GRIEVANCES &

E.S.I. Scheme

Dr. Anil Bhadoria

EFFECTIVE GRIEVANCES HANDLING & ATTITUDINAL CHANGES TO ENSURE SMOOTH & SMART DELIVERY OF BENEFITS….

30 AUGUST 2013

TRAINING PROGRAM FOR MP, ESI SERVICES

GRIEVANCES HANDLING

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WHY WE NEED TO DISCUSS……

We are Health Industry, day begins with complaints.

Complaints not attended properly, Patient will be dissatisfied and generating GRIEVANCE.

WHY WE NEED TO DISCUSS……

ESI Scheme has – 150 Hospitals & 42 Annexie Wards 22325 beds 1402 Dispensaries 7983 IMO & IMPs 1.67 Crores IP and their family units 28.60 Insured Females > 7 Crores Beneficiaries 1 Million ESI Beneficiary attend our service outlets

daily nation wide. In MP, daily average of 5686 patients have attended

ESI Set-up in 2012-13.

WHY WE NEED TO DISCUSS……

1 Million Patients is a huge number. There is sufficient scope of inadvertent

& willful harassment of IPs and Family Members because- Expectations are high. Limited resources. IP is our VIP as well. IP is a consumer as ours are contributory

services.

WHY WE NEED TO DISCUSS……

Citizen Charter was introduced in 1997 To improve Public service delivery system. A service excellence model SEVOTTAM was

initiated in 2005 to thrust implementation of citizen charter.

Citizen Charter & Grievance Redressal Bill 2011 is right of citizens for time bound delivery of goods & services & Redressal of their grievances bill or Citizen Charter bill 2011

ESIS is also covered under RTI Act 2005

WHY WE NEED TO DISCUSS……

What is Vision Panchdeep:1. Better coordination & awareness of scheme.2. Improvement in –

Delivery system, Work environment, Grievance Handling & Fulfillment of Men & Material resources.

3. Scheme in new areas.4. Skill Development.5. Simplify Rules & Regulations for hassle free

services.

GRIEVANCE

How do we Define:

Any lack in service that disappoints the beneficiary of ESI Scheme and is presented to service-provider verbally or in written is a Grievance.All beneficiary have equal right to present his complaints to service provider at lower or higher levels to obtain their redressing.

GRIEVANCE HANDLING

90% of grievances are minor at ESI Scheme which include:

1. Improper attention to patient.2. Delayed services like supply of drugs, impending

surgery.3. Generic & substitute Drug Products.4. Unavailability of basic services like path investigations.5. Reimbursement- Rejection or Delayed or at CGHS rate.6. Misbehavior by health care provider.7. Mob Management as every one is in hurry.8. Not meeting with the expectations like cashless facility,

proper referral or advance sanctioning.

GRIEVANCE HANDLING

CAUSES -1. Emergency health situations.2. Work Environment.3. Poor Infrastructure of health industry.4. Poor quality of material.5. Misbehavior (From either side).6. Services not meeting with expectation.7. Excessive Patient Input.8. Punctuality

GRIEVANCE HANDLING

INVESTIGATE THE GRIEVANCE:1. What is the matter?2. Who is involved?3. Why did the situation occur?4. Where did the grievance occur?5. What are the circumstances?6. What remedy the Grievant is seeking?

GRIEVANCE HANDLING

Grievance Redressing:1. Develop a list of available alternative

solutions.2. Gathering information from past

experiences.3. Final decision in clear & unbiased

terms.4. Follow up.

GRIEVANCE HANDLING

5 stages to resolve the problem:1. Level - 1 redressing in first 48 hours.2. Level - 2 redressing in 3 days.3. Grievance committee level making GR in 7

days & decisions implemented within days of receipt of recommendations from committee.

4. Appeal for revision in 1 week.5. Arbitrator level GR whose decision shall be

binding on both the party.

GRIEVANCE HANDLING ATTITUDE

G.R. PROCEDURE:1. First & foremost……….Don’t Panic.2. Hold your temper.3. Take a lead.4. Consider the possibility of early

settlement which is possible in maximum cases.

FEAR FACTOR

GRIEVANCES CAN BE FILED – To State Medical Council which reaches the MCI

ultimately. Under IPC 304A to the Police and To the State or National Consumer Forum

By filing a case in State Medical Council, the complainant has a fair chance of getting more compensation if the State Medical Council gives a decision against the doctor which includes 1. Warning, 2. suspension of license on finding any deficiency of service in the hospital treatment.

There is a fundamental principle in law that one is supposed to LOOK ONLY INTO THE ALLEGATIONS specified by the complainant and not pursue or do the post mortem of the whole case.

FEAR FACTOR

Suspension of license is a criminal punishment versus compensation which is a civil punishment.

Medical councils do take actions against medical doctors. Action against doctors is much higher in the medical councils than

in the Consumer Forums. Doctors are covered for a financial disputes under a contract, for

civil negligence under the law, for criminal negligence under IPC 304A and for a professional misconduct under MCI Ethics regulations.

MCI Law 7.5 says that once you are convicted in a criminal case, the same amounts to professional misconduct.

If there is a warning or a suspension of license, the same can be taken adversely by the Criminal Courts or the Consumer Courts which may award punishment or heavy compensation to the patient even without going further into the inquiries.

GRIEVANCE HANDLING ATTITUDINAL CHANGES: 1. Be punctual.2. Be a good Listener.3. Identify potential cause.4. Correct the problem promptly.5. Encourage corrective suggestions.6. Be objective & consistent.7. Be fully informed about policy matters.8. Be communicative & give advance notice to

changes. Continued……

GRIEVANCE HANDLING

……….continued

9. Any grievance, not attended or answered within 48 hours or specified time limit shall be submitted to next step, be it Regional Dy. Director or Medical Supdt.

10. Grievance not appealed to next step in writing within time limit will be considered withdrawn.

GRIEVANCE HANDLING

Benefits of EARLY settlement of Grievance Redressal-

1. Quick Resolution2. Superior Credibility3. Services Entrusted4. Respect Regained5. Prolonged conflict avoided6. Local mob control is maintained7. Further Grievance avoided

GRIEVANCE MEETING

Discuss rationally - Law of natural justice. Review the Grievance with grievant & the

representative. Don’t bargain with the grievant. Be certain that you have all the information you need

before responding. Don’t respond to a demand for an instant answer. Adhere to time line for your response. Provide an answer which is concise & complete. Obtain acknowledgement of receipt or your answer

from grievant with time & date mentioned.

GRIVANCE REPORTING :

LOCAL LEVELIMO/IMP at Dispensary/Panel clinic level.Manager at Branch Office level.MS/DMS at Hospital level.

STATE LEVEL GRO or Regional Deputy Director or Director,ESIS SMC or Sr SMC

CORPORATE LEVEL/ HQDG / MC / IC or Director (Public Grievance)Toll free : 1800-11-2526 Email: jd-pg@esic.nic.inFor Suggestions & Grievances

GRIEVANCE HANDLING

Prevention at local level:1. Direct observation.2. Suggestion box.3. Personal counselor.4. Exit Interview.5. Misc Channels. ( Receiving inputs from field

workers about supply chain, Inventory & follow up of grievances placed at higher levels).

6. Grievance Register at all levels.

GRIEVANCE HANDLING

Key features of good grievance handling procedure:

1. Fairness2. Procedural steps3. Promptness4. Definite time limits (TL)5. Facilities for representation at each

step.

TAKE HOME MESSAGE

Every Grievance has a Life Span. Early resolution is better. No grievance is bigger so long as we are-

Punctual Communicating Patient Friendly Sympathetic as well as Empathetic Informing properly the channels above &

below

WAKE UP

Goalkeeper & attending Grievance cell are same. You can make a 100 brilliant saves but the only shot that people remember is the one that gets past you.

You don’t need a reason to help people.

An error gracefully acknowledged is a victory won.

THANK YOU !