Creating a Patient Complaint Capture and Resolution ...

1 The Joint Commission Journal on Quality and Patient Safety Patient -Centered Care Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient -Centered Representation Cynthia Mahood Levin, MHSA; Joseph Hopkins, MD, MMM. H ealth care organizations today are finding that simply pro- viding a good health care experience is insufficient to meet Patient expectations. Organizations must train staff to Article-at-a-Glance Background: A growing body of evidence suggests that provide excellent customer service to all patients . Many patients Patient (including family) feedback can provide compelling have become savvy health care consumers and consider cus- opportunities for developing risk management and quality tomer service when they evaluate the quality of care they re- improvement strategies, as well as improving customer sat- ceive.

2 The challenge for health care organizations is that patients isfaction. The Patient Representative Department (PRD) at want and expect not only outstanding clinical interventions but Stanford Health Care (SHC) (Stanford, California) created also excellent customer service on every single (p. 25) a streamlined Patient Complaint Capture and Resolution pro- A growing body of evidence suggests that Patient (including cess to improve the Capture of Patient complaints and griev- family) feedback can provide compelling opportunities for de- ances from multiple parts of the organization and manage veloping risk management and quality improvement strategies, them in a centralized database.

3 As well as improving customer 5 Research links pa- Methods: In March 2008 the PRD rolled out a data man- tient dissatisfaction with malpractice claims and unnecessary agement system for tracking Patient complaints and gener- 10 Cold food, rude behavior, long waiting periods, ating reports to SHC leadership, and SHC needed to mod- and quality of care concerns should be taken seriously by hos- ify and address its data input procedures. A reevaluation of pital leadership not only because such attention is addressed the overall work flow showed it to be complex, with over- in Joint Commission accreditation standards or required by lapping and redundant steps, and to lack standard process- the Centers for Medicare & Medicaid Services (CMS) but be- es and actions.

4 Best-practice changes were implemented: (1). cause it is the right thing to do. The Joint Commission stan- leadership engagement, (2) increased Capture of complaints , dards speak to the collection of, response to, and documenta- (3) centralized data and reporting, (4) improved average tion of complaints from hospital patients and their families,*11 response times to Patient grievances and complaints , and (5). and CMS deems a time frame of 7 days appropriate for res- improved service recovery. Standard work flows were creat- olution for most complaints , with 21 days for complex com- ed for each category of Complaint linked to specific actions.

5 Plaints. 12 In addition, in July 2008 Joint Commission Sentinel Results: complaints captured increased from 20 to 270. Event Alert 40 stated that disruptive and intimidating physician per month. Links to a specific physician rose from 16% . behavior toward patients and colleagues may lead to medical 36% to more than 80%. In addition, 68% of high-com- errors, poor Patient satisfaction, preventable adverse outcomes plaint physicians improved. With improved work flows, re- sponses to patients expressing concerns met a requirement of * Rights and Responsibilities of the Individual (RI) Standard : The pa- less than seven days.

6 Tient and his or her family have the right to have complaints reviewed by the hos- pital. Conclusions: Standardized work flows for managing com- plaints and grievances, centralized data management and . According to CMS, a Patient grievance is a written or verbal Complaint (when the verbal Complaint about Patient care is not resolved at the time of the Complaint by clear leadership accountability can improve responsiveness staff present) by a Patient , or the Patient 's representative, regarding the Patient 's to patients , Capture incidents more consistently, and meet care, abuse or neglect, issues related to the hospital's compliance with the CMS.

7 Hospital Conditions of Participation (CoP), or a Medicare beneficiary billing com- regulatory and accreditation requirements. plaint related to rights and limitations provided by 42 CFR 489.. 484 November 2014 Volume 40 Number 11. Copyright 2014 The Joint Commission The Joint Commission Journal on Quality and Patient Safety and increased costs of Therefore, all health care entities ports. In reevaluating its overall work flow in 2008 (Appendix must thoroughly investigate and document Patient complaints 1, available in online article), PRD found it to be complex, with and grievances and respond in a timely fashion.

8 Stanford Health overlapping and redundant steps; lacking in standard processes Care (known as Stanford Hospital & Clinics until July 2014) and actions; and not meeting certain requirements, such as the (SHC; Stanford, California) implemented a robust process to CMS requirement for 7- and 21-day The PRD col- measure and analyze all Patient feedback to improve process- laborated with the Compliance, Risk Management, and Qual- es and Patient satisfaction. SHC views management of Patient ity and Safety Departments in an effort to better understand complaints and grievances as an area to infuse Patient -centered how to quickly and efficiently move Patient concerns through care.

9 The institution is committed to hear, record, and respond the review, investigation, and response process. The review re- to Patient concerns. Hearing is critical because an organization vealed uncertainty as to when to hand off Patient concerns to cannot fix problems if it is not aware of them; recording is es- the appropriate department(s), the level of collaboration need- sential to allow for providing metrics of performance and iden- ed, and when to consider the file closed. tifying patterns; and responding is the hallmark of service recov- Modification of Work Flow.

10 Following this analysis, work- SHC's Patient Representation Department (PRD), which flow improvements were developed. Modifications included is part of Guest Services, is tasked with the responsibility of adding very specific steps for documentation and handoffs, managing all complaints and grievances on behalf of the orga- contacting appropriate parties for investigation, and collabo- nization. During an 18-month period, the PRD embarked on rating with appropriate departments to conclude and close a a mission to develop robust processes to monitor and address Complaint .