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If you’re like most ED managers, dealing with an irate patient or family member is not your idea of a good time.
"I can’t think of a more difficult place to manage expectations than an ED," acknowledges James J. Augustine, MD, FACEP, vice chairman for clinical operations for the department of emergency medicine at Emory University School of Medicine in Atlanta. "The ED sees essentially every member of our society, and almost none of them wants to be visiting there."
The situations that result in the individual being in the ED almost always are stressful, adds Augustine. "The individual has essentially no way of controlling what goes on. One of the few recourses they have for poor service is to walk out," he says. "They don’t even get the psychological satisfaction of saying I want my money back!’"
As a manager, you should consider all complaints a golden opportunity, argues Augustine. "Complaints are a rare opportunity to get objective feedback on how well we are doing our job," he says. "The hotel, restaurant, and recreation industries have vastly improved services based on effective management of complaints."
Here are effective ways to manage patient complaints:
• Thank patients for complaining. Tell patients that you are glad the problem was reported so that it doesn’t happen to others, says Michelle Regan Donovan, RN, BSN, president of Millennium Strategies, a health care consulting firm based in Charlottesville, VA. "Thank them profusely for calling this to your attention, and assure them you’ll get back to them," she adds.
• Address complaints regarding medical care with the appropriate individuals. If there is an allegation of poor medical care, a conversation with a skilled provider may help, says Augustine. "This may include the patient’s own physician," he notes. He gives an example of how to address this: "Yes, a saline lock was accidentally left in your arm when you left the ED. I will have the ED physician examine your arm, and if you would feel better, we will talk to your family doctor to let him know what happened."
For a complaint about a nurse unsuccessfully sticking a patient several times for an IV, Augustine recommends having the patient talk to the physician or the charge nurse on duty, or both. "They should be able to explain that there are difficult veins in some patients," he says.
• Try to address complaints immediately. When possible, resolve the problem while the patient is still in the ED, Augustine recommends. "Allay any concerns about medical care immediately," he advises. Empower staff to correct a problem on the spot, urges Augustine. For complaints about poor customer service, he recommends offering patients simple tokens available right in the hospital, such as a gift certificate for the gift shop or a free meal in the cafeteria.
"For situations which require just a little TLC, this is a great opportunity to exceed expectations," Augustine says. Some patients and families can be "forgotten" on a busy day, says Augustine. "This would be a great opportunity to offer a sign of consideration for their lost time," he suggests.
For serious complaints involving quality of care, Donovan recommends responding with a phone call within 24 hours. "The next step may be a lawyer if you don’t respond pretty quickly," she notes. A patient whose complaint is not addressed might go to the state board, warns Donovan. "The next thing you know, they are on your doorstep because a patient didn’t get a blanket at 4 a.m.," she says.
• Make sure a phone call, personal contact, or meeting occurs for each complaint. A complaint should not be managed without talking to the person raising the issue, at least over the phone, says Augustine. "Voice contact and the information contained in a person-to-person interaction is invaluable to the process," he stresses.
• Have a policy in place to address complaints. Establish a policy on complaint management in order to have a consistent approach by all staff members, Augustine recommends. "It also results in data being collected and a quality improvement process being put into place," he says. (See "Complaint management: A comprehensive performance improvement process," in this issue.)
• Encourage staff to be proactive in addressing complaints about others. Staff may believe that a patient complaint is "not my problem," says Augustine. "In a busy ED, it can feel overwhelming to try to address a complaint that involves someone else," he acknowledges. "But if everyone addresses issues for each other, there will be less work performed by all."
Augustine gives this example: A facility maintenance person changing light bulbs in the ED may overhear a patient complain about how hot or cold the room is, or that the doctor was rude. "Ideally, this worker would contact the nurse responsible for the patient, so the issue could be addressed directly," he suggests. ED physicians and nurses routinely should resolve problems for each other, adds Augustine. "Otherwise, simple complaints can turn into ugly allegations of poor care," he says.
(To see a flowchart outlining the complaint management process at Premier Health Care Services in Dayton, OH, click here.)
For more information on complaint management, contact:
• James J. Augustine, MD, FACEP, Department of Emergency Medicine, Emory University School of Medicine, 1365 Clifton Road, Suite B-6200, Atlanta, GA 30322. Telephone: (404) 778-2608. Fax: (404) 778-2630. E-mail: email@example.com.
• Michelle Regan Donovan, RN, BSN, Millennium Strategies, 977 Seminole Trail, Suite 274, Charlottesville, VA 22901. Telephone: (800) 249-7774 or (202) 438-4870. Fax: (540) 923-4045. E-mail: firstname.lastname@example.org.