Resolving Patient Complaints: A Step-by-Step Guide to Effective Service Recovery, Second Edition

Provides detailed recommendations for dealing with a variety of difficult and challenging patients.

Gives service recovery protocols for a variety of health care settings.

Includes sample scripted responses for the most common types of complaints heard by different practitioners and responses that can be used by staff.

Contains sample resolution correspondence to patients that can be modified to fit particular situations.

Provides examples of forms that can be used by staff to document and review patient complaints.

Introduction

Chapter 1. Patient Complaints Are Important
 A. Why Patient Complaints Are Important
 B. Service Recovery-What Is It?
 C. Service Recovery-Why It Is Important
 D. Purpose of this Book

Chapter 2. Service Recovery
 A. Identify the Most Frequent Problems
 B. Service Recovery-How To Do It
 
Chapter 3. Service Recovery: Additional Considerations
 A. Culpability Scale
 B. Emotional Overlay
 C. Complexity of the Issues/Depth of the Review
 D. Patient Expectation for Resolution

Chapter 4. Review Process for Quality of Care Complaints
 A. Nursing and Ancillary Staff
 B. Medical Staff

Chapter 5. Correspondence with Patients
 A. Initial Letters
 B. Follow-up Letters
 C. Progress Report Letters
 D. Billed for Copy of Patient Records
 E. Request to Hold or Suspend Billings
 F. Decertification
 G. Results of Review
 H. Transfer of Case to Risk Management
 I. Financial Settlements

Chapter 6. Documenting and Reporting Patient Complaints
 A. Documenting Complaints
 B. Tracking Complaint Data
 C. Reporting Complaint Activity

Chapter 7. Identification of Trends
 A. Trending Physician Complaints
 B. Trending Non-Physician Complaints

Chapter 8. Dealing with the Difficult Patient
 A. The Annoying Patient
 B. The Challenging Patient
 C. The Isolated Incident
 D. The Abusive Patient
 
Appendix A. Service Recovery Protocols/Receptionists
Appendix B. Service Recovery Protocols/Physicians
Appendix C. Service Recovery Protocols/Patient Representative Department
Appendix D. Service Recovery Protocols/Member Services Department
Appendix E. Service Recovery Protocols for Home Health Agencies
Appendix F. Level 5 and Level 6 Quality of Care Reviews
Appendix G. Subject of Complaints

Additional Readings

• “This book outlines proven methods for appropriately and effectively reviewing, responding to, and documenting patient complaints in health care organizations. Mangers, physicians, and HMO employees can use these methods to help increase customer satisfaction, reduce risk- management claims and associated costs, and lower subsequent stress on staff. Osborne draws on 15 years experience in patient relations in a large HMO, offering a system for documenting, monitoring and analyzing patient comments; a mechanism to change behaviors of providers and improve delivery systems; strategies for dealing with abusive patients; and sample response letters for common types of complaints.”

   

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