How Cleveland Clinic triages patient complaints in real time

All hospitals are focused on improving patient experience, a priority that has been proven to not only affect HCAHPS scores, Press Ganey survey ratings and CMS reimbursement policies, but also leads to improved quality and outcomes.

At the heart of patient experience, there are two strategies. The first is to put in place initiatives to actively improve satisfaction. The second is to appropriately manage patient complaints.

"Effective management of complaints and grievances contributes to our medical center's overall patient experience approach, which focuses on teamwork, empathy, safety and ease," Stephanie Bayer, senior director of patient experience at Cleveland Clinic, and co-authors wrote in a 2021 paper in the Journal of Patient Experience.

By focusing on patient complaints, healthcare systems can not only improve experience but can also "save organizations money from a reduction in lawsuits, legal fees, and insurance costs," the researchers wrote.

Meeting patients' expectations is always a moving target, because all patient complaints aren't equal. This is why the hospital is using a "grievance severity scale" to categorize complaints in real time. The scale allows the hospital to take action to solve problems as fast as possible but to also differentiate between issues that require immediate attention from the "noise which distracts caregivers from other more important things," Ms. Bayer told Becker's. 

"Patient complaints matter and can be a great tool to make us better," Ms. Bayer said, noting at the same time, some complaints — which patients then might associate with poor experience — don't always require immediate attention. As an example, she said, complaints about safety practices — such as needing to have someone else to drive home after sedation or, during the pandemic, masking policies — are "things we won't compromise on."

The five-level severity scale is used by the hospital's ombudsman to rate complaints from level 1 — an inconvenience or "not actionable" — meaning the "patient care was not impacted or the issue is not preventable," to higher levels where the patient may be at risk for harm. Level 5 deals with patient deaths after a complaint was filed.

Cleveland Clinic's ombudsman looks to intervene at the earliest possible time to make sure the patient knows their voice has been heard. The ombudsman is the hospital's first line of defense when it comes to patient concerns; they help to set expectations in the case of a level 1 complaint — or level 2, where the patient was inconvenienced but did not suffer harm. Additionally, the ombudsman actively gets involved when necessary to bring faster resolution to more complicated level 3 complaints. 

A level 3 complaint on the severity scale represents mild or moderate, but temporary, harm to a patient such as a delay in receiving medications, clinician failure to follow up on a patient following a procedure, and even cancellation of a procedure with the need to reschedule. In these cases, the ombudsman can not only ease a patient's concerns but can work with caregivers and schedulers to solve the problem at hand.

At level 4, there has been significant, potentially permanent harm to the patient. This includes a misdiagnosis, complication or infection. Again, the ombudsman can intervene as a communication conduit to either help solve the problem more expeditiously or make sure the patient understands the situation and what can be done to manage it. 

An analysis of 9,233 complaints made at Cleveland Clinic between Sept. 1, 2017, to Aug. 31, 2018, showed most of the grievances involved communication challenges with hospital employees (25 percent), followed by patient perceptions that medical care and patient safety were compromised (14 percent). 

About two-thirds of the complaints viewed were listed as level 2 on the severity scale — minor inconveniences or communication issues.

"In contrast to HCAHPS data, complaint and grievance rates can give hospitals a more agile, real-time approach to resourcing and performance improvement opportunities," Ms. Bayer and her colleagues wrote in the study. "These data represent a supplemental source of detailed feedback about experiences which can drive improvements for safe, high quality, and better care."

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