Turn every patient complaint into a QI study
Turn every patient complaint into a QI study
Integrate handling of complaints with your hospital
(Editor’s note: In this first of a two-part series on patient complaints, Hospital Home Health takes an in-depth look at how two hospital-based home care agencies strictly track and monitor patient complaints. Next month, we ll provide tips on the best ways to review your own patient complaint tracking system.)
It’s human nature for individuals to keep most complaints to themselves. But for those in the service industry, that’s not always good. While you don’t necessarily want to hear every patient voice every minor inconvenience, it’s good to hear what their major complaints and concerns are. For agencies without a thorough patient complaint tracking system, a trend that leaves a poor impression on patients could last indefinitely or at least until a patient finally speaks up.
That could have been the case for Southern Home Care, in Jeffersonville, IN. Patients were unhappy with the number of different nurses they were seeing. But the agency was made aware of the trend early on and was able to change its processes and thus bring the patient complaints in that area to a halt because it had provided an outlet for patients to complain and for the agency to react quickly to those complaints.
"They called them Heinz 57 nurses," says Lorraine Waters, BSN, C, MA, executive director. "We probably wouldn’t have caught that [trend] as quickly if we hadn’t had the system in place."
To solve the problem, the company changed the way it scheduled its nurses.
Now, nurses are much less likely to change their schedule. Also, scheduling receives top priority with continuity of care from the patient’s perspective first and foremost. Scheduling had been pushed down below management level but has since returned to a management responsibility. Patient complaints regarding continuity of care ceased shortly thereafter.
Many hospital-based home care agencies don’t take the time to track all complaints about their services, leaving them blind to problem trends that might have cropped up. It’s not hard to track patient complaints, but it does require some time and effort.
Hospital Home Health talked with two hospital-based home care providers that track patient complaints and then take the extra step often overlooked by many agencies to integrate these efforts into their hospitals’ patient satisfaction programs. Here is how their systems work.
Southern Home Care and Contin-U-Care Home Health in Chattanooga, TN, use comprehensive systems for recording and tracking complaints that patients or others make about the companies’ services. These include:
• Patients are continually reminded to call if they have a complaint.
Contin-U-Care Home Health’s patients are instructed at admission to home care and at almost every subsequent visit to call the agency if they have any problems with the service provided, says Nancy Woods, RN, specialty services director.
At admission, patients are given the agency’s phone numbers and the state’s toll-free hotline number for making official complaints about home care providers. In case patients feel uncomfortable calling in their complaints, the company also provides them with a pre-addressed form on which they can write their complaints and send them into the agency.
"Our field staff always ask how things are going and whether we can do anything differently for them," Woods explains. "We remind them at almost every contact we have with them to call us if they have a problem."
Upon admission, patients of Southern Home Care are given an information sheet containing all of the telephone numbers for the state health care hotline and for the company and its various branches. The information sheet also lists the phone number of Waters.
"No one has ever called it, but it’s there. I want them to know they can always call me," Waters says.
• Complaint recipient completes Opportunity For Improvement form.
All Southern Home Care employees are instructed at orientation to refer any complaint that comes in through phone, mail, or in person to a member of the agency’s management team or to the aide supervisor if the complaint is about an aide. These management team members handle and resolve the complaint, and fill out a complaint record. (See sample complaint tracking form, p. 113.)
When a patient or other party makes a complaint, the Contin-U-Care employee who receives the complaint fills out an Opportunity For Improvement (OFI) form. The OFI asks the recipient of the complaint to record the nature of the complaint including who made it and to write down possible solutions to the problem. Employee complaints aren’t handled through this system.
All employees, from receptionists and aides on up to the top managers, fill out OFIs. If the recipients can handle and solve the problems on their own, they do so. If not, they must notify their supervisors.
The employees who receive complaints must follow up on the complaint to ensure the problem reported was fixed, even if they already notified their supervisors. This follow-up also must be documented on the OFIs.
• Agency administrator reviews complaint.
Once staff at Contin-U-Care have written an OFI, they give one copy to the agency administrator who reviews it, makes sure the problem was solved satisfactorily and takes any further action necessary.
The agency administrator then gives that copy of the OFI to Contin-U-Care Home Health’s quality improvement (QI) coordinator.
Southern Home Care’s complaint records do considerable mileage as they circulate through home care and hospital management:
One copy of every report goes to the executive director, Waters.
One copy goes to the hospital’s vice president of nursing, to whom Waters reports.
One is sent to the CEO of Southern Home Care’s hospital, Clark Memorial Hospital, also in Jeffersonville, IN.
The hospital’s guest relations committee, which handles patient satisfaction, receives the CEO’s copy of complaint reports once the CEO’s office has reviewed them.
The hospital’s QI committee receives a copy of the complaints;
Another copy of the report is kept in Southern Home Care’s patient complaint log book, which is kept in chronological order.
A description of the complaint and its resolution is entered into a master list of all patient complaints, which also is kept in the patient complaint log book. (See sample log book master list of patient complaints, below.)
• QI coordinator reviews complaints and tabulates complaint data.
The QI coordinator reviews each OFI immediately after she receives it. Once a month, she compiles the OFIs and tabulates the data from them to look for any developing trends. For example, one month the QI coordinator might find a number of complaints that the company lets its telephones ring too long before answering them.
When the QI coordinator spots a trend, she alerts the relevant department director, who is then responsible for making improvements.
At Southern Home Care, Waters reviews all complaint reports to ensure problems have been resolved and recorded satisfactorily.
• Committee/management reviews complaint reports.
The QI coordinator also compiles a report from her tabulations of the OFIs every month. After alerting the QI manager, she provides the tabulations to the QI committee, which consists of all members of the agency’s upper management. If any problem trends are evident, the QI committee discusses them with the relevant department heads to determine causes and possible solutions.
Contin-U-Care Home Health’s patient complaint tracking system was started a year ago after middle managers at the company said that, although they spent considerable time handling customer complaints, upper level management never found out about them and therefore could not spot problem trends.
The program was first developed and used in Contin-U-Care’s private duty division, then expanded to the home care division, the durable medical equipment division, and the 13 other home care agencies with which the company is affiliated. Also, Woods and her colleagues helped set up the same system at the occupational medicine department of Contin-U-Care Home Health’s hospital, Erlinger Medical Center, also in Chattanooga.
Once a month, the Southern Home Care management team reviews all complaints filed in the preceding month to check for problem trends. The team asks itself some of these questions:
Does further research need to be done on the causes of the reported complaints?
Were the resolutions to the complaints satisfactory?
Is a larger change in process needed to prevent future complaints?
Were the complaints valid?
Send them to hospital’s guest relations
For Southern Home Care, the hospital CEO’s office reviews all complaint reports and forwards them to the hospital’s guest relations committee, which is responsible for patient satisfaction. Any concerns the CEO’s office has about a complaint are relayed through the hospital’s guest relations committee. Southern Home Care’s hospital QI committee also reviews all of home care’s complaint records. The home care QI manager is on the hospital QI committee.
• The hospital’s guest relations committee reviews complaints.
The hospital’s guest relations committee also reviews home care patients’ complaints. The discussions of this committee are easily communicated to the home care agency’s management, as the home care education manager is on the hospital’s committee. Also, a member of that committee always calls Waters to ask any questions the committee has about the home care patient complaint reports, and to ask whether the problem was resolved.
"We have an agency representative," says Waters. "We address the problems ourselves. It’s not the responsibility of the committee to say Here’s a problem, do something.’"
Getting the hospital involved has helped the hospital staff stay current on how well the home health agency is performing in relation to patient satisfaction.
"They know what we’re doing, rather than just wondering if things are going well," she says
During a Joint Commission survey, Waters said the surveyor was impressed with her agency’s process.
"They liked it a lot," she says. "They were impressed with how thorough it was."
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