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Responding to Patient/Family Complaints and Grievances (1.3.3)

Responding to Patient/Family Complaints and Grievances (1.3.3) - Policies, Clinical, UW Health Clinical, Administrative, Event Reporting and Grievance

1.3.3


UW HEALTH CLINICAL POLICY 1
Policy Title: Responding to Patient/Family Complaints and Grievances
Policy Number: 1.3.3
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: October 20, 2017

I. PURPOSE

To define the process to address complaints and grievances filed by patients or their families regarding their
care or experience. Note: This policy applies to all UW Health settings, inpatient and ambulatory, with the
exception of grievances on the Inpatient Psychiatric Unit, or in an AODA, or other Mental Health Clinic. For
all such grievances, please refer to UW Health clinical policy #2.4.5, Grievance Policy and Procedure for
Patients Receiving Care on the Psychiatric Unit or in an AODA or Behavioral Health Clinic.

II. DEFINITIONS

A. "Complaint" is the expression by a patient or the patient's authorized representative regarding
dissatisfaction with any aspect of care or service. A complaint can be promptly addressed by the staff
members or management present (i.e., nursing staff, nursing coordinators, therapists, patient relations,
administration, etc.) and resolved in a way that meets with the patient's satisfaction. Examples of complaints
might be a patient's room not being clean, a patient receives the wrong meal, a patient has a lengthy wait at
an appointment or the patient is unable to schedule a nonurgent appointment at the time they desire.
Complaints also include:
i. Service delivery failures that are promptly resolved through Service Recovery.
ii. Verbal feedback that is provided orally after a patient's hospitalization or clinic visit that would
normally have been addressed by the staff present if the communication had occurred during the
stay/visit.
B. "Grievance" is the expression by a patient or the patient's authorized representative regarding
dissatisfaction with any aspect of their care or service that cannot be promptly addressed by the staff or
management present. Grievances also include:
i. All verbal or written communication regarding abuse, neglect, patient harm, or compliance with
Joint Commission and Center for Medicare and Medicaid Services requirements.
ii. Anytime the patient or the patient's authorized representative requests their issue be handled as a
formal grievance or requests a formal response from the organization.
iii. Written correspondence regarding dissatisfaction with patient care is generally handled as a
grievance. Written information contained in patient satisfaction surveys is handled as grievances if
the patient or the patient's authorized representative identifies self and if the issue is one that UW
Health would normally handle as a grievance.
C. "Allegation of Caregiver Misconduct" is an allegation expressed by the patient or the patient's authorized
representative that an employee of UW Health or member of the Medical Staff intentionally abused or
neglected a patient or misappropriated patient property. Such allegations require prompt follow-up. See UW
Health administrative policy #4.47, Caregiver Misconduct Investigations and Reporting.
D. The Grievance Committee is a group designated by senior leadership that meets on a regular basis to
provide oversight for the grievance process, review complaint and grievance trends, and evaluate and
respond to requests for an appeal of the resolution of a grievance.
E. "Service Recoveryā€¯ is a UW Health process that empowers employees to handle patient complaints
effectively at the point of service.

III. POLICY ELEMENTS

UW Health is committed to supporting the rights of all patients to express satisfaction or dissatisfaction
regarding their experience with the hospitals and clinics and to seek resolution and response to their
complaints and grievances. Any employee retaliation against patients, families, friends, or other participants
in the complaint/grievance investigation process will not be tolerated. Employees found to be in violation of
this may be subject to disciplinary action, up to and including termination.

It is the policy of UW Health in accordance with state and federal regulations, to respond promptly and
thoroughly to any patient complaint or grievances made against UW Health, its employees, or members of
the medical staff. UW Health informs each patient of the right to file a grievance in accordance with federal
and state regulation.



UW HEALTH CLINICAL POLICY 2
Policy Title: Responding to Patient/Family Complaints and Grievances
Policy Number: 1.3.3


Every employee of UW Health is responsible for carrying out the procedure described below when s/he
receives a patient complaint or grievance. UW Health staff has the responsibility to listen to patient
complaints in order to attempt to resolve them as soon as is practical. UW Health staff is encouraged to
request the assistance of management and the Patient Relations Department as needed to expedite
resolution of complaints and grievances.

Any complaints or grievances related to suspected abuse, neglect or misappropriation of property shall be
addressed in accordance with UW Health administrative policy #4.47, Caregiver Misconduct Investigations
and Reporting. The employee and manager shall promptly address complaints and grievances about the
safety or well being of a patient in order to remove any potential threat to the patient.

The Patient Relations Department, in consultation with the Grievance Committee, is the official channel for
the review and resolution of patient or family complaints/grievances about the quality of patient care or
service received anywhere within UW Health. Patient Relations staff will work with the appropriate manager
to investigate the issues identified and resolve them whenever possible. The Patient Relations Department
is also responsible for notifying management and administration of serious complaints, grievances, and
trends. Generally, grievances are considered resolved when the patient is satisfied with the actions taken on
their behalf. In some instances, Patient Relations staff may determine that a grievance is resolved after
reasonable efforts have been made to appropriately follow-up on a patient's complaint or grievance, despite
the fact that the individual remains dissatisfied with the outcome of that review.

IV. PROCEDURE

A. Filing of Complaints and Grievances
i. Patients or their authorized representatives may inform staff of complaints and grievances in
person, via telephone, in writing, or via email.
ii. Any of these categories of feedback can be addressed to any staff member, manager, department
head, director, senior manager, or to the Patient Relations Department.
B. Responding to Patient/Family Complaints
i. Staff members should make every effort to promptly address patient complaints at the point of
service. Complaints are immediately resolved through the efforts of staff present and via Service
Recovery.
C. Responding to Patient/Family Grievances
i. As always, Patient Relations staff members are available to assist staff and faculty in resolving
patient grievances. If you would like to request a staff member to work with a patient/family
immediately, please call the Patient Relations Department at 263-8009 or call paging and request
the patient relations coordinator on call be paged.
ii. For grievances that arise after an episode of care or when it is not necessary for Patient Relations
to get involved immediately.
a. A staff member who receives a grievance about patient care or service is required to
inform his/her supervisor or manager of the grievance.
b. The staff member or supervisor will forward a copy of the grievance within two business
days to the Patient Relations Department. It is helpful if grievances can be submitted in
written format. Grievances can be sent to Patient Relations in one of the following ways:
by emailing the Patient Relations email box at: patientrelations@uwhealth.org, by fax to
265-1704, or via interdepartmental mail to Patient Relations, G7/210 CSC, mail code
2460.
c. The Patient Relations Department and the appropriate medical
staff/manager/administrator will investigate and develop a written response to the
grievance.
d. When patients disagree with the outcome of a grievance investigation, the matter will be
forwarded to the Grievance Committee for review and resolution.
e. All serious grievances will also be brought to the attention of the appropriate Clinical
Chair, Director and/or Administrator.
f. If the grievance is validated by the investigation, the involved department or service
should take corrective action as called for.
g. Whenever possible a patient's grievance will be addressed in writing within 7 business



UW HEALTH CLINICAL POLICY 3
Policy Title: Responding to Patient/Family Complaints and Grievances
Policy Number: 1.3.3

days of receipt of the grievance. If the grievance will not be completed within 7 days, the
patient or the patient's representative will be informed that their grievance is still under
review. They will also be advised of the estimated timeframe for completion of the review
and written response. UW Health staff and faculty strive to resolve and respond to
grievances as soon as possible.
h. All written responses to patients/families about grievances must be reviewed by the
Patient Relations Department prior to mailing the letter to the patient/family. The written
response will include the steps taken to investigate the patient's grievance, the results of
that review, the date and the name of the hospital contact person(s). Written responses
will be translated when the patient or the patient's authorized representative has limited-
English proficiency.
D. Grievances Made by Medicare Beneficiaries
i. Within one business day of receipt, if a Medicare patient so requests, the Department of
Coordinated Care will refer the patients to the Important Message from Medicare regarding patient
rights to appeal premature discharge and/or quality of care. Patients can contact UW Health Patient
Relations for assistance.
ii. For Medicare Beneficiaries with grievances related to their Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS) (e.g., applicable to Home Health or retail
pharmacies) within five (5) calendar days of receiving a beneficiary's grievance, the Department
providing the DMEPOS shall notify the beneficiary, using either oral, telephone, e-mail, fax, or letter
format, that it has received the grievance and that it is investigating. Within 14 calendar days, the
DMEPOS supplier shall provide written notification to the beneficiary of the results of its
investigation and response. Patients can contact UW Health Patient Relations for assistance.
E. Responding to Billing Questions/Complaints
i. The Patient Accounts Customer Service team will review patient questions/complaints about their
UW Health bills. Any complaints/grievances related to the quality of the patient's experience while
in our care shall be referred to the Patient Relations Department for review. In such cases, the
procedure outlined in section IV.C. above will be followed.

V. COORDINATION

Author: Director, Patient Relations
Senior Management Sponsor: VP, Quality and Patient Safety
Reviewers: UW Health Legal
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: September 18, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES

UW Health clinical policy #2.4.5, Grievance Policy and Procedure for Patients Receiving Care on the
Psychiatric Unit or in an AODA or Behavioral Health Clinic
UW Health administrative policy #4.47, Caregiver Misconduct Investigations and Reporting

VIII. REVIEW DETAILS



UW HEALTH CLINICAL POLICY 4
Policy Title: Responding to Patient/Family Complaints and Grievances
Policy Number: 1.3.3

Version: Revision
Last Full Review: October 20, 2017
Next Revision Due: October 2020
Formerly Known as: Hospital Administrative policy #4.46, MF Responding to Patient/Family Complaints and
Grievances