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

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

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

Two perspectives Regulatory Human

Regulatory perspective

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

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

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

human

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

Safety tips

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  

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

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

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

Take action

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

Educate staff

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

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

Follow-up

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

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

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)

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

Questions ???????