Patient and Family Complaints Require Careful Response
April 1, 2024
EXECUTIVE SUMMARY
Healthcare organizations should have processes for responding to complaints from patients and families. The nature and seriousness of the complaint will dictate how much of a response is required.
- Clinicians and other staff should be trained to respond properly to complaints.
- Always be courteous and nonconfrontational when responding.
- Some complaints should be escalated to risk management for further investigation.
Complaints from patients or family members are commonplace in healthcare, but knowing how to respond is not always clear. Some complaints will be trivial or unfounded, while others may indicate a serious patient safety issue or an incident that could lead to litigation and liability.
Risk managers can help channel those complaints in the right direction by helping frontline staff know how to respond, as well as when and when not to escalate the complaint.
There is no magic answer to what to say in response to a complaint, says Paul D. Werner, JD, an attorney with Buttaci Leardi & Werner in Princeton, NJ. It is impossible to predict how the complainant will react to anything because the situation often is quite charged and dynamic.
“While it can be frustrating to not have a script when addressing complaints, the lack of a specific methodology also gives those responding to the complaint the ability to adapt to the specific circumstances,” Werner says. “Anyone who may potentially be responding to a complaint in the healthcare context should be trained on the basic do’s and don’ts, but also trained on substantive matters that will afford them the ability to review and react to the situation.”
Werner advises clients to avoid making concessions or direct apologies for actions or behaviors and instead focus on understanding and empathizing with the complainant’s situation. For example, rather than directly conceding that an error was made when talking with a complainant, Werner often advises clients to apologize for the inconvenience the complainant perceives or the problem the complainant is mentioning.
“By way of a specific example, I advise clients to say, ‘I’m sorry to hear that you’re experiencing discomfort,’ or ‘I’m sorry you’re surprised by the fact that you were billed for that service,’ as opposed to ‘I’m sorry that happened to you,’ or ‘I’m sorry for that error.’” Werner explains.
Any complaint should be fully documented in the patient’s chart. To the extent a complaint is received in writing, that writing should be preserved in the file as well. Any audio or video recordings of the complaint, if they exist, also should be preserved.
In addition to documenting the complaint, any actions taken in response to the complaint should be documented, Werner says. If an internal investigation is conducted, that should be done with the assistance of counsel to ensure completeness and to protect privilege.
Lend a Sympathetic Ear
There should not be much difference in how clinicians and administrators respond, Werner says. Because clinicians are much more likely to receive complaints in person with the complainant face-to-face, clinicians need to maintain composure and provide thoughtful, calculated responses.
When hearing a complaint in person, it is recommended that the clinician simply listen to the complaint, acknowledge that it has been made, and assure the complainant that they will investigate and respond, Werner advises. Off-the-cuff responses, especially when there is the potential that professional judgment or skill is being questioned, often escalate things unnecessarily.
“The best tool in the toolbox for de-escalating a situation is being sure to listen to complaints, not simply hear them. Listening to and understanding the complaint allows you to provide a more thoughtful and complete response,” Werner says. “In my experience, when the first response to the complaint is insufficient or perceived as a ‘blow-off,’ complainants are much more likely to press on.”
Healthcare professionals should be receptive, empathetic, and sympathetic to anyone who is complaining, says Eric S. Strober, JD, partner with Rivkin Radler in New York City. It is normal for patients and families to want everything to go perfectly right every single time, and healthcare workers know that is not reality, he notes. That may lead to frustration with a complaint that seems unrealistic, but healthcare staff should nonetheless respond in an understanding way.
“If you address it and sympathize with the complainer’s point of view and try to make sure that there’s no harm done, then that’s the best you can do under those circumstances. I don’t think being defensive and knee-jerk reactions are the best way to go,” Strober says. “You’re not going to calm anybody down or assuage any kind of concerns by getting immediately defensive. In fact, you could just inflame matters that way.”
Not every complaint needs to be escalated to risk management or nursing administration, but some do, Strober notes. A complaint about the response time for calling in a prescription or how long a patient had to sit in a room is just a garden-variety dissatisfaction with the realities of medical care in America in 2024.
“Those don’t need to be reported to risk management. If there’s no adverse event and no injury or no harm that has come to a patient, then it doesn’t seem like there’s a need to report anything,” Strober says. “But if somebody was inadvertently stuck with a needle while someone was trying to draw blood — sure, report that.”
Streamline the Response Process
Providers should have a streamlined process for responding to patient complaints, says Aubrey B. Gulledge, JD, an attorney with Baker Donelson in Memphis, TN. All complaints that rise to a level of severity to pose a threat of litigation or a threat to safety should be directed to risk management as soon as possible. The complaint should be acknowledged in a timely and conciliatory fashion, and the response should reflect that the provider takes the complaint seriously and is investigating.
Clinicians and administrators should consider that written communications with patients and their families are discoverable in litigation, Gulledge notes. Any complaint response should not include overreaching promises of remedial action, legalese, or medical jargon.
“Providers should be cognizant of privacy and confidentiality concerns when responding to complaints, and responses should not reference specific individuals,” she says. “Providers should never comment regarding whether there was any lack of compliance with the standard of care applicable to the provider, or whether there was a perceived lack of compliance with policy or regulations. The responses should avoid commentary that could expand the facts involved in the complaint.”
Risk management should have a process for documenting patient complaints that includes the date of the complaint, the name of the person complaining and/or patient name, indication of who received the complaint, the content of the complaint, an indication of whether the complaint was written or verbal, and recommended follow-up, Gulledge says.
Gulledge notes that the necessary action depends on the nature of the complaint and the potential effect on the patient, other patients, and the public. When patient safety is at issue, engaging all stakeholders to take appropriate immediate action is imperative.
Follow-up communication with the patient and/or family should always happen, and in severe instances, risk management should be aware of potential third-party investigation, she says. The follow-up should acknowledge receipt of the complaint, and should occur upon completion of the investigation.
Both clinicians and administrators should engage their legal representatives and risk management professionals when they become aware of a patient complaint that involves patient safety issues and/or could turn into litigation, Gulledge advises. Clinicians should indicate that they have forwarded the complaint to management. Clinicians who are not in management positions should proceed with the direction of management and/or legal according to the department’s policies and procedures. They should document in the medical record if they have personally received a complaint but should not document any communications with risk management or discussions regarding remedial action.
“We often find that the reason for litigation is the lack of understanding of what happened to the patient. Clinicians who take the time to explain disease processes and answer questions when there is an unexpected outcome are less likely to be sued,” Gulledge says. “Taking time with patients and family members and not appearing to be in a hurry or cut them off when they ask questions will help avoid litigation.”
Prompt and frequent communication with the patient or family is the most critical component of attempting de-escalation, Gulledge notes. A written record of acknowledgment, investigation, response, and follow-up is a powerful tool in ensuring a comprehensive response to complaints and best efforts to avoid future litigation. “This communication is the best way to promote patient satisfaction and gain, maintain, or regain patient and family trust,” she says.
Do Not Admit Wrongdoing
From the perspective of litigation and complaints of medical incidents that have resulted in harm, the first step in responding to a complaint is to take it seriously and to show appropriate empathy without admitting to any wrongdoing, says Bill Bower, senior vice president with Gallagher Bassett in Rolling Meadows, IL, which provides healthcare professional liability claims and risk management consulting. Previously, Bower was chief risk officer at a major health system. Patients and family members should be advised that their complaint will be investigated, and that the institution will get back to them.
Many organizations have a disclosure policy or protocol that dictates the methods by which the institution will respond, Bower notes. Internally, complaints should be directed to the risk management department or to the particular body within the organization that is charged with clinical investigations of incidents. Often, this will allow for a determination of whether the complaint arises from an incident that might provide an opportunity for process improvement. This will lead to routing to the appropriate team — perhaps risk, patient safety, or process improvement. In addition, a complaint should be directed to those within the organization who are charged with notifying insurers of events that could result in a claim.
“If there are artifacts or evidence involved in the event — video coverage, retained foreign bodies, pathology, etc. — it is essential that such evidence be preserved. If an investigation reveals further evidence, such as text messages, these must also be preserved,” Bower says. “Oftentimes, if the event is of a certain magnitude or litigation seems likely from the start, retention of counsel can be employed to begin an analysis from that perspective and to gain attorney-client privilege where feasible. Privilege may also be afforded under the Patient Safety Act as patient safety work product, if applicable.”
SOURCES
- Bill Bower, Senior Vice President, Gallagher Bassett, Rolling Meadows, IL. Phone: (630) 773-3800.
- Aubrey B. Gulledge, JD, Baker Donelson. Memphis, TN. Phone: (901) 577-2218. Email: [email protected].
- Eric S. Strober, JD, Partner, Rivkin Radler, New York City. Phone: (212) 455-9560. Email: [email protected].
- Paul D. Werner, JD, Buttaci Leardi & Werner, Princeton, NJ. Phone: (609)799-5150. Email: [email protected].
Healthcare organizations should have processes for responding to complaints from patients and families. The nature and seriousness of the complaint will dictate how much of a response is required.
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