarding the grievance.
4. Steps taken to investigate the concern and findings. Every grievance letter should be individualized to that issue. When disclosing evidence or resolution, stick to the facts. Opinions and subjective information should be left out. Per CMS CoPs, “The organization is not required to include statements that could be used in a legal action against the hospital, but the hospital must provide adequate information to address each item stated in this requirement.”
5. Date of the follow-up, if a follow-up is needed.
6. Steps taken to rectify further issues should be discussed. Per CMS CoPs, “The hospital is not required to provide an exhaustive explanation of every action the hospital has taken to investigate the grievance, resolve the grievance, or other actions taken by the hospital.”
7. Date of completion.

Handling patient complaints and grievances effectively requires a combination of empathy, thoroughness and proactive problem-solving. By addressing issues promptly, communicating transparently and taking corrective actions, healthcare providers can turn complaints into opportunities for improvement and strengthen their relationship with patients.

At LHA Trust Funds, our claims and risk professionals are always here to help you with any complaints and grievances you may receive. Please feel free to contact us if you need assistance.