1. Managing the complaint process
Lynne Anderson, FACHE, cphrm rhia
May 14, 2015

3. introduction
We have all had to deal with some type of complaint (patient, family, staff member)
Risk management synonymous with complaint management
Usually not pleasant
There is an art to dealing with complaints successfully
Have to be patient
Have to listen
More than one side of a story
Today we are going to talk about ways to deal with complaints successfully

4. objectives Identify standards for dealing with patient complaints
Learn perspectives on dealing with patient complaints
Learn ways to defuse angry complainers
Learn various approaches to managing complaints
Learn to develop safety measures for dealing with difficult people

5. Two perspectives
Regulatory
Human

6. Regulatory perspective

7. CMS/State regulations
Must have a process for patient grievances resolution (policy)
Patient grievance = complaint (not all complaint rise to level of grievance)
Verbal or written
Hospital must inform patient how to file (hospital contact and state agency)
Time frame for review of grievance and provision of response
Written response/follow-up

8. The Joint commission or DNV
Expectation for timely resolution
Can lead to complaint investigations
Patient Rights chapter
Policy
Notification of who to contact and how complaint process works
Governing body responsibility for process
Time frames for handling
Referral to Utilization Review, Quality Management, Peer Review, or Quality Improvement Organization (QIO) as appropriate
Written notice to the patient of decision/resolution

9. Approaches to complaint management
Centralized (handled by one department)
Good control of process
Good follow-up
No surprises if complaint investigation
Decentralized (handled by the affected department)
Individuals close to situation more connected to resolution
Supervisors of persons involved in complaint more accountable for their employees’ performance

10. human

11. Human consideration
Consider all sides (usually three: patient; staff; truth)
LISTEN to both sides
Gather FACTS
Ask parties what they would like to see as resolution
* Some just want someone to listen
*Some have specific requests that are easy to comply
Propose a resolution
*Tell people what you CAN do first
*Tell people what you CANNOT do second (and why)
Be direct with both parties

12. Safety tips

13. Safety first Identify early on if mental issues
Never allow them to be between you and door
Have a plan for dealing with “crazies”
Colleague
Security
Emergency Department
Alarms or code words
Gestures

14. Defuse the situation Stay calm yourself Breathe Relax
Maintain healthy attitude
Allow angry person to vent (within reason)
Demonstrate empathy

15. Defuse the situation cont…. Empathy…DO
DON’T
Allow ample time to respond
Give short responses
Tailor response to situation
Use even voice tone
Try to understand their needs
Automatically give advice
Pretend to understand
Respond with clichés
Sound condescending
Jump to conclusions

16. Defuse the situation cont…..
Master the art of listening
Pay attention
Eliminate “buts”
Repeat what the tell you for understanding
Focus on issues and not on behaviors
Heed warning signs
Always, always, always take threats seriously
Report threats

17. Take action

18. Action steps Log the complaint (name, date, investigation, resolution
Complete the investigation
Determine cause of complaint
Written follow-up (letter, )
Work with staff to change processes in order to avoid same issues again

19. Educate staff

20. Staff education
Always use teaching moments to review what led to the complaint
Obtain input from staff on their feelings about complaint
Review positive ways of dealing with issues so as to avoid complaints
Include staff in the investigation and resolution
Teach staff how to speak with persons filing complaint in a constructive manner after the complaint

21. Staff education cont…… general tips on managing anger
Reduces anger
fuels anger
Lacking respect in tone
Not looking at person
Needing to be right
Sarcasm, humiliation
Aggressive gestures, pointing
Inflexible
Lack of responsiveness
Showing respect
Making eye contact
Open mind
Even, calm tone of voice
Neutral open gestures
Active listening skills
Flexible
Positive phrases
Responsiveness
Follow-up

22. Follow-up

23. Follow-up Restore order after complaint At least once
Staff (visit, phone call, )
Person who filed complaint (written, or letter)
Determine if action was effective
Document follow-up

24. Restore order?????? Facilitate a discussion with parties
Advise not to avoid the angry person (complainer or staff member)
Provide a non-dramatic return to “patient care as usual”
Offer to mediate a follow-up conversation

25. conclusion
Two perspectives to complaint management: Regulatory and Human
Regulatory standards for dealing with complaints (CMS, State, TJC, DNV)
Human perspective: LISTEN; ask what resolution they desire; tell them what you CAN do
Approaches to dealing with complaints: Centralized and decentralized
Safety Tips: Identify mental issues; protect yourself; have a plan
Educate staff
Follow-up (staff, patient, written)

26. Quick reference tips Stay calm
Defuse situations quickly; allow person to vent
Imagine yourself in their place
Encourage others to talk but don’t put them on defensive
Address issues; not behavior
Apologize; make corrections quickly
Allow other person to save face when possible
Give options, choices
Take all threats seriously
Help affected employees get back to normal promptly
Don’t avoid angry person after episode is over
Practice tolerance
Choose behaviors that reduce anger
Be tough and tender

27. Questions ???????