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Service Recovery
Jodi Fawcett
Director, Office of Patient Affairs
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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It’s Who We Are!
Our goal at Vanderbilt is to identify and to
the best of our ability address patient and
family concerns, complaints and
grievances. “It’s Who We Are!”
©VUMC, 2005
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What is Service Recovery?
• Making right what went wrong
• Rebuilding positive feelings and
satisfaction
• Learning from our customers and
each other
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Tip of the Iceberg
… Consumer and medical literature
indicate voiced complaints represent
only a small fraction … for every pt/fm
that complains there are many more …
Annandale. Accounts of disagreements with doctors. Soc Sci Med 1998.
Carroll. Characteristics of Families that Complain Following Pediatric Emergency Visits. Ambulatory Pediatrics. 2005.
"Consumer Complaint Handling in America: An Updated Study for the U.S. Office of Consumer Affairs," 1986.
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Spectrum of Patient Dissatisfaction
Lawsuits
(tip of the
iceberg)
Voiced
Complaints
Drop outs
Non-adherence
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Preferred Service Recovery
Model
Level 1: Concerns are addressed immediately by
employee using HEART
Level 2: Concerns are addressed at employee
or management level with additional tools
Level 3: Employee/manager refers
Patient/Family or concern to Patient Advocate in
the Office of Patient Affairs for assistance with
resolution
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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H-E-A-R-T Protocol1
1) Hear the patient
2) Empathize
3) Apologize*
4) Respond to the problem
5) Thank the patient/family member for
sharing their concerns
1
*
From C. Santalucia, Cleveland Clinic Foundation, 2002
Really acknowledge and sometimes apologize
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Hear the Patient
• Introduce yourself
• Focus on the person; be aware of your body language
• Ask open-ended questions
– Tell me what happened?
– How can I help?
• Be very slow to interrupt
• Avoid defensiveness
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Empathize
• Reflect the feelings
– ‘I am sure this is frustrating’
– ‘This is upsetting …’
– ‘I can appreciate how helpless you must feel’
• Remember your body language
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Apologize*
• Tell the patient/family we are concerned
about …
• Apologize that we have not met …
• If appropriate apologize
• Be positive
• Don’t joust
* Acknowledge
©VUMC, 2005
© CPPA , OPA & VUMC, 2005
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Respond to the Problem
• Tell the customer what you will do …
• Give a time frame for getting back
• Follow through …
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Thank the person
• ‘I appreciate the fact you shared … with
me.’
• ‘Thank you for taking the time to give
feedback …’
• ‘Your concerns are important …”
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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What if H.E.A.R.T. is not
enough?
If the pt/family remains unsatisfied
1. Speak with the Manager on duty
2. Consider a Voucher
3. Refer to OPA or other resources
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Talking to the Manager on Duty
•
•
•
•
Succinct presentation of the dissatisfaction
What you have already tried
Patient’s response
Your suggestion for next step
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Voucher Option
picture of the voucher…
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Before considering a
voucher you should take the
Patient/Family’s
Emotional Temperature and
consider the perceived
cause of the frustration. It is
NOT always appropriate to
offer a voucher.
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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The Voucher is that little something extra…
“I know that this voucher can not make up
for your concern but we would like for you
to use this as an additional way for us to
say that we do care about your experience
here at Vanderbilt.”
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Example of Completed Voucher
Page 1
Jane Doe
Emergency
Department
Holly Berry/26154
Holly Berry/10/13/05
# 005
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Example of Completed Voucher
Page 2
John Doe
005005555
10-13-05
10:00 PM
Adult Emergency
Dr. Marcus Welby
Pt’s wife was upset that wait was over 8
hours in the ED before getting a bed
assignment. She said that the response
from the nurse, Margaret Houlihan, was
very rude in saying “I am sorry I am too
busy to answer you now”. Margaret
Houlihan is the charge nurse
Listened to the concerns and explained
reasons behind wait. Let pt know that I
would pass nursing concerns on to the
manager. Wife and patient feel better.
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Completing the Voucher
Distribution Forms
• STAFF: Complete the Service Recovery Coupon
and place in designated place for manager
review.
• MANAGEMENT: Review the issues and deliver
forms to OPA
• TRENDS: OPA will document and trend events
requiring the use of coupons for Service
Recovery
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Service Recovery includes
Understanding Appropriate
Acknowledgment
of
Patient
Complaints & Grievances
“It’s Who We Are”
©VUMC, 2005
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Definition of Complaint
• Complaint –
– A concern regarding patient care or services that can
be resolved at the point of service by the staff
present.
– A post-hospital-stay verbal communication regarding
concerns that would routinely have been handled by
staff present if communication had occurred during
the hospital stay/visit
– Billing or Privacy issues that do not include patient
quality of care issues.
©VUMC, 2005
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Definition of Grievance
• Grievance
– Patient Care issues which are not promptly resolved by staff
present
– A complaint that includes a request that it be formally filed
– A complaint that is communicated in writing or includes a request
for a written response
– Verbal or written complaints that involve patient abuse, neglect,
patient harm, or hospital compliance with CMS Conditions of
Participation
– Complaints written or attached to a patient satisfaction survey for
which resolution is requested, or when the compliant submitted
with the survey is one that the hospital would customarily treat as
a grievance
©VUMC, 2005
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CMS Guidelines
Complaint
Grievance
• Concern addressed following Service
Recovery Policy guidelines.
• Office of Patient Affairs to be notified
and ad hoc grievance committee
formed. Concern addressed following
Service Recovery Policy guidelines.
•No written response required if
concerns are resolved at the point of
service.
•Written response generated to the
patient or patient’s representative
within 7 days to notify of resolution or
that resolution is in process.
•Grievance is considered closed when
the patient, or representative, is
satisfied with actions taken OR when
the hospital has taken appropriate and
reasonable actions to resolve concerns.
©VUMC, 2005
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The Role of OPA
• Engage in crisis prevention by interpreting the
institution’s philosophy, policies, procedures, and
services to patients and families
• Serve as the centralized grievance mechanism for the
institution, ensuring CMS guidelines with regard to
grievances are met
• Act as a liaison between patients and families and the
organization
• Collect and channel concerns/perceptions about
patient care situations to the appropriate management,
physicians, and departments so corrective action maybe
taken
• Coach staff in service recovery efforts
©VUMC, 2005
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How to refer to OPA
• Ask Patient/Family member to call 3226154 and ask to speak with a patient
advocate
• Let Patient/Family member know that you
will call 322-6154 on their behalf and that
a patient advocate may follow up
• Ask Patient/ Family to stop by the OPA
office for face to face discussion
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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How to refer to OPA
• Encourage patient family to send a letter to OPA
• Show patient family the In-Patient Guidebook or
in VUH Interactive Television regarding the
services offered by Patient Affairs
• Refer to Vanderbilt Office of Patient Affairs
Website
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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To OPA when:
• Concerns involve several departments
• Complaints involve physicians
• Patient asks to terminate an MD/pt
relationship
• Complaint is unresolved (or repeat
complaint)
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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To OPA when:
• Allegations of Malpractice, threats to
call the media (Involve OPA and Risk
Management)
• Concerns relate to a bad outcomes
(Involve OPA and Risk Management)
• Concern is presented in writing.
• Patient/Family request to file a “formal
complaint”.
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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To OPA when:
• Allegations of abuse/boundary issues (Involve
OPA,VUPD, and Risk Management)
• Complaints regarding Confidentiality Issues
(Involve Privacy Office and OPA)
• Concerns are about patient /injury sustained
while on Vanderbilt property (Involve Risk
Management – Veritas-RM)
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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TEAMWORK
Service recovery is the responsibility
of each staff & faculty member.
When patients are angry or upset,
they see each of us as a representative
of the entire Medical Center.
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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When In Doubt…
Refer Questions to:
• The Manager on Duty
• The Office of Patient Affairs
Policies available on line
OP 10-10.25 Service Recovery
OP 10-10.28 Complaint and Grievance Resolution
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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Contact
Jodi Fawcett
615-322-6154
[email protected]
© CPPA , OPA & VUMC, 2005
©VUMC, 2005
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