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Handling Complaints in the Medical Profession

Term Definition Introduced in:

Closed-ended question A specific question phrased so that it requires a yes or no answer Module 2

ComplaintAny expression of dissatisfaction by a patient about a medical service or treatment, whether justified or not Module 1

EmpathyUnderstanding the complaint with no interest in either agreeing or disagreeing, but instead acknowledging emotion(s) Module 2

Level 1 Complaint A general non-urgant copmlaint or misunderstanding Module 1

Level 2 Complaint An escalated complaint that requires a specialized person to handle it Module 1

Open-ended questionA question that could prompt careful, thoughtful analysis and an answer beyond a simple yes or no Module 2

Procedural justiceTaking a patient through a process that makes them feel that their problem was validated, it was investigated, and it was determined whether it was justified or not. Module 1

QTIP An acronym that stands for Quit Taking It Personally Module 2

SympathyInvolves agreeing with some aspect of the other person’s feelings or beliefs, and may even involve accepting blame Module 2

Glossary

FRED PRYOR SEMINARS HANDLING COMPLAINTS MODULE ONE – WHY PATIENTS COMPLAIN HAN121127-1 JULY, 2013

Female: Module number one – Why Patients Complain. Many of us choose to

enter the medical profession so we can help people. We have big hearts

and want to help people through what can be difficult times. But on some

days, these same patients can make a hard job even harder, a long day

even longer. And sometimes they can even make us forget why we joined

our profession to begin with. There are definitely some things you can do

to make these days better and your job easier. And in this module, we’re

going to look at what you can do to take back control in what may

sometimes feel like an uncontrolled situation. We’ll show you how to

provide the quality of service and care that you want to provide and how to

make sure patients are taken care of properly when they complain so they

aren’t walking all over you. Remember that you are there to serve the

patients. You know the old adage the customer is always right? I don’t

believe that is true all the time – especially in the medical venue. But we

still need to work with our patients. It’s important to think of them as

customers because they are the reason we are there. Without the

customer or patient, we don’t have a job or a reason to serve. Our job is

to support them and to serve them. Today we will learn how to handle

complaints, both justified and unjustified. Let’s start by understanding the

most common complaints – what they are, why they occur, and how to

reduce them. The first is unsatisfactory accommodations. Perhaps the

patient is in a hospital and wants another pillow. It could be that his room

is too cold or too warm. In a clinic, it could be that a chair is

uncomfortable. Something about the environment is unsatisfactory. This

is one of the most common complaints you will hear. The next common

complaint is some sort of service issue. Maybe she had to wait too long.

Maybe the doctor didn’t spend enough time with her. Maybe he didn’t feel

he got what he wanted, or was expecting. The next common complaint is

an informational issue. Maybe she didn’t get the right kind of information,

or maybe he was ignored or he didn’t feel like something was properly

explained. The next common complaint is a misunderstanding. Perhaps

he was told information and didn’t hear it properly. Or maybe she didn’t

understand what she was told. And the last common complaint is a billing

issue. This could be an incorrect bill, not understanding a charge, or

something else to do with billing or insurance. It’s important to remember

that patients complain for many, many reasons. They’re not bad people.

They may just be having a really bad day. We want to keep that in the

back of our minds as we work with them. Let’s look at why they’re

complaining, try to understand the complaint, and see what’s really going

on. A complaint is simply an expression of dissatisfaction. The patient is

telling you he is unhappy about something. Unfortunately, most patients

haven’t taken Communication 101, so they may not know how to express

their dissatisfaction constructively. Therefore they do it any way they can

usually however they learn to handle conflict, which might not be

effective in any aspect of their lives. Sometimes they yell, they scream,

they get irrational. Sometimes they are calm and very good at

communicating. Why do we want to handle complaints better? The

obvious answers are to prevent lawsuits, malpractice claims, and

compliance risks as well as to increase our patient satisfaction. As we

increase patient satisfaction, we also increase patient referrals. In

addition, we can also avoid first time complaints turning into legal actions.

Another benefit of handling complaints better is your own personal

satisfaction. So not only does handling complaints help the patient, it

helps the practice and it helps your personal enjoyment of your position

and in your career, and it makes your days go better and makes going

home to your family a whole lot easier and happier, too. Let’s take a look

at how to deal with these difficult patients. Just having a process for

handling complaints can have a long-term effect on reducing issues in the

practice, such as reducing malpractice claims or even compliance issues.

Most patients are willing to forgive an occasional annoyance or

disappointment if they perceive that you and your office staff care about

their needs and that you are trying to satisfy them. Let’s look at six tips for

handling complaints and how to make sure you’re doing everything you

can to help your patients when they have complaints. First, respect the

patient’s right to complain. If they are unhappy, they have a right to share

that with you. They don’t have a right to walk on you. They don’t have a

right to yell at you. They don’t have a right to use profanity. You can

certainly set those limitations, and it’s important that you do. To help them

feel that they receive satisfaction, make sure that you offer procedural

justice. What procedural justice means is that you will take them through

a process that makes them feel that their problem was validated, it was

investigated, and it was determined whether it was justified or not. Their

complaint itself is always justified. But whether what they are complaining

about is real or valid needs to be determined. If someone does complain,

perhaps by phone or by mail, it is important to invite the person in to talk

about it. Don’t let it fester or ignore the annoyance to the point where the

first time someone complains, it ends up being a lawsuit. You can say

something as simple as, “I understand, Miss Smith, that you are frustrated.

We’d like to have you come in so we can understand what happened.

What day would be good for you?” Once a person’s voice is heard, she

often won’t seek other ramifications or other paths to be heard. It’s

important that you show a commitment to solving problems. Second, you

want to review the complaints as you get them. Complaints are an

inevitable part of business. So it is important that you review them. When

you have your weekly meetings, review the complaints that are coming in.

As you begin to see patterns, look to see how you can reduce those

patterns. Sometimes it’s as simple as making sure the patient

understands what his next appointment is for, why you are doing

something. A lot of times it’s simply a misunderstanding. So some simple

additional communication can reduce complaints quickly. Keep a written

log of complaints as you receive them. As you train each staff member

who interacts with patients, be sure they know that it is important they

keep a log of complaints. This will help you to start tracking patterns and

see what help and what solutions are available. Always seek to improve

your processes and procedures. As patients see that you are doing things

to improve and make things better, they’ll give you more leniency and

have fewer complaints. Third, educate all staff on complaint procedures.

It’s important that your staff understands each step of the process, and it’s

important that you avoid rationalizing in response to patient complaints.

Rationalizing is a canned answer that sounds something like, “Well, it’s

the insurance company’s fault,” or, “This is the way we have always done

it.” Consider whether the rationalization is an explanation or if it sounds

like an excuse. Avoid it whenever possible. The last tip on the education

point is to train staff. Usually when someone is dissatisfied, you are not

the cause of dissatisfaction. But you are the individual they are sharing it

with. So be careful not to take the complaint as a personal attack.

Separate yourself from the problem. We’ll talk later about how to remain

calm and stay in control of yourself when a patient is unhappy or

dissatisfied. Tip number four is to notify the appropriate teams. Often if a

patient has complained and it is an item that could potentially turn into

litigation, it’s important that you notify your legal team. They do need to be

notified as soon as possible, and the earlier the better, so they can provide

information and guidance for how to handle that specific issue. And of

course notify the insurer as well. Often if a patient threatens a lawsuit, you

need to notify the insurer. Many times it’s a requirement of the policy and

in some cases the insurer may even authorize a quick settlement. So it’s

important to notify the insurer immediately. The fifth tip is to have a written

complaint form. In a later module, we will go over the specifics of a written

complaint form – what needs to be in there and how you can use the form

to truly reduce complaints, and even when to use the form. And we’ll talk

about where, when, and how to offer it. Tip number six is to have a clearly

written complaint policy. It’s important that it is written out and that you

have a procedure. We talked earlier about procedural justice. When each

member of the staff follows your policy step by step, it makes it a lot easier

for the patient to feel like she’s getting fair treatment. It’s important that

the policy have timelines. For example, when a complaint is submitted,

within how many days should the patient receive a notification of the

results or of the decision? What are the steps that a complaint goes

through? Your policy needs to be in easy-to-understand language – not in

legalese. It should be simple for your patients to understand. It should

also clearly explain the outcome – what can the patient expect? The last

point is about breaking complaints into level one and level two. Level one

are your general complaints. These could be service complaints,

misunderstandings, or general non-urgent complaints. They can usually

be handled by anybody who has been trained to handle conflict or to

handle the patient’s concerns. A generalist will often handle level one

complaints. Level two complaints need to be escalated to a turned conflict

management individual who has been turned specifically for escalated

complaints. This could be an ombudsman type situation where a third

party is brought in to handle it. You want to go to a level two person for

any escalated complaint. Perhaps you’ve tried to resolve the issue, but it

isn’t working. So you need to take it to a second level. Second level

individuals are trained at a higher level. They are certified in conflict

management. They understand the litigation policy. You can skip level

one and go immediately to level two for anything that has possible legal

actions associated with it. So if you can quickly identify that this is a legal

issue, perhaps it was an issue with medication or unsatisfactory clinical

treatment, inappropriate conduct, infection control practices, or hygiene

issues. These things need to immediately escalate to level two. Again,

these are urgent complaints. Anything that can be seen as a possible life

threatening complaint, anything that could be level two needs to go to a

higher individual immediately. It’s important that you escalate quickly in

level two situations to make sure that things are handled properly every

step of the way and the patient is treated correctly and that he does get

procedural justice. By separating complaints in a level one and level two,

you can reduce your number of complaints quickly because your patients

understand that you have a very serious policy in place and that you take

their complaints seriously.

FRED PRYOR SEMINARS HANDLING COMPLAINTS MODULE TWO – HOW TO HANDLE COMPLAINTS HAN121127-2 JULY, 2013

Female: Module Two – How to Handle Complaints. In this module we will talk

about steps one and two of the six step procedure for handling complaints.

Step one is listen and empathize. Step two is clarify. Let’s break the

procedure for handling complaints into six steps. The first thing you need

to do is understand the problem. To do that, you need to do step one –

listen and empathize; and two, clarify by asking questions. Next, you want

to look at the solution. So the third step is to respond to the complainant

and then fourth, check back to see if they understand and agree with the

solution you purpose. Finally you have the resolution. So the fifth step is

to document what happened and what you did. And the sixth step is to

follow up with the patient to make sure he is satisfied. We will go through

each of these steps in detail and talk about how to execute each one so

you have a very clear understanding of how to process a complaint and

what to do. In addition, you will want to adapt these steps to your practice

so you can write out your own procedure and train your staff to carry it out

whenever anyone complains about anything. We will assume at this point

that we are talking about level one complaints. Remember, we talked

about level one and level two complaints at the end of module one. Of

course this procedure can also be applied to level two complaints, but you

may actually put together a different procedure for level two. So at this

point, we’re really working on level one complaints. For level one

complaints, we want to make sure that we are listening and empathizing.

Have you caught yourself saying, “Of course I’m listening. I heard every

word you said.” But if you were multitasking – finishing a log entry, putting

something away, not giving the speaker your full attention – the question

isn’t really were you listening, but rather did she feel like she was being

heard? Often when someone complains, especially when it isn’t a serious

or critical complaint, the person may be complaining because he needed

to be heard. He didn’t feel that his voice was heard. By listening carefully

and obviously, you can reduce much of your patient’s anxiety by showing

that you are concerned about where their challenge is or what their

problem is or what their concern is. So here are four tips for using

nonverbal clues to show you are listening. The first is to make sure that

you look at the person. Watch her. Don’t be staring at your computer.

Don’t be staring at someone off in the distance. Give her your full,

undivided attention. Listen to what she is saying and look at her. Next,

lean in slightly. Don’t lean halfway across your desk. Just lean in a little

to show that you’re listening – that you are interested in what she is

saying. This creates a little bit of intimacy and helps the patient feel

valued. Next, use listening noises. These can be very simple like uh-huh;

or really? or okay. You are letting them know that you are listening and

that you are hearing what they are saying, and you are processing it.

Last, nod as appropriate. If a patient is saying something and you want to

encourage him to continue to talk, and we’ll talk about how to do that in a

moment, nodding will help you do that. Again, the key is “as appropriate.”

You don’t want to go overboard to the point that you are a bobble headed

doll. Nod where it’s appropriate to show that you are really paying

attention. How do you stay calm, especially if someone is yelling at you,

has raised her voice, is upset, or even worse, if a patient’s family member

is coming at you upset about her loved one who isn’t getting the right

treatment. That can push you over the edge and be very frustrating and

make your job all the much harder. So how do you stay calm? How do

you stay in control? And how do you keep going forward? First, don’t

take it personally. There’s an abbreviation for that that you may have

heard – QTIP – Quit Taking It Personally. I remember when I first started

training and received some bad reviews. I took it really personally. Oh, I

thought this is never going to work. I’m terrible at this. I should just go do

something else. And then one of my colleagues said, “Hey Stephanie,

remember QTIP.” And she handed me a little cotton swab and told me

what it meant. After that, when I started to take things too personally, I’d

just pull out my Q-Tip and remember what it meant – quit taking it

personally. You are not the problem. Maybe the patient is having a bad

day and she just needs to share it and get it out, and you happen to be the

person she gets to share it with. Many of the people who have heard me

tell this story tape a cotton swab to their computer screen to help them to

remember not to take it personally. So again, it’s not about you. It’s just

the patient trying to express his dissatisfaction. Next, remember that the

patient has a right to complain and to share when he is dissatisfied.

Patients don’t have a right to abuse you. They don’t have a right to walk

on you. And they don’t have a right to use profanity. But they do have a

right to share dissatisfaction. Third, listen to the problem. Listen for

what’s going on. And what’s going on may not be what they’re telling you.

So sometimes you have to listen between the lines. Finally, pause before

answering. Take a breath. Collect your thoughts and give yourself some

time so you aren’t reacting instead of responding. You don’t want to jump

to conclusions or say something you didn’t mean to say and wouldn’t have

said if you had taken time to think first. The best way to do this is to take a

small breath, a pause. Be aware of your own feelings and opinions. It’s

easy to be defensive, especially when a patient hits a hot button of yours

or maybe has a differing opinion, or actually is blaming you for something

that isn’t your fault. Let him express what he’s saying without taking it

personally and without offense. Let’s talk about the difference between

sympathizing and empathizing. This is a difficult concept and it took me

many years to understand the difference and be able to switch from

sympathy to empathy. As a natural caregiver and somewhat of a rescuer,

I always wanted to give the person a big hug, often ended up apologizing,

and sometimes even took responsibility for something I didn’t do, and

ended up getting used or walked on for it. Sympathy may involve

agreeing with some aspect of the other person’s feelings or beliefs and

may even involve accepting blame for the problem. Sympathy is okay

when appropriate. But sometimes it can get you into hot water, especially

if you accept blame for something that could end up having litigation

attached to it. You could end up putting yourself in the position where you

admit something that you didn’t do and you didn’t realize that you were

admitting blame for it. It’s really important that you spend more time

empathizing instead of sympathizing. Empathy involves understanding

the complaint with no interest in either agreeing or disagreeing. But

instead, simply acknowledging the person’s emotions and perhaps sharing

the feeling with them. Let me show you an example. Sympathy is, “Oh,

that’s terrible. I feel so bad that we gave you the wrong prescription.” Do

you hear how there’s an admission of guilt? There’s some blame? If you

say, “I feel bad that we gave you the wrong prescription,” you’re admitting

that you gave them the wrong prescription. Instead, an empathetic

response is, “I see that you are upset. I’d be upset, too. Tell me what

happened.” When you have a chance to look at the facts, you may find

that it wasn’t the wrong prescription given, but another error was made

where the patient thought she was getting something different. Perhaps

she misunderstood the doctor and what he said he was giving her. To

give empathy and not sympathy, you need to know the difference and be

able to take sympathy out of the equation so you can protect yourself and

protect your practice. Here are some empathizing phrases: I see that you

are ...; It seems that you are ...; You appear ...; And my favorite, I imagine

that you are ...; These might sound like I see that you are angry, or it

seems like you were hurt, or I imagine that you are hurt. Use phrases that

acknowledge their emotions and acknowledge they are going through

something that is unpleasant and they are unhappy. Also, if you attribute

an emotion they’re not feeling, they will probably correct you. That helps

them see that you understand what’s going on and more importantly, that

you’re listening and you care. Step two is to clarify. Now that they

understand you are listening, it’s time to go to step two to find out what’s

going on. It has been documented that when people are upset, they

actually lose about half of their IQ. It is impossible to be angry and smart

at the same time. I know that when I lose 50 percent of my IQ, I have

trouble speaking clearly, enunciating, clarifying, or being able to tell you

what’s really going on in a clear way so you can understand. When a

patient is upset or irrational, it’s important for you to be able to help her

articulate because she may not be saying what she means. To do that

there are two kinds of questions you can ask. The first kind is the open

ended question. These are questions such as which doctor were you

with? What prescription was prescribed? Where were you when this

happened? When did this happen? How long have you felt this way?

Ask permission to take notes so you can document what they are saying.

This gives them a feeling of importance and says that you are taking their

issue seriously. Document what they tell you. Write down the details as

much as you can. If you have a form, use it. Open ended questions

develop trust. They are perceived as less threatening and allow for

unrestricted responses. They allow the patient to talk. Sometimes when

someone is angry or upset or unhappy, he just needs to be heard. So

allowing him to speak gives him the procedural justice he is looking for.

There may not be anything you can do. But he needs to know someone is

listening and knows he is unhappy. Sometimes using open ended

questions and allowing the person to speak will end the issue. At some

point you will need to start asking closed ended questions to clarify. You

need to be careful with these because not only can they get agreement

and calm someone down, but they can silence the person as well. Closed

ended questions tend to become accusatory, presuming, probing, and

even leading if not used properly. I like to use closed ended questions as

transitions to the next step. For example, we’ve been talking about the

problem, which was the wrong prescription. I can start with open ended

questions. Tell me what the prescription was. Who wrote the prescription?

When did he write it? Once I’ve got all the information about the problem,

I’ll say, “Is it okay if I share with you a few options on how we can solve

this?” This is a yes or no question. I’m looking for agreement. It is a

transition to help me move from the problem to the solution. So use

closed ended questions once you understand what the problem is, and

you’re looking for agreement or you’re ready to move him to the next step.

If you use closed ended questions too soon, you will shut them down or

even silence them, or they will feel as if they were being silenced, which

could increase their anger or emotions and it won’t help calm them down.

[End of recording.]

FRED PRYOR SEMINARS HANDLING COMPLAINTS MODULE THREE – HOW TO HANDLE COMPLAINTS HAN121127-3_1 JULY, 2013

Female: Module Three. In this module, we’ll discuss the last four steps of how to

handle complaints. Step three, respond; step four, check back; step five,

document; and step six, follow up. After you’ve completed step one -

listen and empathize, and step two – clarify, step three is respond. You

can respond in either of two levels. Level one is to offer a solution.

Usually this is a simple problem with one solution and you simply offer it.

The solution could be, “I’d be glad to adjust the temperature in the waiting

room.” On the other hand, if the solution is, “I’m going to contact someone

and have them get back to the,” this is a level two response. You don’t

want the solution to be passing the buck. However, if you really are

moving on to level two, make sure they understand you want a specialist

to handle the problem because you are concerned that the problem is

serious and needs to be handled properly. “I’m going to contact Joe and

he will walk you through the next steps. Is that okay?” Ask for their

approval. If it’s something small, like the person waited too long to be

seen for an appointment, you could say, “I understand you’ve been waiting

a long time for this appointment. Is it okay if in the future, we offer you the

first one in the morning?” Or, “Is it okay if in the future we inform you if

there will be a delay?” Make sure your solution is acceptable for the

patient and that you have her approval. Step four is check back. Ask if

what you have proposed is an acceptable solution. You want them to say

yes. Once they say yes, they have bought into your solution and now they

can let go of the problem because they have a solution. You don’t want

them to leave without a solution. It’s important to do this and it also helps

relieve the stress. Of course if you’ve escalated this to level two, they may

not leave with a solution. But they will leave with the knowledge of who

will get back to them, when they can expect to get a response from that

person, and what’s going to happen next. So in a sense, they do have a

solution that they’ve agreed to. It may not be the final solution. Some

phrases that you can use are, “Does that sound like a reasonable

solution?” And, “Are you comfortable with that solution?” Step five is to

document what happened. Even if it’s a small incident and it is resolved

quickly, small incidents can lead to bigger things down the road. So you

always want to document what happened and how it was resolved. Put a

note about even the smallest of complaints in the person’s file or personal

chart as well as in the log you keep about complaints. Putting it in her

chart shows the client you are taking her complaints seriously. In addition,

if the worst case scenario comes to pass, it does go to litigation, or there’s

something else that happens after you think the complaint is resolved, you

have complete documentation of what was done. The same is true if it

becomes a compliance issue. In addition, if somebody else has to handle

a complaint, they can look in the chart, see what was done the first time,

and know how to respond. We talked about keeping a complaint log in

module two. This log helps you see patterns in complaints. If several

people complain about the temperature of the waiting room or the comfort

of the chairs, you can start to see that this is an issue that should be

addressed and that the one complaint you took isn’t an isolated incident.

Also, if you have a large staff and different people take the complaints,

having them all in one place allows the office manager to see patterns that

may not be apparent to individual staff members. Let’s talk about your

complaint form. Ideally you want to have the patient fill out a form as soon

as possible if they can. Sometimes you’ll have to fill out the form for them

and let them sign it. It’s important that they complete it as thoroughly as

possible. The more details you have, the easier it will be if anything goes

to litigation or becomes a compliance issue in the future. We’re going to

look at the specific items you want in your form. Use your handout to

make notes on what would be appropriate to put on your form, or changes

you might make to an existing form. The first thing we’ll note is how the

complaint was submitted and by whom. Was it submitted in person, by

phone, or by mail? By the patient or a family member? It’s important to

know who submitted it and when. Note the patient’s contact information –

name, address, and phone – so you can get back in contact with him.

What is the nature of the complaint? Was it a HIPAA violation, a quality of

care issue, billing, customer service? Of course you will have your own

categories that match the services your facility provides. Next, what does

the complaint involve? Is it a clinical issue, social services, lab, radiation?

Last on this page is sufficient room to describe the incident in detail.

What’s not shown here is the space for the signature. You’ll want to have

a line for the signature of the patient or the person filling out the form

asserting that this is accurate information. This goes at the bottom of this

page. The other side of the form is for internal use so you can document

what happened and the results of your investigation. You might want to

clarify any information stated by the patient on page 1 with any corrections

or clarification they tell you during an interview. You also want to list the

procedures you took and the results of the internal investigation that took

place based on this complaint. Seeing this area on the form, which you

will probably discuss with the patient when you’re ready to resolve the

issue, helps him feel not procedural justice. He wants to know that

someone cared enough to go through his complaint and look at what

happened, why it happened, understand what happened, and really

determine if the complaint was correct or not. Sometimes as long as there

is procedural justice, you’ll see that the ramifications of the complaint are

reduced dramatically. In the resolution section, write down what you did to

resolve the complaint. It might be as simple as, “I notified Mary and now

we have temperature controls in all the rooms.” The resolutions don’t

always have to be big. Sometimes they are small. Indicate when the

patient was notified of the resolution. This is important. It’s step number

six that we’ll talk about next – following up with the patient. The patient

needs to know that you did something about the issue and what you did.

Also indicate the name of the person who resolved the problem and who

is responsible for letting the patient know the problem was resolved. The

last item on the form is, was the patient satisfied? Notice that there is a

place on the form to indicate whether the patient was satisfied, and if not,

whether the patient was formally notified of his right to appeal if he was

unsatisfied. Once again, it is important to have a complete complaint

procedure in place so the patient understands he will get procedural

justice. You will know that you have a formal process that you are going

to walk him through, and you are going to make sure his complaint is filed

and investigated and that there will be a resolution. The last of the six

steps to this procedure is to follow up. We talked about this in terms of the

complaint form. But in case you don’t have a form or didn’t use it, you still

need to follow up with the patient about the complaint. Did the solution

meet the patient’s needs? Was she satisfied? Remember, a complaint is

just an expression of dissatisfaction. She wanted to let you know that

something wasn’t right, or she wasn’t happy. There was a missed

opportunity. Simply by following up, caring enough to do the investigation,

go through the steps, find out what happened and then report back

satisfies many complaints. Sometimes you don’t even have to change

anything. You just need to let them know you did something to take the

complaint seriously. Other cases may be more critical. There could be

litigation involved. So it’s important that you dot your I’s and cross your

T’s and follow all the steps. And follow-up is the last step. That completes

our discussion of the six step procedure for handling complaints. We have

discussed a six step process for handling complaints. The first part of the

process is the problem. In step one, you listened to the patient to

understand what the problem actually is. In step two, you reflected back

to the patient what you heard to make sure that you understood the

problem completely. The next part is the solution. In step three, you

responded to the patient giving him the solution that you came up with to

solve the complaint. And step four is checking back with the patient to

make sure that was an acceptable solution. The last part of the process is

resolution. In step five, you documented everything that happened both

on the patient’s chart and in your complaint log. It’s best to have a

complaint form, and we looked in detail at a sample complaint form so that

you can make your own. Step six involves following up with a patient to

make sure that he was satisfied with the outcome of the complaint. And if

not, to understand what his rights are to appeal the process.

[End of recording.]

FRED PRYOR SEMINARS HANDLING COMPLAINTS MODULE FOUR – HOW TO HANDLE ISSUES HAN121127-4 JULY, 2013

Female: Module four – Examples. Let’s go through some examples of these issues

and how to handle them specifically. Let’s start with a patient complaint

about waiting too long. Of course you begin by listening to the problem

and empathizing with the patient. When you are clear about the issues,

you see several options. One is to offer to make her the first patient in the

future. Part of documenting the issue is to be sure to make a note in her

chart that she prefers not to have to wait. If there’s an option to get her in

earlier, you can also try to schedule her at times you know there will be

less waiting. I know when I take my daughter to the pediatrician, they

always schedule me first thing in the morning so I don’t have to wait. Also,

they always schedule me with one particular doctor because he gets

patients in and out efficiently while the other one is always late. You want

to help your patients reduce complaints as well. Find out their preferences

and help to personalize the service they receive. Remember, they are still

a customer and the customer may not always be right, but you want to try

to cater your practice to your customers. You may be thinking that a

practice or a clinic or a hospital may not seem like businesses. But they

really are. They are a business that exists to serve your patients or clients

who are your customers. So it’s important that you look to serve their

needs. Another scenario is that the patient isn’t getting the results he

expected. He’s been on a medication and is just not seeing anything

happen. Try not to handle these problems over the phone. Always try to

discuss them in person. Often you will get a much better response when

working with a patient face to face than you will over the phone. There’s a

lot to be said about body language, and you lose the body language

communication piece when you try to do things via phone. And please

don’t ever do them over email. Avoid email interactions with emotional

issues at all costs. Any time there is an emotional issue in an email, it’s

best to at least pick up the phone if you can’t have an in-person meeting.

The majority of your communication – 55 percent – more than half,

happens through body language; 38 percent is tone; and only 7 percent is

the words that you speak. So if you’re emailing something emotional,

you’ll lose 93 percent of your message by only using words. It’s very

important that you at least try to do it over the phone, and it’s even better if

you can get the person into your office in person. When someone is

getting unexpected results or is not getting what he wanted, ask him to

come in and invite him to bring a family member. Sometimes you’ll find a

patient has somebody whispering in his ear behind the scenes who is

prodding or poking him to complain. If that person can come with the

patient and hear first-hand what is going on, often you can reduce these

complaints as well. As you explain the risks of the procedure, mention

that bad outcomes are not necessarily the result of human failures.

Sometimes patients are quick to say, “This doctor doesn’t know what he’s

doing.” Sometimes if you just mention that bad outcomes happen and

what the risks are for this particular treatment or procedure, you will

understand that sometimes there is no solid solution for every problem,

and it is the trial and error. That’s why they call it a practice, right? Just

because the treatment isn’t coming out as expected doesn’t point to any

human failure or human error. It’s important that they understand that.

For the next example, let’s say there is resultant damage that needs

correction. Perhaps a foreign body remained after surgery. This is a very

sensitive issue and obviously, this is a level two issue. Make sure, as with

any level two issue, to inform the patient as part of a diagnosis, treatment

plan, or other informed consent procedure to reduce the litigation issues.

To calm the person down and avoid pointing fingers, stick to the facts.

Any time you have a potential litigation issue, stick to the facts and try to

avoid the emotions on your side. They may have emotions on their side

and you’ll want to address those using the techniques we talked about

earlier regarding empathy. So you don’t want to say, “Oh my God, we’re

so sorry. I can’t believe we did that.” That’s not where you want to go.

That’s admitting blame and you don’t want to do that. Ask simply what

happened, or say, “X was found. We need to do Y.” Be very

straightforward and very matter-of-fact. My husband came home from a

hip replacement with an IV in his arm that they had forgotten to remove.

We kind of freaked out when we saw it. And since the clinic was about 50

miles away, we really didn’t want to have to get back in the car and drive

back there. So we called and they were very calm, which calmed us

down. They said, “Just pull out the tape and it will come right out. No

problem.” If they had freaked out, it would have upset us more. But their

calm, no-big-deal attitude helped us to calm down and resolve the

problem very quickly. Finally, don’t blame or cast dispersions on the

doctor or anyone else on your staff. If someone made a mistake, you still

don’t want to blame anyone. This is what happened. This is what we’re

going to do. That’s what you want to say. Keep it very straightforward

and document, document, document. It’s critical that as these things

occur – especially the more serious issues – that you document what

happened, what was done, what was offered, what the patient asked for,

and be able to put all of that in the record. I’ve given you several

examples of things you can say in different situations. So let’s take a look

at some words that work. We have talked a lot about empathizing today.

Here are several great empathetic responses. You can fill these in on the

page for module four in your handout. “I can see why you are upset.”

Here’s another one. “Let’s step over here to talk. That way, we won’t be

interrupted.” If someone is upset in a public setting where others are in

the waiting room or can overhear the conversation, it’s best to take the

patient away from the public setting. Take the patient to a private area

where you can talk to her alone. Sometimes the audience will encourage

the patient to escalate her feelings higher. So you definitely want to talk to

her privately. Also, ask her to sit down. That will reduce her emotions and

help her calm down. You want to do everything you can to reduce the

patient’s emotional stress. “So let’s step over here to talk. That way we

won’t be interrupted.” This is a great phrase to say as you take them off to

the side so you can listen, understand what’s happening, and walk them

through the six step process. The next one is, “What I hear you saying is

...” This will help you clarify what they are saying to make sure you

understand, especially if they are very emotional. They may be saying

some things they don’t realize they are saying and they may not be

articulating what they want to say clearly. By reflecting back what they

say, often you will find they can articulate much more clearly and they can

give you more details. Also, they calm down. That simple phrase, “What I

hear you saying is ..; Is that right?” will help you get that agreement and to

understand that you are both on the same page. Once they admit that

you understand, you have an opportunity to move forward. Sometimes

you’ll have a person who likes to complain. They just have problem after

problem after problem, and you can’t ever seem to find a solution.

Sometimes those individuals can be very difficult to work with. What we

find works really well is to ask, “Tell me, what were you hoping would

happen?” Find out what solutions they want. This is a great tip when

they’re not asking for something specific, but they’re just complaining

about what happened and who did what and who said what and how

upset they are. After they’ve gone on for a bit, ask, “Tell me, what are you

hoping to have happen. How can I help you?” Sometimes they just need

to get it off their chest. And they might actually say, “Well, I don’t imagine

you can really do anything. I just really wanted to tell you what

happened.” One more phrase you can use is, “What did you mean by

that?” The important thing in saying this is to say it in a completely natural

– even curious – tone. Because you are asking them to clarify what they

said, they will often use different words, which might even contradict what

they said first, which wasn’t what they meant anyway. Or you may have

thought they were saying something mean or otherwise upsetting and you

may have misunderstood. You’ll realize that when you give them a

chance to state it another way. These are five powerful phrases you can

use. Because this can be such a sensitive area and there are so many

different variations, sometimes I find that I just need the right words. You

can pick up a lot of tips from Susan Keane Baker and Leslie Bank who

have a book called I’m Sorry to Hear That – Real Life Responses to

Patients 101 most Common Complaints About Healthcare. This is a

fantastic book for anyone in the healthcare industry who has thought how

do I say that? They go over specific words and specific responses for the

most common complaints. So if you know what to do but you aren’t quite

sure what to say, check out this book. You’ll find that once you use the

right words a couple of times and you get used to using those words, you’ll

find yourself doing it automatically. And soon, you’ll begin making up your

own scripts.

FRED PRYOR SEMINARS HANDLING COMPLAINTS MODULE FIVE – PREVENTING COMPLAINTS HAN121127-5 JULY, 2013

Female: Module Five – Preventing Complaints. We’ve mentioned a lot of things

during this webinar about what you can do to prevent complaints. This

module will sum them up all in one place, plus add some other ideas we

haven’t talked about yet. You know that your patients or your clients or

your customers in the office faculty are there for you to serve them.

Having a patient-centric focus as the top priority, asking what you can do

to cater to the patient’s needs can help with many of these complaints. To

have a patient-centric focus, make sure you conduct regular training to

teach any staff member who works with patients how to handle conflict.

Anytime you work with people, you will have conflict. What happens to

that conflict or where it leads depends on how you handle it.

Unfortunately, you can’t send all your patients to conflict management

training to help them communicate better or help them understand what to

do and how to say things, or to be less crazy in the way they

communicate. So you need to take on that responsibility to get trained to

understand how to handle their conflicts. In addition, each time there is a

conflict, you want to look at what worked and what didn’t work. What are

others in your office doing that works when someone is upset, and what

doesn’t work? I hope I’ve convinced you today that there are ways to

handle aggravated, angry, upset, complaining people. Sometimes it just

takes training. It just takes going through that process and learning what

works and what doesn’t work. It’s important that every staff member have

that training – not just one. And it’s important that it’s reviewed

periodically to keep it fresh. I know that every time I review training, I

learn something a little different or see another possibility or see it from a

different angle. It helps you stay sharper and provide the best possible

care for your patients. Another thing we talked about is weekly meetings

where the staff can discuss complaints that happen and actions taken on

a regular basis. What do you see, and how can you resolve these

incidents? Sometimes it’s simple, or little things. And sometimes the

client doesn’t know how to complain and bottles it up until the littlest thing

sets him off. Make sure you have your complaint policy posted so patients

know how to complain. You don’t want that first complaint to be a lawsuit.

You want to make it all right for patients to share their complaints and

concerns so that you can work through any problems with them so they

aren’t finding litigation as their first option. The next thing you can do to

prevent complaints is to say thank you. This may sound rudimentary. But

an informal survey among clinics and offices indicated that offices say

thank you less than one or two times. They didn’t think about saying it.

Many of them had forgotten that the patients were their customers. When

asked if this were a customer, would you say thank you, they said of

course. So remember that your patients are your customers. And let’s

look at five times you can say thank you to your patients. Number one is

when they arrive, especially if they arrive on time. It’s important that they

know you appreciate them. Thanks for coming in today. It’s great to see

you. Thanks for getting here. Wow, you’re early! Thanks for being early.

Thank them for doing something positive. You want to reinforce positive

behavior. Be excited to see them. I understand completely that

sometimes that’s not easy – especially if the last person just got done

chewing you out for something that wasn’t even your fault. You’ve just

dealt with an unhappy or angry person. Now the next person walks

through the door and you’re still recovering from the last one. I

understand that happens. But remember, don’t take it personally. It’s not

about you. It’s about the patient. And some people are unhappy. So

enthusiastically greeting the new person is the best way to get past that

nasty client. It’s called “estate change.” If you make an effort to change

your mood to greet the next person, you are literally erasing what

happened with the complainer. This is the best reason for greeting

everyone as if you were happy to see them. Be glad that new person is

there. Welcome her. The next time to say thank you is when someone

informs you of a change in status. Let her know that you appreciate her

for informing you of that change. You can even say that you appreciate

receiving that information. Next, say thank you when someone informs

you of a problem. Most people who have problems don’t ever tell anyone.

Many just go someplace else. So if a patient is letting you know about a

problem, that’s really wonderful and he deserves your thanks. Otherwise,

how would you even know that it’s a problem? I know that this sounds

counterintuitive. I’m supposed to appreciate them for complaining? But

make sure you let them know that you appreciate them telling you that

something is not meeting their needs. What is true about complaints is

that for every complaint you get, there may be four or five complaints that

you are not getting. Other people with the same complaints aren’t saying

anything. Sometimes if you can catch a small complaint early, it won’t

develop into a large complaint. So it’s important that if they do inform you

of a problem or something that’s unsatisfactory to them, you let them know

that you appreciate them for sharing the problem with you, and that you

will work to resolve it as quickly as possible. Another time to thank them is

when they pay. Thank them for making a payment on time. Thank them

for being a valued client of your practice. Last, don’t forget to thank them

when they refer another patient or client to your clinic or office. It’s easy to

forget to ask for referrals. Referrals are the lifeblood of any practice, any

hospital, any business. So be sure to thank them for doing so. Show your

appreciation for them bringing you new business. And make sure to say

thank you then as well. When any new patient comes into your office, ask

who referred them or how they found out about your office. If it was a

current patient who referred them, be sure to put a note in that patient’s

file and that way the next time they come in, someone will remember to

say thank you. Now let’s take a look at your office layout. You may be

thinking what does that have to do with complaints? If you have a busy

office, people may spend a significant amount of time there, which means

that if they’re uncomfortable and the office or waiting room is not calming

and soothing, you may find that the complaints are actually brewing right

there. So here are four tips on how to make your office layout a more

friendly and more comfortable environment. First, start with a splash of

color. Recent research found that natural colors – that is colors found in

nature – tend to produce a calming effect. Many years ago, pink in

hospitals, in jails, was very common. Today it is nature colors – subtle

browns, subtle greens, which have a calming effect. Stay away from the

sterile white that often produces a clinical feeling. That clinical feeling

leads to a black and white, yes or no type of atmosphere or emotion. And

clients tend to become more complaining in those environments. When

it’s more of a friendly atmosphere where patients feel they are talking with

their friends, where it feels warm and inviting, they tend to be much more

forgiving when problems occur. So having a warm, nature-like

environment can potentially reduce your complaints as well. Next, look at

your furniture. Think of a pregnant woman going into an OBGYN office

with couches. Do you know how hard it is for a woman who is seven

months pregnant to get up out of a couch? If pregnant women need to

stand in your waiting room because none of the furniture is comfortable for

them, do you think that might lead to complaints? Now consider older or

elderly patients. They often prefer straight-back chairs for the same

reasons. It’s hard to get up from low, soft furniture. So make sure your

furniture matches your patients. If your patients will be there for a long

time, perhaps in a waiting room outside the emergency room, or in a clinic

where they may need to wait for a spouse or a child, make sure the chairs

and furniture are comfortable. You may need a variety of types of chairs

for people with different needs or desires. If you have a lot of kids in your

waiting room, you may need kid-sized furniture, too. Next, consider wall

art. The art should also make the environment friendly and welcoming.

Strange, loud abstract art can have an agitating effect on your patients.

And again, match the type of art to the majority of people who will be

visiting your practice. Finally, consider the reading material. You might

have information about the type of procedures that your office performs.

But it all shouldn’t be clinical material. Again, consider the needs of your

patients. In a pediatrician’s office, you would want to have things that are

interesting for parents – both younger parents and older parents, and even

grandparents who might be taking a child to the doctor. You also want to

have things that will entertain the children and keep them happy,

especially if you have long waiting periods. I’ve been in pediatrician’s

offices that are very sterile and where it is uncomfortable to wait more than

a few minutes. But recently I took my daughter to the optometrist’s office,

and they had chairs and toys. And we waited for a half an hour and it felt

like just a few minutes because there was so much to do. Many offices

have a separate area where kids can play and often have videos that kids

can watch. By adjusting your waiting room to match the needs of your

patients and considering their needs, your office will reduce the number of

complaints and your patients will feel much more comfortable when they

come to visit you. Where do you go from here? What actions will you

take from having listened to today’s webinar? You can make notes in the

handout on the page for module five. The first step is to review your own

processes. Look at what you currently do. Is your process clearly

written? Do patients feel like they get procedural justice? Go through

your process and look for any gaps and what you can do to fill those gaps.

That’s the first step. Second, once you identify your gaps, educate or re-

educate your staff on how you will fill those gaps. Perhaps they need to

ask more clarifying questions, have the forms filled out more quickly or

sooner or more completely. Scheduling whatever education is required is

a great second step. Third, make sure you start saying thank you more.

It’s a small thing, but it can have a big impact. Showing appreciation and

gratitude helps to reduce complaints as well. Fourth, evaluate and adjust

any office layout issues that you see, whether it’s having more comfortable

furniture, updating some coloring, making the environment more friendly

and less clinical – anything you can do to help your patients feel more

comfortable in your office environment.

[End of recording.]

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