According to Medicare's Conditions of Participation, a hospital must protect and promote each patient's rights.  Part of this federal regulation states that a hospital must establish a process for prompt resolution of patient grievances and must inform each patient whom to contact to file a grievance. The hospital's governing body must approve and be responsible for the operation of this process, unless the responsibility is delegated in writing. There must be timely referral of patient concerns regarding quality of care or premature discharge issues. The hospital must establish a clearly explained procedure for a patient to submit a written or verbal grievance and there must be time frames specified for review and response. The hospital must provide written notice of the decision in the resolution, which contains the name of the hospital contact person, steps taken on behalf of the patient regarding the investigation, the results of the process and the date of completion.

The emphasis on encouraging customer comments should be consistent with a healthcare organization's framework for performance improvement and the organization's policy on patient grievances. The acceptance of those comments/concerns should be expected of all employees. If a concern is not resolved immediately, it should follow the organization's grievance process and be documented through the event reporting system. All actions taken in response to customer concerns or comments should be undertaken with the goal of improving care and service delivery, and should include:

• investigation and resolution of customer concerns
• routing of positive comments to the appropriate departments
• identifying trends in care, service delivery, and system organization
• developing solutions, implementing changes to improve care and service

Patient grievances are formal or informal, written or verbal complaints made to the hospital by a patient or the patient's representative when prompt resolution is not possible. When a complaint cannot be resolved promptly by staff present or is referred to the risk manager or administrator it is considered to be a grievance. Billing issues are not normally considered a grievance unless the patient or his/her representative requests that it be treated as such.

Follow-up responses can include written or telephone responses or formal meetings with administrative staff addressing the identified concerns. The organization event reporting policy should include tracking and trending the concerns and the corrective action. Risk/patient safety issues should be forward to the organization's patient safety committee for evaluation and recommendation as appropriate.

It is extremely important to know your organization's policy with regard to grievances. Patients admitted to acute care hospitals are afforded the protection of a number of rights established under state and federal law. Information about patient rights and the hospital grievance procedure is normally provided to the patient upon admission to the hospital and is communicated in both oral and written form. Acute care hospitals want all of their patients to have a safe, satisfactory experience while there and provide the highest quality service to patients and their families.

Resources

§ 482.13 Medicare Condition of Participation: Patients' Rights.

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