01.02.06. Patient and family complaints
Patient and family complaints are addressed promptly with empathy and understanding
Complaints in practice
- A complaint is a verbal issue brought forward by a patient, a family member or the patient’s SDM (substitute decision maker) that is minor in consequence severity.1
- The complaint can be resolved promptly or within 24 hours and requires only the involvement of the staff who are present at the time of the complaint.
- Complaints are handled before the patient leaves the department whenever possible.
- Most complaints will not require a facility to send a written response to the patient; however, it should still be documented formally within the facility.
- A complaint can become a grievance if the complaint is not resolved.
- A grievance is a formal or informal complaint (written or verbal) that is made to the facility by a patient, a family member or the patient’s SDM. The issue has moderate to severe consequences (e.g., patient rights violation, facility compliance with regulations) or represents a complaint not resolved at the time by staff present.1
- Patients and family members can make formal complaints to a regulatory body, even if the complaint has been resolved at the facility level.
- Common patient/family/SDM complaints in a clinical setting include those related to2–5:
- Members of the healthcare team (e.g., poor communication, lack of cultural sensitivity)
- The environment (e.g., cleanliness, appropriate equipment, space issues)
- Departmental efficiency (e.g., significant delays, inconsistent or lack of policies)
- Aspects of patient care (e.g., continuity and follow-up, care service limits)
- Adverse incidents, including post-communication issues
- Individuals from minority populations and underserved communities often avoid voicing complaints even when they experience significant problems with care delivery.6
- Many people, even those not typically considered vulnerable groups, fear that voicing a complaint could jeopardize the quality of the clinical care they receive.7,8
- MRTs are responsible for being familiar with and following facility complaints policies and procedures.
- The local department that supports patient and family relations can be contacted for guidance when responding to a complaint or grievance. Union representatives may also need to be contacted for grievances.9
- MRTs are ethically bound to file a complaint to the appropriate regulatory authority where the conduct or competence of an MRT could be considered professional misconduct and/or professional incompetence.
Concern resolution process
- MRTs and/or their departmental leadership can often effectively manage complaints to the satisfaction of the patient, family member or SDM.
- MRTs and/or their departmental leadership should take the necessary time to fully acknowledge the concern being voiced10:
- Listen fully to the complaint and respect the patient, family member or SDM’s right to express concerns
- Ask questions to ensure the experience and perspective is understood
- Validate and confirm the patient/family/SDM’s perspective
- Avoid taking a defensive approach; be fair and objective in responses
- Once the complaint has been heard and understood, MRTs and/or their departmental leadership may discuss a possible resolution(s) to the complaint:
- Offer practical suggestions and discuss how a resolution can be made10
- Give clear and honest explanations throughout, take into consideration any needs the individual may have (e.g., cognitive ability, cultural understanding)10
- Take action to implement the solution offered, within scope of practice and workplace duties
- Confirm patient, family member or SMD’s satisfaction with the response, or if not, that the matter will be taken to facility administration
- MRTs need to consider patient privacy at all times while also ensuring personal and patient safety concepts (i.e., ensuring others are close by in case of emergency).10
- If it has been alleged that a patient’s rights have been violated, immediately alert the department supervisor or act in accordance with facility policies and procedures.
- MRTs should complete any documentation in a comprehensive, consistent and timely manner, and include information such as11:
- Offers to meet with the patient, family member, or SDM to discuss concerns
- Record of voice messages, telephone discussions and electronic communications
- Disclosure and other in-person meetings
- Options and alternatives provided to resolve complaint
- Response by patient, family member or SDM
- It is possible that there may be a delay between an incident and a complaint or grievance. MRTs should consult their department’s leadership to determine if completing documentation is required for an incident in advance of a potential complaint (e.g., provide written description of the incident).
- If an MRT is asked to respond to a complaint from a regulatory college, the MRT should seek legal counsel for any formal response to the regulatory college.
Learning from the complaint process
- Patient complaints are a widely accepted measure of patient satisfaction with healthcare service. Analysis of complaints can inform improvements in service quality, and contribute towards overall health systems performance.12
- Health care complaints are an underutilized resource for quality and safety improvement.13
- The knowledge gained from such complaints can support workplace cultures where staff are unwilling or unable to raise quality and safety issues themselves14
- Responding to complaints can also benefit the facility by1:
- Improving safety and quality of care
- Restoring the trust and confidence of patients and those who care for them
- Increasing efficiency through quick and simple resolution of complaints
- Promoting a culture of reporting and accountability
- Creating a more satisfactory working environment
- Building a reputation as a learning organization
References
- Centers for Medicare and Medicaid Services. State Operations Manual. Appendix A—survey protocol, regulations and interpretive guidelines for hospitals. Published online November 20, 2015. Accessed January 24, 2022. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf
- van den Berg PF, Yakar D, Glaudemans AWJM, Dierckx RAJO, Kwee TC. Patient complaints in radiology: 9-year experience at a European tertiary care center. Eur Radiol. 2019;29(10):5395-5402. doi:10.1007/s00330-019-06158-z
- Liu X, Faes L, Kale AU, et al. A comparison of deep learning performance against health-care professionals in detecting diseases from medical imaging: a systematic review and meta-analysis. Lancet Digit Health. 2019;1(6):e271-e297. doi:10.1016/S2589-7500(19)30123-2
- RÅBERUS A, HOLMSTRÖM IK, GALVIN K, SUNDLER AJ. The nature of patient complaints: a resource for healthcare improvements. Int J Qual Health Care. 2019;31(7):556-562. doi:10.1093/intqhc/mzy215
- Mack JW, Jacobson J, Frank D, et al. Evaluation of Patient and Family Outpatient Complaints as a Strategy to Prioritize Efforts to Improve Cancer Care Delivery. Jt Comm J Qual Patient Saf. 2017;43(10):498-507. doi:10.1016/j.jcjq.2017.04.008
- Turpel-Lafond ME. In Plain Sight: Addressing Indigenous-Specific Racism and Discrimination in B.C. Health Care. BC Ministry of Health; 2020. Accessed January 24, 2022. https://engage.gov.bc.ca/app/uploads/sites/613/2020/11/In-Plain-Sight-Full-Report.pdf
- Howard M, Fleming ML, Parker E. Patients Do Not Always Complain When They Are Dissatisfied: Implications for Service Quality and Patient Safety. J Patient Saf. 2013;9(4):224-231. doi:10.1097/PTS.0b013e3182913837
- Scott DAH, Grant SM. A meta‐ethnography of the facilitators and barriers to successful implementation of patient complaints processes in health‐care settings. Health Expect Int J Public Particip Health Care Health Policy. 2018;21(2):508-517. doi:10.1111/hex.12645
- Canadian Labour Congress. Section 4: Grievances. Canadian Labour Congress. Accessed January 24, 2022. https://canadianlabour.ca/uncategorized/section-4-grievances/
- Health Quality Council of Alberta. Patient Concerns Management: A Framework for Alberta. Published online 2017. Accessed January 24, 2022. https://hqca.ca/wp-content/uploads/2018/05/HQCA_Patient_Concerns_Framework_062217.pdf
- Healthcare Insurance Reciprocal of Canada. Management of Patient and Family Complaints. Published 2020. Accessed January 24, 2022. https://www.hiroc.com/resources/risk-reference-sheets/management-patient-and-family-complaints
- Mirzoev T, Kane S. Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature? Glob Health Action. 2018;11(1):1458938. doi:10.1080/16549716.2018.1458938
- O’Dowd E, Lydon S, Madden C, O’Connor P. A systematic review of patient complaints about general practice. Fam Pract. 2020;37(3):297-305. doi:10.1093/fampra/cmz082
- Newdick C, Danbury C. Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire. J Med Ethics. 2015;41(12):956-962. doi:10.1136/medethics-2012-101048
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