Presentation on

Grievance Redressal Policy

Name – Bonney son shangdiar

Master of Hospital
Administration
USTM
 CONTENT

• INTRODUCTION
• POLICY
• TYPES OF GRIEVANCE
• OBJECTIVES OF GRIEVANCE HANDLING
• PROCEDURE
• PURPOSE
• GRIEVANCE COMMITTEE
 INTRODUCTION
• Dissatisfaction - Anything that disturbs an employee, whether or not the unrest
is expressed in words.
• Complaint - A spoken or written dissatisfaction brought to the attention of the
head of the department
• GRIEVANCE can be define as any communication that expressed dissatisfaction
about an action or lack of action about the standard of service/deficiency of an
insurance company and/or any intermediary or asks for remedial action.
A patient complaint is considered to be a grievance if:

• The complaint cannot be resolved promptly with the staff present, or

• The complaint requires further investigation and action, or
• The complaint was referred to other staff for resolution, or
• The complaint was made in writing, or
• The complaint was written on or attached to a patient satisfaction survey, or
• The complaint was received by telephone after the patient was discharged, or
• The complaint was asked to be handled as a grievance, or
• The complaint involved an allegation of abuse or neglect, or
• The complaint was related to a compliance issues
Grievance/complaint Due to

Non-availability of Services Non-availability of staff, equipment, reagents, ward

arrangement, ambulance services, operation theatres,
pharmacy and blood banks etc.

Denial to entitlements\ benefit schemes etc. Non-availability of drugs, diagnostic test, cash benefits,
transport facilities etc.

Inadequate Infrastructure Inadequate\non-availability of basic amenities for patients and

their attendants like sitting arrangements, water, toilets,
electricity

Poor Quality of Services Sub-standard care provided by doctors, nurses and support
staff - their skill, experience, warmth, responsiveness,
communication and courtesy, regular cleanliness and
replacement of linen

Sub-standard Clinical Care The experience of the patient with clinical processes (treatment
processes and outcomes of care) in the hospital

Administrative Procedures Admission process, test reports, discharge process, grievance

redressal

Corruption/bribe Any staff asking for any monetary/non-monetary benefit

 POLICY
• 1. Any complaints made by the patient/relatives either in lieu of violation of patient's
rights , provision of medical care etc will be brought into the notice of the Chief
Medical Superintendent of the hospital either by the patient/relatives directly or by a
hospital staff.

• 2. Incase the complain is made through any hospital staff the Chief Medical
Superintendent will enquire the authenticity of the same from the particular
patient/relative.

• 3. The Chief Medical Superintendent will immediately investigate the complain either
in person or through designated individual staff member/s to find out the authenticity
of the complain, reason for the complain, staff member responsible (if any).

• 4. Based on the findings of the investigations appropriate actions will be initiated to

resolve the issue and address the patient/relative's grievance.

• 5. Written instructions are been displayed in various areas of the hospital

encouraging patient/relatives to report any grievance/complain to the Chief Medical
Superintendent of the hospital.
 TYPES OF GRIEVANCE
• Individual grievance-
complain that an action by management has violated the right of individual as set
out in a collective agreement or law or by some unfair practice
• Group grievance-
Complain by a group of individuals
• Policy grievance-
Complain by the union that the action of management is violated of the
agreement that could affect all who are covered by the agreement
 OBJECTIVES OF GRIEVANCE
HANDLING

• To enable patient to air his/her grievance

• To clarify the nature of grievance
• To investigate the reason of dissatisfaction
• To obtain a speedy solution to a problem
• To take appropriate action and ensure that promise are kept
• To inform patient his/her right to voice the grievance and take it to the next stage
of procedure
PROCEDURE:

• 1. Prior to receiving care, patients will be informed of their right to file a complaint by the Patient Access Clerk.
Patients will be given contact information (name, address, and phone number) for filing a formal grievance.
• 2. Any staff member who receives a complaint will attempt to resolve it through appropriate intervention. A
complaint is not considered to be a grievance if the patient issue can be resolved promptly on the spot by the
staff present. “Staff present” includes any hospital staff present at the time of the complaint or who can quickly
be at the patient’s location to resolve the patient’s complaint. Staff members will inform patient of steps taken
to resolve their complaint.
• 3. If the complaint cannot be resolved at the level of the department supervisor or manager where the
complaint originated, it is considered to be a grievance and should be forwarded to the Quality Management
Director for investigation.
• 4. Complaints that are not related to patient care or patient services are to be forwarded to the following
personnel for investigation and resolution:
Complaint regarding an employee – Human Resources Director
Complaint regarding a bill or account – Revenue Cycle Director
Complaint regarding a possible HIPAA violation – Privacy Officer or Security Officer
Complaint regarding a rural health clinic – Clinic Practice Manager
• 5. All written grievances must include the name and address of the person
filing, the description of the grievance, and the action and/or remedy of relief
sought by the grievant. Efforts will be made to complete the investigation
within 7 working days from the date the grievance was received. If the
investigation cannot be resolved within 7 working days due to the complexity
of the situation, the patient will be notified and given an approximate date for
completion of the investigation.
• 6. All grievances will be reviewed by the hospital’s Grievance Committee in an
effort to resolve the grievance. The Grievance Committee will consist of the
Chief Executive Officer, the Quality Management Director, and the Chief
Nursing Officer. Committee meetings will be held as needed.
• 7. The patient or representative will be contacted in writing at the completion
of the investigation. The written notice must include the name of the hospital,
the contact person, the steps taken on behalf of the patient to investigate the
grievance, the results of the grievance process, and the date of completion. All
correspondence related to the grievance will be retained by the Quality
Management Director
• 8. If the grievance has not been resolved to the satisfaction of the patient or
representative, he/she will be informed of their right to appeal the decision to the
hospital’s Chief Executive Officer. The grievant will be given the name, address,
and phone number of the Chief Executive Officer. If an appeal is made, the Chief
Executive Officer will submit the documentation of the grievance to the Board of
Directors at their next regularly scheduled meeting. The Board will make every
effort to resolve the grievance to the patient’s satisfaction. The Board will issue a
written notice of determination regarding the grievance no later than 30 days
following their initial notification.
• 9. After the Board of Directors has reviewed the grievance, the hospital may refer
any unresolved grievances to the Quality Improvement Organization (QIO) for
review provided the grievance involves a Medicare patient and refers to a quality
care concern or an appeal of a premature discharge. All Medicare patients will be
informed by the hospital of their right to have their grievance reviewed by the
QIO.
• 10. At no time during the investigation of a complaint or grievance will the patient
or the patient’s family be denied their right to protection. If at any time a staff
member suspects that a patient may be in imminent harm, it must be reported to
• 11. All hospital staff and medical staff members will cooperate with the
investigation and resolution of patient complaints and grievances. Patient
complaints and grievances will be discussed only with staff members involved
in the investigation and resolution process.
• 12. The Hospital will make appropriate arrangements to assure that disabled
persons can participate in or make use of this grievance process on the same
basis as the non-disabled. All written notices must be communicated in a
language that is understood by the patient or representative.
• 13. The data collected regarding patient complaints and grievances will be
incorporated in the hospital’s Quality Assessment and Performance
Improvement Program.
• 14. The Quality Management Director will report to the Board of Directors
quarterly on the status of all grievances.
 GRIEVANCE COMMITTEE

•The Grievance Committee (“the committee”) has the oversight responsibilities, duties and
authority with respect to the grievances received by patients or any of their concerned family
and friends that constitute a grievance and the Patient Complaint and Grievance Protocol..
 OBJECTIVES AND GUIDELINES OF
GRIEVANCE COMMITTEE
• To have a robust, efficient and effective grievance redressal system dedicated
to improvement of health care services and satisfaction of the clients
• To form a health system which is more responsive to the health needs of the
community
• To provide a platform for the beneficiaries to communicate their grievances to
the appropriate authorities
• To reduce the delay in the provision of care by prompt response to grievances
• To encourage the public and users to offer suggestions to improve the
functioning of the hospitals
• To analyze the grievances and suggest appropriate changes in the functioning
of the Government health institutions and to monitor the improvement in the
performance of the institutions
 COMPOSITION
 

The committee shall have at least the following core disciplines represented:
 Senior leadership
 Nursing leadership
 PI Department leadership
 Case management leadership
 Medical staff leadership and
 Financial leadership (from a billing and registration aspect).  
Other disciplines or representatives may be added on a permanent or basis, at
the majority vote of the members
 MEETINGS

•The committee shall meet on a regular basis to conduct needed business,

with meetings scheduled on at least a quarterly basis. Each meeting of the
committee is for the purpose of reviewing the grievances filed since the prior
meeting, the resolution actions taken to-date, and recommending any further
actions, all with the intent of improving the quality of healthcare provided by all
healthcare providers.
 AUTHORITY AND RESOURCES

The committee shall have the necessary authority, as granted by the Board of
Directors, and resources to discharge its responsibilities and duties. This shall
include the authority to make recommendations for changes in processes,
policies, and other such related actions.
 RESPONSIBILITIES AND DUTIES

1. On a quarterly basis, members will receive a packet or email of detailed

information on each grievance filed since the last mailing. The information is to
be thoroughly reviewed and the members prepared to offer any
recommendations for action to modify or enhance any system or process.
2. Prior to the quarterly meetings of the committee, the members will receive,
a) the monthly detailed information, as per the monthly process, as well as,
b) a summary and analysis of complaints and grievances to-date for the fiscal
year. This information is also to be thoroughly reviewed and the members
prepared to offer any recommendations for action to modify or enhance any
system or process, as well as any recommendations to address any trends of
concern.
3. Appeal option
a. If a person filing a compliant or grievance is dissatisfied with the resolution
managed through the initial complaint/ grievance process and desires and elects
an appeal, this committee will receive the request, review and consider it, and
opine a final decision.
i. The committee may convene in person or may discuss and recommend via
electronic or written means.
ii. The committee may or may not elect to offer the appealing party an
audience with the group either in person or via electronic or written means.
iii. As this committee consists of senior leadership, the decision of this group is
to be conveyed as the final internal decision to the appealing party. Any
other actions will then likely be managed through risk management
processes, including mediation through the third-party administrator or legal
counsel or in response to the issue being filed with an external party such as
the state Office of Healthcare Quality or the Joint Commission.
iv. The decision of the committee will be conveyed by a member of the
committee other than the Patient Representative. If the decision is in support
of the initial resolution, the contact information for the state Office of
Healthcare Quality and the Joint Commission should be included in the
response letter.
 DESCRIPTION OF THE PROCESS:

• Provision of complaint box in the patient care areas.

• Display of grievance redressal mechanism in prominent areas.
• Display of important mobile number like Medical Superintendent, Grievance Redressal
chairman/other member of Grievance redressal committee Medical officer-in-charge for
effectiveness.
STEPS IN ESTABLISHING PATIENT
GRIEVANCE PROCESS

Establish a Write policies and

grievance Resolves
procedures
committee

Educate patient Document

Educate staff Incorporate

grievance data into
the hospital quality
process
Investigate
 CHARACTERISTIC OF GRIEVANCE
HANDLING
• It may be unvoiced or expressly stated
• It may be written or oral
• It may be valid, untrue or false
• It may be related to the organisational work
• An employee may feel an injustice has been done It may affect the
performance of work
 RECORDS:

• The Committee should ensure that the following minimal set of records is kept for matters
attended by the Committee. It shall be the responsible unit that ensures the filing and
safekeeping of the records.
• The nature of the grievance
• Written grievance statement
• Action taken with reasons for it to be taken
• A written statement of the decisions
• Minutes of meeting
 CONFIDENTIALITY :

• All members of the Grievance Committee and those assigned for record keeping, as
well as any staff member questioned in relation to an issue at hand, are bound by
the duty of confidentiality ant all times and hold in confidence, all documentation and
information exchanged in the process.
Thank you