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How Patient Complaint/Grievance Root Cause Analyses can help
improve the Patient Experience
Pamela Segura, MBA, CPXP, LSSGBDirector of Regulatory Patient Affairs and Service Excellence
Cook Children’s Medical Center Fort Worth, TX
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OBJECTIVES▹ Building a good foundation with appropriate teams.
▹ Identify tools and methods used to identify and close gaps while improving the experience by utilizing measurable actions from reported complaints and grievances.
▹ Describe and provide examples of tools used with facility leaders to help strengthen investigations so the appropriate action plans can be created from identified trends.
▹ Describe ways to provide verification and closure to complainants.
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IT TAKES A VILLAGE!
▹ Patient Affairs team- 4▹ Risk Management - 4▹ Legal - 2▹ Accreditation/Compli-
ance – 1▹ Medication Safety
Officer – 1▹ Ad hoc Members
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COMPLAINTS/GRIEVANCES
“To Have a Grievance is
to Have a Purpose in
Life.
-Alan Coren
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▹ Near Misses/Medical Errors/ Pain Management
▹ Lack of Communication, Introductions and Education
▹ Insurance or Billing Questions
▹ Requests and Compliments
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Patient/Family Report
▹ Quality of Care Issues ▹ Coordination of Care
Issues/ Accessibility (waits, delays)
▹ Patient Safety and Privacy/Compliance Concerns
▹ Staff and Physician Demeanor throughout CCMC
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ROOT CAUSE ANALYSIS
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SERVICE IMPROVEMENT PLAN
PersonResponsible for Action
ActionTaken/To be
Taken
ImplementationDate
MeasurementStrategy
Reporting and Communication
Medical Director
Nursing Leader
Risk Management/
Legal
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▹ Set up Meeting▹ Go over Timeline▹ Identify Barriers ▹ Staff comes up with an
Action Plan▹ Set Deadlines for Action
Plans to be completed
COMMUNICATION PITFALLS
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ILLNESS, INJURY, DEATH, UPHAPPY PATIENTS, FAMILIES, STAFF, CORPORATE FAILURE
THE OTHER GUY NEVER READS THE SAME BOOK AS YOU
ACCOUNTABLITYEXECUTIVE OWNER
FOLLOW UP ON ACTION PLAN ITEMS
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OUR PROCESS IS NOT EASY BUT IT’S EFFECTIVE
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first second last
THE AIRING OF GRIEVANCES!
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https://www.youtube.com/watch?v=0JR6xt9S02o
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WE DO IT FOR OUR PATIENTS!
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THANK YOU!
Any questions?
34Contact Information:
Pamela Segura, MBA, CPXP, LSSGBCook Children's Health Care System Director of Regulatory Patient Affairs and Service ExcellencePhone: [email protected]
