MANAGING T

HE

COMPLAIN

T

PROCESS

LY N N E A N D E R S O N , FA C H E , C P H R M R H I A

M AY 1 4 , 2 0 1 51

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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 3

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

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TWO PERSPECTIVES

• Regulatory

• Human

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REGULATO

RY

PERSPE

CTIVE

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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

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THE JOINT COMMISSION OR DNV• Expectation for timely resolution

• Can lead to complaint investigations

• Patient Rights chapterPolicyNotification of who to contact and how complaint process works

Governing body responsibility for processTime frames for handlingReferral to Utilization Review, Quality Management, Peer Review, or Quality Improvement Organization (QIO) as appropriate

Written notice to the patient of decision/resolution

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APPROACHES TO COMPLAINT MANAGEMENT

• Centralized (handled by one department)Good control of processGood follow-upNo 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 9

HUMAN

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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

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SAFETY

TIP

S

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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

 

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DEFUSE THE SITUATION

• Stay calm yourselfBreatheRelaxMaintain healthy attitude• Allow angry person to vent

(within reason)• Demonstrate empathy

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DEFUSE THE SITUATION CONT….EMPATHY…DO

• Allow ample time to respond

• Give short responses

• Tailor response to situation

• Use even voice tone

• Try to understand their needs

DON’T• Automatically

give advice

• Pretend to understand

• Respond with clichés

• Sound condescending

• Jump to conclusions

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DEFUSE THE SITUATION CONT…..• Master the art of listening

Pay attentionEliminate “buts”Repeat what the tell you for understanding

• Focus on issues and not on behaviors

• Heed warning signsAlways, always, always take threats seriously

Report threats

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TAKE A

CTION

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ACTION STEPS

• Log the complaint (name, date, investigation, resolution

• Complete the investigation• Determine cause of complaint• Written follow-up (letter, email)• Work with staff to change

processes in order to avoid same issues again

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EDUCATE S

TAFF

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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

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STAFF EDUCATION CONT……GENERAL TIPS ON MANAGING ANGERFUELS ANGER

• Lacking respect in tone

• Not looking at person

• Needing to be right

• Sarcasm, humiliation

• Aggressive gestures, pointing

• Inflexible

• Lack of responsiveness

REDUCES ANGER• Showing respect

• Making eye contact

• Open mind

• Even, calm tone of voice

• Neutral open gestures

• Active listening skills

• Flexible

• Positive phrases

• Responsiveness

• Follow-up

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FOLL

OW-U

P

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FOLLOW-UP

• Restore order after complaint• At least once

Staff (visit, phone call, email) Person who filed complaint

(written, email or letter)• Determine if action was effective• Document follow-up

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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

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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)

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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 tender26

QUESTIONS

???????

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