September 16, 2005

Plan turns complaints into opportunities

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Plan turns complaints into opportunities

When patients and families are forced to complain about service or treatment, some people at Vanderbilt University Medical Center see it as an opportunity. Not only does a complaint present an opening to recover patient cooperation and loyalty, it also can help shed light on persistent causes of patient dissatisfaction at the Medical Center.

Vanderbilt is rolling out a two-part strategy of standardizing staff and faculty response to complaints while also pinpointing and fixing the causes of complaints. It's part of elevate, the wide-ranging VUMC improvement effort begun last year.

“Higher patient satisfaction is important because of what it represents — closer adherence by patients to recommendations of the health care team and thus better patient outcomes,” said Associate Dean for Clinical Affairs Jerry Hickson, M.D., director of the Vanderbilt University Center for Patient and Professional Advocacy. “Dissatisfied patients are more likely to skip their meds and follow-up appointments and less likely to comply with treatment in general.”

Service recovery is a management term having to do with how employees across an organization respond to customer complaints. At a recent leadership seminar, Hickson, a member of the elevate Service Recovery Team, introduced approximately 700 VUMC leaders to the HEART protocol — hear, empathize, apologize, respond and thank.

According to a new VUMC service recovery policy, all staff and faculty are expected to give priority to any patient complaint and to use the HEART protocol according to their best judgment, including finding solutions to complaints or making appropriate hand-offs. This fall, nurse managers in the hospital and clinic will be trained to use HEART, and they'll be asked to train their staffs.

“This is about empowering staff and faculty to solve problems for patients,” Hickson said. “We're all representatives of Vanderbilt.”

The protocol is simple to understand, but applying it well requires, among other things, attention on the patient and the complaint, appropriate body language and an understanding of how to apologize without blaming others or prematurely accepting blame for oneself or the institution.

After using the HEART protocol, it is also often necessary for staff to enlist the help of patient advocates from the Office of Patient Affairs, and the service recovery policy clarifies when to do so: several departments are involved; doctors are involved; the patient perceives that the complaint has not been resolved; the complaint involves injury, confidentiality issues, or allegations of malpractice, abuse or violation of personal boundaries. (Of course, many of these occurrences would also involve referral to other VUMC groups such as Risk Management, campus police and the Privacy Office.)

As stated in the policy, Patient Affairs provides “a liaison between VUMC and patients in achieving equitable solutions.”

“We act as a team with the staff to resolve patient and family concerns,” said Jodi Gumucio, director of Patient Affairs.

The office logs unsolicited complaints from across VUMC, then Hickson's team categorizes the complaints, tracks them by clinical area and by physician and analyzes any patterns that emerge.

Hickson told leaders at the recent seminar that among Vanderbilt University Hospital units there is a whopping 43-fold spread in rates of unsolicited complaints per patient per day.

There are strong reasons to believe that fixing the causes of unsolicited patient complaints helps not only to raise patient satisfaction, but also to reduce risk of medical malpractice complaints.

Hickson and his research partners have shown that, in one institution after another, around 9 percent of physicians are implicated in around 50 percent of all medical malpractice suits — a finding that is borne out today at VUMC. They've also found that the doctors who are more often sued for medical malpractice and the doctors who attract more unsolicited patient complaints are the same doctors. Inadequate rapport with patients is seen as a likely link.

As the VUMC complaint database helps identify sources of patient dissatisfaction, the appropriate administrator or physician leader presents the information to the relevant nurse manager or physician in a confidential, low-key way.

Hickson stressed that for every customer who makes an unsolicited complaint, studies find there are many more dissatisfied customers who remain silent.

“There's a nugget of gold in every complaint because it can help uncover sources of dissatisfaction that may otherwise have remained hidden,” he said.

As use of HEART spreads across VUMC, one of Hickson's goals is to capture more complaints in the database. Gumucio said that patient care staff in the hospital and clinic will soon receive $5 vouchers that can be redeemed by patients and families at the cafeteria or the gift shop.

The upcoming training will cover when it is and isn't appropriate to follow use of the HEART protocol with an offer of a voucher. Each time a voucher is given to a patient or family member who has complained, staff will briefly document the complaint and managers will pass these notes to Patient Affairs for entry in the database.