how patient complaint/grievance root cause analyses can ... · how patient complaint/grievance root...

How Patient Complaint/Grievance Root Cause Analyses can help

improve the Patient Experience

Pamela Segura, MBA, CPXP, LSSGBDirector of Regulatory Patient Affairs and Service Excellence

Cook Children’s Medical Center Fort Worth, TX

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OBJECTIVES▹ Building a good foundation with appropriate teams.

▹ Identify tools and methods used to identify and close gaps while improving the experience by utilizing measurable actions from reported complaints and grievances.

▹ Describe and provide examples of tools used with facility leaders to help strengthen investigations so the appropriate action plans can be created from identified trends.

▹ Describe ways to provide verification and closure to complainants.

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IT TAKES A VILLAGE!

▹ Patient Affairs team- 4▹ Risk Management - 4▹ Legal - 2▹ Accreditation/Compli-

ance – 1▹ Medication Safety

Officer – 1▹ Ad hoc Members

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COMPLAINTS/GRIEVANCES

“To Have a Grievance is

to Have a Purpose in

Life.

-Alan Coren

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▹ Near Misses/Medical Errors/ Pain Management

▹ Lack of Communication, Introductions and Education

▹ Insurance or Billing Questions

▹ Requests and Compliments

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Patient/Family Report

▹ Quality of Care Issues ▹ Coordination of Care

Issues/ Accessibility (waits, delays)

▹ Patient Safety and Privacy/Compliance Concerns

▹ Staff and Physician Demeanor throughout CCMC

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ROOT CAUSE ANALYSIS

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SERVICE IMPROVEMENT PLAN

PersonResponsible for Action

ActionTaken/To be

Taken

ImplementationDate

MeasurementStrategy

Reporting and Communication

Medical Director

Nursing Leader

Risk Management/

Legal

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▹ Set up Meeting▹ Go over Timeline▹ Identify Barriers ▹ Staff comes up with an

Action Plan▹ Set Deadlines for Action

Plans to be completed

COMMUNICATION PITFALLS

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ILLNESS, INJURY, DEATH, UPHAPPY PATIENTS, FAMILIES, STAFF, CORPORATE FAILURE

THE OTHER GUY NEVER READS THE SAME BOOK AS YOU

ACCOUNTABLITYEXECUTIVE OWNER

FOLLOW UP ON ACTION PLAN ITEMS

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OUR PROCESS IS NOT EASY BUT IT’S EFFECTIVE

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first second last

THE AIRING OF GRIEVANCES!

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https://www.youtube.com/watch?v=0JR6xt9S02o

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WE DO IT FOR OUR PATIENTS!

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THANK YOU!

Any questions?

34Contact Information:

Pamela Segura, MBA, CPXP, LSSGBCook Children's Health Care System Director of Regulatory Patient Affairs and Service ExcellencePhone: 682.885.6698Pam.Segura@cookchildrens.orgwww.cookchildrens.org