Emergency Department Directors Academy Phase I Fall 2019 Complaint / Compliment Management DESCRIPTION “Oh no…not another complaint!!” People complain when they are dissatisfied. Add the anxiety, confusion, and potential peril of an emergency and the number and seriousness of complaints increase. Complaint recognition and management are critical components of the successful ED director. When handled properly, a dissatisfied and angry person can achieve satisfaction. Alternatively, the improper management of a complaint can lead to a disgruntled person who seeks retribution. Leaders that recognize the relationship between quality and consumer satisfaction seek opportunities to improve by taking steps to reduce the root cause of dissatisfaction. The presentation will consider three issues: a) Who complains, why they do and methods of prevention; b) Successful program (process and tools) for complaint and compliment management; and c) Several classic ED complaints with underlying issues and methods of resolution. OBJECTIVES

• Identify who complains and the reasons they complain. • Describe techniques to prevent complaints, including the application of the “Yes” theory, Realistic Triage, Resetting

Expectations, Letting them know that you know, etc. • Explain methods to investigate complaints from patients, staff, administration, etc. • Implement a complaint management form and tracking system. • List classic complaints, the underlying issues, and prospective and retrospective solutions. • Complaint / Compliment Management

11/14/2019, 3:30PM - 4:45PM FACULTY: Robert W. Strauss, MD, FACEP BIOGRAPHY: Dr. Strauss practices clinically and administratively and is the Assistant Chair of Emergency Medicine at the Christ Hospital in Cincinnati, Ohio. He is TeamHealth’s Corporate Vice President of Program Development. Among his organized medicine leadership positions, he is a past chair of the “Residency Review Committee for Emergency Medicine (RRC-EM), a senior ABEM director, and the Course Director of ACEP’s ED Directors Academy. He is chief editor and contributor to Strauss and Mayer’s Emergency Department Management. Dr. Strauss has been honored with several ACEP awards, including the “James D. Mills Outstanding Contribution to EM” in 2015, “ACEP’s Outstanding Speaker Award,” “Hero of Emergency Medicine,” and “Outstanding Contribution to Education in Emergency Medicine.” DISCLOSURE: (+) No significant financial relationships to disclose

Robert W. Strauss, M.D., FACEP Emergency Dept Directors Academy

Dallas, 2018

Complaint & Compliment Management Systems

Objectives

Ø Describe the “Why” of effective complaintmanagement

Ø Implement Prevention Techniques

Ø Define Complaint Mgmt.Components

Ø Demonstrate Complaint Mgmt.Tool

People complain because

Ø Perceived injuryØ Perceived mistreatmentØ Expectations went unmetØ When and why do you?

Do you ever think…

I’d really like to get that jerk fired, but…

you do nothing.

Particular susceptibility of emergency care providers:

Ø Brief relationshipsØ Poor rapportØ Hurried and inattentiveØ Ineffective language (nlp)Ø “Emergency” or “Waiting” room

So why do you care? Reasons for Concern

Ø Census ImpactØ RegulatoryØ Medico-legal

The Regulatory Imperative

Ø Joint CommissionØ Department of HealthØ Office of Prof Med Conduct

If you think your only responsibility is to practice high quality medicine, I’ll have your contract in a minute.”

Karl Mangold

To whom does your administrator pay attention?

The Administrator’s Imperative

What does your administrator want from you?

Ø Problem solvers withevidence of success welldocumented

Ø Satisfied customers

What they don’t want is…

What does the ED staff want from you?

It’s more than the patient who must be satisfied, because if you don’t solve it then you become the problem.

Wrong Message

ØHmmm, 40% of ambulance patients get admitted, average reimbursement about $7,500.00

ØWhat are you doing here! Youjust brought two patients hereless than an hour ago!!!

The Ultimate Goal: Patient Satisfaction

Webster defines a customer:

“A person who purchases a

commodity or service.”

Do dissatisfaction / complaints increase or decrease with

Ø AgeØ IncomeØ Education

1) “Yeah, well I did everything right. Just look at the chart!”

2) “Let me explain to you how it works around here.”

3) “Our pamphlet explains our waits.”

Interpreting the classic responses

1) “Yeah, well I’m not paid to be a pillow fluffer. I really don’t care!”

2) “Let me explain how it’s not going to work for you aroundhere.”

3) “Yes, we’ve actually hard-wired our mediocrity.”

Interpreting the classic responses

Satisfaction Defined

Pre-purchaseexpectationsare met or surpassed…

Which meansIn order to create satisfaction, we may have to first lower expectations

Creating DISSATISFACTION by RAISING expectations

SATISFACTION requires meeting, and perhaps

Lowering expectations

How we raise expectations

We lie!Ø She’ll be in in a minuteØ I’ll be right backØ Just go to the ER-get an X-ray

Prevention TechniquesØ Realistic Triage

Ø Describe the process in advanceØ Lower expectationsØ ExaggerateØ Surpass lowered expectations

Ø Realistic TriageØ Resetting Expectations (WR)

Ø The waiting room visitØ Explain delaysØ Make the promiseØ Deliver the promise, and be

prepared to say, “You’re welcome.”

Prevention Techniques

Ø Realistic TriageØ Resetting Expectations (WR)Ø The bedside check

Ø Take off the blindersØ What’s the fear?Ø What really happensØ You can’t do it alone.

Prevention Techniques

Just say

“YES”

Ø Realistic TriageØ Resetting Expectations (WR)Ø The bedside checkØ The Theory of “Yes”Ø Key PhrasesØ Letting them know you know

Ø Pick up 4 charts and work backwardsØ Exaggerate time and begin treatment

Prevention Techniques

Ø Realistic TriageØ Resetting Expectations (WR)Ø The bedside checkØ The Theory of “Yes”Ø Key PhrasesØ Letting them know you knowØ The “Closing Question”

Prevention Techniques

Ø Realistic TriageØ Resetting Expectations (WR)Ø The bedside checkØ The Theory of “Yes”Ø Key PhrasesØ Letting them know you knowØ The “Closing Question”Ø The “Unnecessary Test,” Do you?

Prevention Techniques

Ø Bob Hockberger’s advice:“We’re here to treat people’s needs, physical and psychological.”

Ø Marshall Segal’s adage:“When things go wrong, nobody ever

themthanks you for having saved money.”

The Unnecessary Test

A Complaint Management System

Ø What are the components?Ø Who are the stakeholders?Ø Who manages the complaintØ What is the messageØ How is it documentedØ What is the follow-up and feedback

The Approach

Ø Which complaints are real?

Ø Who handles the complaint?

Ø What is the message

Painful necessity or asset?You choose

Ø Ignored complaints create dissatisfaction and perpetuate a negative reputation.

Ø Alternative point of view - They cared enough to complain so that the problem could be addressed.

Ø Script the interactionØ “This comes at an opportune time…”

Effective listening means hearing it from their perspective.

What do complainers want?Ø

Ø

Ø

Ø

Ø

The System Components

Ø Log for tracking (444) DetermineØ Current statusØ Individual numbers and totalØ TypesØ Outcomes

Ø Situation assessment form (442)

Situation Assessment Form

Ø Sources – multiple

Ø Issue(s) – simple, objectiveØ Investigation – inclusive

Ø Resolution – real answers

RESOLUTION

“Look for natural consequences.”

Ed Bliss

The PI Process

Ø ConclusionØ Standard of Care: met / unmetØ Adverse Patient Outcome (0 – 5)

Ø SignatureØ ConfidentialityØ Filing System

Communication &

Reporting:

The Critical Final Step

Ø Celebrating successØ Balancing the processØ Telling “the rest of the

storyØ Give and take credit for

the good work that youdo

The Compliment Management System

Dear Dr.

We know that you were instrumental in saving our son Jim’s life. We can’t even begin to imagine our lives without him and are so grateful that he is healing. You are a very special person and we would like to commend you and your staff for excellence in every area. We have a long road but are progressing. You will never ever be forgotten and we will remember you in our prayers always. Thank God you were there.God Bless You, Our Love The ’s

Ø Dr. ZippyØ Molasses General HospitalØ Dr. (Mercedes) BenzØ Dr. FrankensteinØ Dr. JerkylØ Dr. (Terry) BradshawØ Dr. (Ray) Charles

Cases: EDDA Phase II