TJC's take on patient complaints
What are the differences between TJC and CMS?
According to The Joint Commission's John Herringer, associate director, standards interpretation group, its policy on patient "complaints" has not really changed. And he says it mirrors the Centers for Medicare & Medicaid Services' (CMS') patient grievance Condition of Participation (CoP), despite the semantic difference between identifying it as grievance (per CMS) and complaint (per TJC).
"We've always called it complaints, and it's been around for years, and if you look at the CMS definition, they define grievance as a complaint. When we were deciding whether to make any changes, we weren't going to get hung up on semantics. So we felt like our process, and [CMS] also felt like our process, met the intent of the Condition of Participation [CoP]. So we didn't make any changes," Herringer says. He says in most "hospital speak," a grievance tends to be used "more from an HR labor perspective for employee grievances, not for patients."
Any changes that were made to the complaint standard, he says, were in line with the editorial changes made as part of The Joint Commission's Standards Improvement Initiative, which aims to clarify language and redundancies.
He says there is no distinction between grievance and complaint and that all complaints should be handled by the complaint process spelled out in Standard RI.01.07.01. "Whatever complaint the patient registers, whatever terminology they want to use, they have to have the resolution process. So we're not getting into all this trying to make a distinction at all between grievance and complaint. It's whatever issue they raise," he says.
The standard requires that patients also be informed about their right to complain and the complaint resolution process. If not immediately resolvable, hospitals "have to acknowledge receipt of the complaint that the hospital cannot resolve immediately and notify the patient" that it will take some time, Herringer says.
He also notes that the standard allows hospitals to determine their own time frame on resolution of patient complaints, adding that CMS also does this, though CMS does have guidance on the time span of the resolution process. He also says there is an element of performance "that simply says the process for resolving complaints includes a mechanism for timely referral to patient complaints regarding quality of care or premature discharge to the quality improvement organization."
Surveyors, he says, will simply survey against whatever policy a hospital has defined. They will start, he says, by asking the hospital what its policy is and how it informs its patients of their rights. While CMS does distinguish grievances as those not resolved immediately by staff present and has some exclusions — for instance, certain responses to patient satisfaction surveys — Herringer says, The Joint Commission's definition of "complaint" is inclusive and CMS is satisfied with its policy and flexible definition.
The differences between TJC, CMS policies
But Sue Dill Calloway, RN, Esq., BSN, MSN, JD, director of hospital patient safety at The Doctors Co. in Columbus, OH, says the wording of Standard RI.01.07.01 has been interesting. In its standards as of Jan. 5, 2009, The Joint Commission used the terms "complaint" and "grievance" but as of its March 26 standards update, the word grievance was omitted.
Now, she says, the standard is for the most part taken right out of the CMS' CoP on grievances. One difference is TJC's element of performance 19, which says the hospital can determine the time frame for complaint review and response. CMS in its policy writes "on average, a time frame of 7 days for the provision of the response would be considered appropriate. We do not require that every grievance be resolved during the specified time frame, although most should be resolved...
"If the grievance will not be resolved, or if the investigation is not or will not be completed within 7 days, the hospital should inform the patient or the patient's representative that the hospital is still working to resolve the grievance and that the hospital will follow up with a written response within a stated number of days in accordance with the hospital's grievance policy."
Another difference between the CMS and Joint Commission policies is CMS' exclusion of certain billing issues as grievances. Calloway says if someone complains about the price of an MRI, for example, that would not be considered a grievance. "But if it's a billing question related to a standard of care, like 'I'm not paying for that because my husband was supposed to have an MRI without contrast because he's in renal failure and you guys put him into a contrast-induced neuropathy or renal failure so I'm not paying the bill'" it is a grievance and an issue relating to quality of care.
The Joint Commission, she says, added its own element about ensuring that patients or their representatives who submit a complaint are not "subject to coercion, discrimination, or unreasonable disruption of care."
As for patient satisfaction survey responses, CMS writes: "Information obtained from patient satisfaction surveys usually does not meet the definition of a grievance. If an identified patient writes or attaches a written complaint on the survey and requests resolution, then the complaint meets the definition of a grievance. If an identified patient writes or attaches a complaint to the survey but has not requested resolution, the hospital must treat this as a grievance if the hospital would usually treat such a complaint as a grievance."
Calloway suggests hospitals look back at the CoPs to understand The Joint Commission's standard, and she believes that the CMS policy is still a bit more stringent than The Joint Commission's. "They're not completely crosswalked," she says. "They used to be on different planets; now they're on the same planet. In fact, they're in the same train stations. You're on different trains, but they're kind of paralleling each other."
According to The Joint Commission's John Herringer, associate director, standards interpretation group, its policy on patient "complaints" has not really changed.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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