1. ©VUMC, 2005 1 Service Recovery Jodi Fawcett Director, Office of Patient Affairs © CPPA, OPA & VUMC, 2005

2. ©VUMC, 2005 2 It’s Who We Are! Our goal at Vanderbilt is to identify and to the best of our ability address patient and family concerns, complaints and grievances. “It’s Who We Are!”

3. ©VUMC, 2005 3 What is Service Recovery? Making right what went wrong Rebuilding positive feelings and satisfaction Learning from our customers and each other © CPPA, OPA & VUMC, 2005

4. ©VUMC, 2005 4 … Consumer and medical literature indicate voiced complaints represent only a small fraction … for every pt/fm that complains there are many more … Annandale. Accounts of disagreements with doctors. Soc Sci Med 1998. Carroll. Characteristics of Families that Complain Following Pediatric Emergency Visits. Ambulatory Pediatrics. 2005. "Consumer Complaint Handling in America: An Updated Study for the U.S. Office of Consumer Affairs," 1986. Tip of the Iceberg © CPPA, OPA & VUMC, 2005

5. ©VUMC, 2005 5 Lawsuits Voiced Complaints Non-adherence Spectrum of Patient Dissatisfaction Drop outs (tip of the iceberg) © CPPA, OPA & VUMC, 2005

6. ©VUMC, 2005 6 Preferred Service Recovery Model Level 1: Concerns are addressed immediately by employee using HEART Level 2: Concerns are addressed at employee or management level with additional tools Level 3: Employee/manager refers Patient/Family or concern to Patient Advocate in the Office of Patient Affairs for assistance with resolution © CPPA, OPA & VUMC, 2005

7. ©VUMC, 2005 7 H-E-A-R-T Protocol 1 1)Hear the patient 2)Empathize 3)Apologize* 4)Respond to the problem 5)Thank the patient/family member for sharing their concerns 1 From C. Santalucia, Cleveland Clinic Foundation, 2002 * Really acknowledge and sometimes apologize © CPPA, OPA & VUMC, 2005

8. ©VUMC, 2005 8 H ear the Patient Introduce yourself Focus on the person; be aware of your body language Ask open-ended questions –Tell me what happened? –How can I help? Be very slow to interrupt Avoid defensiveness © CPPA, OPA & VUMC, 2005

9. ©VUMC, 2005 9 Empathize Reflect the feelings –‘I am sure this is frustrating’ –‘This is upsetting …’ –‘I can appreciate how helpless you must feel’ Remember your body language © CPPA, OPA & VUMC, 2005

10. ©VUMC, 2005 10 Apologize* Tell the patient/family we are concerned about … Apologize that we have not met … If appropriate apologize Be positive Don’t joust * Acknowledge © CPPA, OPA & VUMC, 2005

11. ©VUMC, 2005 11 R espond to the Problem Tell the customer what you will do … Give a time frame for getting back Follow through … © CPPA, OPA & VUMC, 2005

12. ©VUMC, 2005 12 T hank the person ‘I appreciate the fact you shared … with me.’ ‘Thank you for taking the time to give feedback …’ ‘Your concerns are important …” © CPPA, OPA & VUMC, 2005

13. ©VUMC, 2005 13 What if H.E.A.R.T. is not enough? If the pt/family remains unsatisfied 1.Speak with the Manager on duty 2.Consider a Voucher 3.Refer to OPA or other resources © CPPA, OPA & VUMC, 2005

14. ©VUMC, 2005 14 Talking to the Manager on Duty Succinct presentation of the dissatisfaction What you have already tried Patient’s response Your suggestion for next step © CPPA, OPA & VUMC, 2005

15. ©VUMC, 2005 15 Voucher Option picture of the voucher… © CPPA, OPA & VUMC, 2005

16. ©VUMC, 2005 16 Before considering a voucher you should take the Patient/Family’s Emotional Temperature and consider the perceived cause of the frustration. It is NOT always appropriate to offer a voucher. © CPPA, OPA & VUMC, 2005

17. ©VUMC, 2005 17 The Voucher is that little something extra… “I know that this voucher can not make up for your concern but we would like for you to use this as an additional way for us to say that we do care about your experience here at Vanderbilt.” © CPPA, OPA & VUMC, 2005

18. ©VUMC, 2005 18 Example of Completed Voucher Page 1 Jane Doe Emergency Department Holly Berry/26154 # 005 Holly Berry/10/13/05 © CPPA, OPA & VUMC, 2005

19. ©VUMC, 2005 19 Example of Completed Voucher Page 2 John Doe 005005555 10-13-0510:00 PM Adult Emergency Dr. Marcus Welby Pt’s wife was upset that wait was over 8 hours in the ED before getting a bed assignment. She said that the response from the nurse, Margaret Houlihan, was very rude in saying “I am sorry I am too busy to answer you now”. Margaret Houlihan is the charge nurse Listened to the concerns and explained reasons behind wait. Let pt know that I would pass nursing concerns on to the manager. Wife and patient feel better. © CPPA, OPA & VUMC, 2005

20. ©VUMC, 2005 20 Completing the Voucher Distribution Forms STAFF: Complete the Service Recovery Coupon and place in designated place for manager review. MANAGEMENT: Review the issues and deliver forms to OPA TRENDS: OPA will document and trend events requiring the use of coupons for Service Recovery © CPPA, OPA & VUMC, 2005

21. ©VUMC, 2005 21 Service Recovery includes Understanding Appropriate Acknowledgment of Patient Complaints & Grievances “It’s Who We Are”

22. ©VUMC, 2005 22 Definition of Complaint Complaint – –A concern regarding patient care or services that can be resolved at the point of service by the staff present. –A post-hospital-stay verbal communication regarding concerns that would routinely have been handled by staff present if communication had occurred during the hospital stay/visit –Billing or Privacy issues that do not include patient quality of care issues.

23. ©VUMC, 2005 23 Definition of Grievance Grievance –Patient Care issues which are not promptly resolved by staff present –A complaint that includes a request that it be formally filed –A complaint that is communicated in writing or includes a request for a written response –Verbal or written complaints that involve patient abuse, neglect, patient harm, or hospital compliance with CMS Conditions of Participation –Complaints written or attached to a patient satisfaction survey for which resolution is requested, or when the compliant submitted with the survey is one that the hospital would customarily treat as a grievance

24. ©VUMC, 2005 24 CMS Guidelines ComplaintGrievance Concern addressed following Service Recovery Policy guidelines. Office of Patient Affairs to be notified and ad hoc grievance committee formed. Concern addressed following Service Recovery Policy guidelines. No written response required if concerns are resolved at the point of service. Written response generated to the patient or patient’s representative within 7 days to notify of resolution or that resolution is in process. Grievance is considered closed when the patient, or representative, is satisfied with actions taken OR when the hospital has taken appropriate and reasonable actions to resolve concerns.

25. ©VUMC, 2005 25 The Role of OPA Engage in crisis prevention by interpreting the institution’s philosophy, policies, procedures, and services to patients and families Serve as the centralized grievance mechanism for the institution, ensuring CMS guidelines with regard to grievances are met Act as a liaison between patients and families and the organization Collect and channel concerns/perceptions about patient care situations to the appropriate management, physicians, and departments so corrective action maybe taken Coach staff in service recovery efforts

26. ©VUMC, 2005 26 How to refer to OPA Ask Patient/Family member to call 322- 6154 and ask to speak with a patient advocate Let Patient/Family member know that you will call 322-6154 on their behalf and that a patient advocate may follow up Ask Patient/ Family to stop by the OPA office for face to face discussion © CPPA, OPA & VUMC, 2005

27. ©VUMC, 2005 27 How to refer to OPA Encourage patient family to send a letter to OPA Show patient family the In-Patient Guidebook or in VUH Interactive Television regarding the services offered by Patient Affairs Refer to Vanderbilt Office of Patient Affairs Website © CPPA, OPA & VUMC, 2005

28. ©VUMC, 2005 28 To OPA when: Concerns involve several departments Complaints involve physicians Patient asks to terminate an MD/pt relationship Complaint is unresolved (or repeat complaint) © CPPA, OPA & VUMC, 2005

29. ©VUMC, 2005 29 To OPA when: Allegations of Malpractice, threats to call the media (Involve OPA and Risk Management) Concerns relate to a bad outcomes (Involve OPA and Risk Management) Concern is presented in writing. Patient/Family request to file a “formal complaint”. © CPPA, OPA & VUMC, 2005

30. ©VUMC, 2005 30 To OPA when: Allegations of abuse/boundary issues (Involve OPA,VUPD, and Risk Management) Complaints regarding Confidentiality Issues (Involve Privacy Office and OPA) Concerns are about patient /injury sustained while on Vanderbilt property (Involve Risk Management – Veritas-RM) © CPPA, OPA & VUMC, 2005

31. ©VUMC, 2005 31 TEAMWORK Service recovery is the responsibility of each staff & faculty member. When patients are angry or upset, they see each of us as a representative of the entire Medical Center. © CPPA, OPA & VUMC, 2005

32. ©VUMC, 2005 32 When In Doubt… Refer Questions to: The Manager on Duty The Office of Patient Affairs Policies available on line OP 10-10.25 Service RecoveryService Recovery OP 10-10.28 Complaint and Grievance ResolutionComplaint and Grievance Resolution © CPPA, OPA & VUMC, 2005

33. ©VUMC, 2005 33 Contact Jodi Fawcett 615-322-6154 jodi.fawcett@vanderbilt.edu © CPPA, OPA & VUMC, 2005