Complaint and Grievance Management in the Office Practice Setting

It goes without saying that psychiatrists are expert communicators; however, psychiatrists (and their office staff) are not immune to receiving complaints and grievances from patients. Patient complaints/grievances in psychiatry typically result from unmet expectations around communication, staff interaction, appointments, response time to patient requests, medication management, billing, and perceptions regarding diagnosis and the plan of care. Addressing patient complaints promptly will help to mitigate the risk of licensing board complaints, malpractice claims, corporate or regulatory compliance allegations, and reputational damage.

Develop a Complaint/Grievance Management Process

A written office complaint and grievance management policy and procedure will help ensure physicians, providers, and staff handle complaints and grievances promptly and consistently. When developing policies and procedures, review federal and state regulations, codes of ethics, and guidance from the AMA, professional associations, and accrediting agencies. Staff education is critical to ensure that staff understand the policies and procedures and their role in the complaint and grievance-management process.

Set Expectations

Patient complaints often stem from the failure to set expectations up front. To help avoid complaints, discuss practice policies with each patient, such as communication methods, after-hours processes, emergencies, prescriptions, cancellation/no show, billing, and termination.

• Discuss and provide the written policies for appropriate use of telephone, email, and text communication and response time.

• Discuss prescribing policies during a screening evaluation. New patients may expect a prescription on the first visit. It is important that patients understand prescribing is guided by professional standards and guidelines, and several office visits may be needed before a diagnosis is made and prescribing considered.

• Inform patients of office procedures for prescription refills. Make expectations clear regarding any continued monitoring requirements such as adhering to regularly scheduled office visits prior to refilling medication.

• Document patients’ understanding of the policy, any nonadherence, and steps taken to correct nonadherence.

• Provide patients with your billing and fee policy at the first visit. Be clear about nonrefundable fees or payment for no-shows and appointment cancellations.

• Inform patients of your complaint and grievance management policy.

Understand Patients’ Perspective

It is common to feel angry or defensive when receiving a complaint. It is important to temper your reaction, including body language and tone of voice, when asking questions or summarizing your understanding of the key concerns. Actively listen to the patient, avoid drawing conclusions, or solving the problem while the patient is speaking.

Investigate Grievances and Document Complaints

While complaints may be addressed immediately, grievances will require investigation and written response. Consult your attorney and insurer for assistance in managing complaints/grievances involving medical error or adverse outcome. Consider these steps:

• Inform patients of your process.

• Clearly communicate response time frames.

• Provide a contact name and details for any follow-up questions.

• Communicate with patients, especially if you are unable to resolve the complaint in a timely manner.

• Be truthful, straightforward, clear, concise, and consistent in your response.

• Document all complaints/grievances in the medical record.

• Document the facts; use quotes to describe the patient’s concern.

• Document billing complaints in the billing file.

• Document the complaint/grievance’s disposition.

A written office policy that includes an established process for complaint/grievance management and staff education will help reduce liability and mitigate the risk of licensing board complaints, reputational damage, malpractice claims, and compliance allegations. ■

^{This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, Ltd, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2023 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.}

Denise Neal, R.N., B.S.N., C.P.H.R.M., is assistant vice president of the Risk Management Group of AWAC Services Company, a member company of Allied World. Risk management services are provided as an exclusive benefit to insureds of the APA-endorsed American Professional Agency Inc. liability insurance program.