Patient Compl p ai l n ai t n s/ s G / r G ie i vanc van es

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1 Patient Complaints/Grievances

2 What all Employees Need to Know MCMH strongly encourages patients and/or the patient s representative to exercise their right to issue a complaint. Patients and families can freely express their complaints without fear of retaliation, discrimination, or interruption of their care. Voicing a complaint is encouraged as it allows us to learn how we can improve services and care at MCMH. Employees are also encouraged to speak up and let us know about concerns and complaints they may have.

3 Patient Rights Patients and/or their representative have the right to make a complaint. Patients have the right to file a complaint internally or report it directly to DHHS (Department of Health and Human Services) and with The Joint Commission.

4 Employee Responsibilities All employees have a role in assisting a patient and/or the patient s representative with a complaint. There is no Complaint Department. Complaints are handled by everyone working together to do what is best for the patient. If a patient and/or their representative comes to you with a complaint or grievance, you must act.

5 Complaint Process If a patient and/or their representative approaches you with a concern, complaint or grievance: 1. Listen patiently. Use your Service Recovery Skills. 2. Ask him/her how he/she would like the situation resolved. 3. Correct any problems within your scope of responsibility. 4. If you need assistance, ask a Supervisor or Manager for help.

6 Complaint Process continued If a complaint related to patient care cannot be resolved at the time of the complaint by staff, or It needs to be postponed for later resolution or It needs to be referred to other staff for assistance or It requires investigation and/or requires further action The complaint should be documented on QSTATIM. This is the event reporting software used by MCMH to document and track patient, family, and staff complaints and to ensure that each complaint is appropriately reviewed and promptly addressed. The QSTATIM link is located on the hospital intranet (Gold star icon on your computer desktop).

7 Click here QSTATIM

8 QSTATIM Then click here

9 QSTATIM What should be entered into QSTATIM: Both verbal and written complaints from the patient and/or the patient s representative. All verbal or written complaints regarding abuse, neglect, patient harm, or hospital non-compliance with regulatory requirements. The complaint when the patient or patient s representative requests that his or her complaint be handled as a formal complaint, grievance or when the patient requests a response from the hospital.

10 Complaint or Not a Complaint? Information obtained from the patient satisfaction surveys usually do not meet the definition of a complaint/grievance unless the patient writes or attaches a written complaint on the survey and requests resolution. Billing issues are not usually considered as complaints/grievances, however a Medicare Beneficiary billing complaint related to rights and limitations are considered a grievance.

11 Complaint Process continued Complaints involving situations that place the patient in immediate danger will be immediately referred to the Nursing Supervisor after all measures to protect the patient s safety have been taken (e.g. protective services, notification of police). Complaints involving significant patient care issues will be referred to the Nursing Supervisor or the Administrator on-call immediately. The CEO, or designee, will also be notified as soon as possible and will coordinate any necessary reporting to external resources.

12 Complaint Process continued The department manager most closely involved with the patient complaint will review, investigate and resolve the complaint, consulting with staff or other departments as appropriate. This process must be completed in a reasonable timeframe (7 business days). If the complaint cannot be resolved within 7 business days, the complainant must be informed. Department Managers are encouraged to consult with their senior leader or Quality Department for guidance regarding the handling of each complaint.

13 Complaint Resolution A complaint/grievance is considered resolved when the complainant is satisfied with the actions taken on their behalf. There may be situations where the hospital has taken appropriate and reasonable actions on the complainant s behalf, in order to resolve the grievance, and the complainant remains unsatisfied with the actions. In these situations, the grievance may be considered closed for the purpose of the CMS (Centers for Medicare and Medicaid Services) requirement.

14 Conclusion If you have any questions regarding complaints/grievances, please speak with your Department Head or Supervisor or contact the Quality Department.