Stay Informed! Employer Considerations Surrounding:  COVID-19

Litigation Management: Turn Your Grievance Program into a Customer Service Program

Healthcare, Property & Casualty, Senior Living & Social Services

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

— Maya Angelou

Maya Angelou’s quote couldn’t ring any truer than when it comes to how senior living and social service providers handle grievances, complaints, or other negative outcome incidents. The involved resident/client and his or her interested parties’ perception of indifference, lack of concern, or caring from the staff or organization is the biggest factor influencing whether an organization can expect future litigation or a complaint visit from the state department.  

Those providers that evaluate their grievance response through the view of customer service and client satisfaction (even taking some tips from the hospitality industry) may be better positioned to provide an optimal resident experience and proactively address issues before they escalate.

While having a formal grievance policy is required in most settings, it is strongly encouraged in all long-term care settings. We are also starting to see more Managed Care Organizations (MCOs) require formal grievance policies prior to provider participation. Before completely tossing your current program out the window, it is important to outline the requirements of a grievance program first and then move forward in embedding a customer service framework.

GRIEVANCE PROGRAM REQUIREMENTS

Grievance Official/Officer – Skilled Nursing Facilities Only

Identify the facility or organization’s grievance officer. The officer is in charge of collecting, investigating, responding to, and reporting grievances to the state or agency, if applicable.

Reporting Requirements and Communication

  • Notification must be made to residents/clients individually, or on a posting of his or her right to file grievances orally or in writing, including anonymity language, either before or at admission
  • Facility must provide the contact information (name, address, email, and phone number) of the designated grievance official – Skilled Nursing Facilities Only
  • Facility must inform residents of the right to obtain a written decision of his or her grievance
  • Facility must provide either individually and/or on a posting in a conspicuous location the independent entity options to file a grievance (i.e. Division of Quality Assurance, Ombudsman) including all relevant contact information

Recordkeeping

Skilled Nursing: must maintain grievances for 18 months. Upon time completion, discard appropriately according to your organization’s record retention policy.

Note: all other settings are not required to keep grievance reports for any set period of time. It is recommended to discard all reports upon completion and resolution of the grievance.


GRIEVANCE PROGRAM RECOMMENDATIONS

Reporting Requirements and Communication

  • Include the grievance policy and reporting procedure in the resident admission or lease paperwork while also displaying the information in an easily accessible public area of the building(s)
  • Reminders and continued education of the facility’s grievance policy and procedure for the residents and affiliated parties should be done in resident council groups, care conferences, tenant meetings, family meetings, or other town hall meetings at least annually
  • Consider embedding an additional layer of internal response if a resident or family member is not satisfied with the facility’s response or wishes for an outside opinion. For example, listing the CEO or COO as an option for residents or families to discuss concerns with before automatically reaching out to independent entities such as DQA or the Ombudsman

Prompt Response

While there is no required timeframe to complete a grievance, organizations are expected to resolve promptly. It is best practice to determine a reasonable time frame the grievance investigation and resolution will be completed.

Typically, five business days is more than sufficient to investigate and provide a response to a client, staff member, or other party. However, ensure there is language in your policy that more than five business days may be needed in certain circumstances. Having a response time frame also assists the grievance official or assigned staff in prioritizing work and ensuring follow-up to the party is completed timely.

Staff Training & Education

It is recommended to provide training and education to staff regarding the grievance policy and procedure as well as incorporating standard customer service tactics. Many tactics from the hospitality and restaurant industry can easily be tailored for senior living and social service providers.

Try These Customer Service Strategies

  • Don’t just hire hands, hire heart
    • Employees will treat residents/clients as you treat them. Has your organization nurtured your employees beyond the initial onboarding period?
  • Serve with a smile
  • Don’t overlook the importance of manners: Thank the resident/client family for the feedback/concern
  • Apologize and empathize with the resident/client or family (see “I’m Sorry” statute)
  • Active & reflective listening: Upon hearing a complaint or request, have the staff member repeat the complaint or request to the person to ensure understanding
  • Avoid saying no: How can your organization accommodate or provide a different acceptable solution?
  • Be proactive: Anticipate the needs and wants of your resident/client and have all items needed to complete your task prior to assisting
    • This also assists with workflow efficiencies
  • Incorporate mock resident/client interaction during interview and onboarding process
    • Audit manners/conversation between staff and residents/clients thereafter
  • Incorporate real-time satisfaction/feedback pulse surveys
    • How would you rate your service today?
    • How long was your wait time?
    • How can we do better tomorrow?

Note: Not every negative comment a resident/client or family says automatically triggers a grievance. Consider developing a flowchart for what your organization qualifies as a formal grievance requiring investigation and follow-up, and which of those can be resolved immediately. If resolution can occur immediately, ensure staff members are empowered to handle the concern and have the knowledge, tools and resources to do so efficiently and effectively.

Handling concerns immediately will not only allow for residents/clients and their families’ concerns to be addressed and resolved quicker, but giving added responsibility and trust to staff to handle issues on their own will lead to improved job satisfaction from your employees. Additionally, this process can assist with alleviating some of the burden of senior leaders, especially during ‘off hours’.

Wisconsin’s “I’m Sorry” Statue §904.14 9

How often have you heard to not apologize due to the admittance of guilt? When it comes to grievances and resolution, it is OK to express an apology or condolence to the impacted resident or affiliated resident party. The Wisconsin “I’m Sorry” statute became effective April 10, 2014. The statute allows health care providers to openly express apologies, condolences or fault. The “I’m Sorry” statute made these comments inadmissible in any civil lawsuit (Coyne, Schultz, Becker & Bauer, S.C.).

Grievance Log

A log is not required nor recommended, however facilities may find grievance logs to be helpful for the organization of a facility’s grievances. If a facility is going to use a log, the log should be brief and a high level overview. The log should provide the date it was reported, subject of grievance while maintaining confidentiality, and date the grievance was resolved.

Grievance Policy, Corporate Compliance, and Quality Assurance

An organization’s grievance policy and program ideally funnels through the quality assurance committee and is embedded into corporate compliance. If the grievance program is tied to the QA program, privileges are granted for investigation, root cause analysis, tracking and trending. Note: The log, if utilized, is not privileged and would need to be provided to surveyors upon request.

During investigation, it is important to take a process vs. person approach by using root cause analysis when analyzing the incident. Blaming a certain person does not fix the problem and potentially leads to staff or residents not reporting grievances in fear of retaliation—even if you have anti-retaliation language embedded. By implementing a culture where grievances are process improvement opportunities, residents/clients, families and staff will feel confident in the facility’s response and resolution of any complaint or issue.

Don’t Hide Away from Complaints, Encourage Them!

Any grievance received should be a welcome opportunity to improve your residents’/clients’ and future residents’/clients’ experience while in your care. As with any customer service program, it is essential to elicit feedback from the members you are serving (residents, families, employees, case management teams, etc.).

When You Address Concerns Proactively, You Can Save

By encouraging grievances/complaints and resolving the issue early, rather than learning of an issue that has gone unaddressed during a survey, you may save not only a regulatory citation, but also real dollars ($). Per CMS, per-incident penalties are on the rise!

It is important to reflect if your organization is asking the right questions.

  • Are you asking for feedback, concerns, and complaints during care conferences or assessments?
  • If you’re a part of an association quality program or have internal surveys/programs, what are you doing with your satisfaction scores and comments?
  • In addition to the members you serve, what about your employees?
    • Are there annual or frequent staff check-ins?
    • Are you directly asking employees if they know of any abuse, unethical behavior or misconduct in the building/organization?
  • What about your vendors and other partners?

Even though it is certainly easier to not deal with something unless it comes up, it is important to take the time to ask difficult questions to mitigate any potential risks.

Please contact your M3 account executive or risk manager for further discussion and resources.

Back to Insight Center