RESPONDING TO COMPLAINTS & CONCERNS
RESPONDING TOCOMPLAINTS &CONCERNS:A Letter Writing Guidefor Healthcare Providersand AdministratorsJanuary 2017
March 2017Healthcare Insurance Reciprocal of Canadawww.hiroc.comHead Office4711 Yonge St, Suite 1600Toronto, Ontario M2N 6K8Tel: 416.733.2773Toll Free: 1.800.465.7357riskmanagement@hiroc.comWestern Region1200 Rothesay St.Winnipeg, Manitoba R2G 1T7Tel: 204.943.4125Toll Free: rms of Use: This is a resource for quality assurance and risk management purposes and is notintended to provide legal or medical advice. Every effort has been made to ensure that the information isaccurate at time of publication.
TABLE OF CONTENTSForeword from HIROC3Introduction4When things go wrong4Why individuals complain5Four easy steps to putting things right when a complaint is received6The complaint response letter layout7Keep these tips in mind8Sample statements for the complaint/concern response letter9Writing the complaint/concern response letter11Writing the complaint/concern response letter to a challenging individual17Final thoughts17Additional Resources18
Forewordfrom HIROCFor the majority of healthcare recipients,their experience of the care and serviceyou provide is positive and appreciated.But when things go wrong anddissatisfaction or unmet expectationsresult, how people and organizationsrespond determines not just how theindividual will feel, but says a lot aboutyour organization’s culture. Respondingto complaints and concerns is anopportunity to acknowledge the incidentand learn from what went wrong.This guide is written for all types andsizes of healthcare organizations andprovides useful and practical informationabout writing effective responseletters. Taking steps to improve howyour organization responds in writingto complaints shows patients/clients,families and staff that you are alwaysopen to feedback and improvement.Please bear in mind as you read thisguide that it is important to complywith any applicable privacy legislationthroughout the process of consideringand responding to a complaint.3
IntroductionWe know your organization does more things right than wrong. But when things do go wrong and thereare misunderstandings, a response is required. From our work with providers of healthcare, we know howimportant listening and learning is to safe, considerate and appropriate care. It is also a critical way to avoidfuture problems.Ideally, the best scenario is to meet with the person who has a complaint, but that is not always possibleor practical. With that in mind, we have created this guide to help you and your staff compose writtenresponses to the concerns of individuals. The information and tips will assist you in writing letters that arenot just perfunctory responses to complaints, but an indication of how your organization cultivates a cultureof openness and feedback. We hope you will find this information useful.We encourage the early involvement of your organization’s risk management personnel in this process.HIROC’s Healthcare Risk Management Department is also available to provide assistance.Writtenresponses tocomplaintsare produciblein legalproceedings.They should bedrafted withthe assumptionthey couldappear in acourtroom,be posted onsocial media orappear on thefront page ofthe newspaper.Please note references to “individual(s)” in this document encompassanyone who receives health services across the continuum of care (e.g.client, patient, family and resident).When things go wrongJennifer White’s story relays the importance of thoughtful andempathetic written responses to complaints. Having written a complaintletter to the hospital about what she described as “attitude” fromsome of the nursing staff during her post-operative stay, Jennifer wasextremely disappointed and dissatisfied with the dismissive tone ofthe hospital’s response letter. There was neither an explanation noran apology mentioned leaving Jennifer with an unsettled feeling thatperhaps this type of behaviour was condoned at the hospital. A friend ofJennifer’s shared a similar experience chalking it up to the overall cultureof the organization.Davis Bannon’s experience was completely different from Jennifer’swhen he complained to the community care agency about difficultieshe and his wife had encountered getting consistent service providersin to care for his ventilator-dependant daughter. After several monthsof frustration, Davis felt compelled to write a letter of complaint tothe agency. The response letter Davis received back was apologeticand caring, leaving Davis with an immediate sense of relief. The letteroffered several solutions to alleviate the problem with clear timelinesfor implementation. Davis was left with the sense that he had beenacknowledged and respected.4
WhyindividualscomplainThere are many reasons why individualscomplain to healthcare organizations.They may: be seeking information about and/or an apology for a negative orunexpected outcome. want reassurance that action will betaken to reduce the likelihood thata similar incident will happen again. want someone to be heldaccountable for what happened. want compensation for theperceived harm.No matter what the cause, unmetexpectations, poor communication anda level of dissatisfaction are often at theroot of these complaints.5
Four easy steps to putting things rightwhen a complaint letter is received:123 4AcknowledgeInvestigateRespondFollow-up1. Acknowledge thecomplaint as quicklyas possible. Adhere toa response timeframe(as outlined in anorganizational policyor guideline) andcommunicate whenthe individual(s) canexpect to receive areply. Be mindful oflegislated response-timerequirements if theseexist in your provinceor territory. Prolonginga reply to a verbal orwritten complaint/concern, may erodetrust and antagonizethe individual. A timelyresponse informsthe individual theorganization has receivedthe information andtakes it seriously. If forany reason, a delay inresponding is anticipated,let the individual knowwhen he/she is most likelyto receive a reply.2. Investigate.Investigate to obtain factsrelated to the subjectmatter of the complaintusing documentation(such as the healthrecord/incident report)and/or discussing withpertinent staff. And doit quickly – memoriesfade and people forgetcrucial details. The scopeof the investigationwill vary depending onthe particulars of thecomplaint. Rememberas you conduct theinvestigation and preparea response that personalhealth informationcan only be disclosedin accordance withapplicable privacy law.3. Respond in personor writing. Whereverpossible, invitethe individual whobrought the complaint/concern forward tohave a conversation.Writing a letter is not areplacement for the faceto-face meeting. Whilenot always practical, thisis optimal. In a face-toface meeting, you canquickly establish whatthe individual or familyis feeling and whatthey see as a suitableoutcome, giving youthe opportunity toappropriately respond tothe situation. If a faceto-face meeting is notpossible – or desiredby the aggrieved party– a written responseis essential. In fact,many people will notlet the matter rest untilthey receive a writtenresponse.4. Always follow-upwhether in personor in writing. If thematter can be resolvedimmediately in-personor over the phone, awritten response shouldbe sent as a followup to summarize andexpand upon your priordiscussion and confirmany agreed-uponactions. Following upmakes individuals feelappreciated rather thanignored and that you areinterested in what theyhad to say.If a written response hasbeen sent in lieu of aface-to-face meeting (notpossible/desired by theaggrieved party), furtherfollow-up in writing is notindicated.Early acknowledgement is pivotal in preventing a minorconcern from escalating into a formal complaint.6
The complaint response letter layout112May 20, 2016.The SALUTATION is a meansof courteous recognition andis the opening of the letter.Acknowledging the receipt of thecomplaint/concern letter is partof the salutation.Dear Mrs. Smithre: Recent visit to Emergency DepartmentELThank you for your letter of May 10, 2016 regarding your recent experiencein our Emergency Department. Clearly our care did not meet yourexpectations with a prolonged wait, lack of courtesy and lack of pain controlfor your back pain. For your experience of all this, I do sincerely apologize.PMI can understand how upsetting this has been for you.I also want to assure you that we take these concerns very seriously and thisis not the patient/family experience we strive for. An investigation into thismatter included a review of your health record of May 7th and interviewswith the staff that took care of you. I have been advised that there wereseveral patients waiting for care that evening, some with life-threateningconditions. Your prolonged wait to see the doctor related to that patientvolume and acuity on that particular shift. Reducing wait times for allpatients/families in our emergency department is a high priority at ourhospital and we anticipate improvements in future as we continue to addressthis concern.ASWhen the Emergency Department nurse manager spoke with the nurseabout her response to you, the nurse indicated she was regretful of her tonewith you and extends her sincere apologies for not addressing your painsooner.If you have any further concerns about this and would like to discuss this inperson with myself or the nurse manager, please contact me at the numberbelow and I will be happy to arrange a meeting for you. I am availablethroughout the day and am happy to schedule a meeting with you.Sincerely,Lisa McDonaldDirector, Patient/Family Relations(Insert contact information)57On your response letter, DONOT COPY all persons on thecomplainant’s letter, unlessauthorized by the complainant.43TheINTRODUCTORYPARAGRAPHshould be conciseand clearly statethe purpose ofyour letter. Thisis where theapology and/orcondolences areexpressed.The MAIN BODYof the letter shouldinclude a paragraphaddressing each of thekey points you wantto make, what youhave learned from thereview and proposedrecommendations.If there are severalcomplaints/concerns toaddress, acknowledgeeach one withoutnecessarily going intoa detailed analysis ofeach.The CONCLUDING PARAGRAPHshould include a final expression ofregret and a concluding statementproviding an offer of furtherfollow-up phone calls or in-personmeetings and pertinent contactinformation.
Keep these tips in mind as youcompose your letterBe aware of privacy and confidentiality issues.Acknowledge receipt of the complaint (whether itis by letter, email or phone) and address the chiefconcern(s) stated by the individual.If there is a request for compensation, considerconsulting HIROC or your organization’s legalcounsel.Ensure each care theme identified in thecomplaint letter is addressed in the apologyletter. If you do not have an answer, let themknow you will get back to them when you do havethe answer. Do not offer excuses. Be sincere, nonadversarial and collaborative.Avoid taking an explicit position that everythingwas handled correctly. This is clearly not thecomplainant’s experience.Avoid referencing situations and/or care themesnot addressed in the complaint letter.Use clear, concise and understandable language.Avoid medical terms or put layman’s terms inparentheses if necessary.Do not use defensive language/phrasing – itdefeats the effort to ensure the complainant feelsvalued and listened to. Avoid confrontation orretort. Maintain a professional tone.Acknowledge the writer’s distress.Avoid long words, long sentences and longparagraphs.Do not patronize, minimize, negate or attemptto correct the complainant’s experiences (“Yourletter indicated the nurse on call did not listento you when you mentioned that your motherwas experiencing a new type of stomach pain.Our investigation does not substantiate thisoccurrence.”).If you are going to apologize, apologize upfront.As per Canadian Patient Safety Institute (2011),“An apology is a genuine expression of beingsorry for what has happened.” Make it personal –use words such as “we” or “I”.Do not comment on whether the standard of carewas breached or there was a lack of compliancewith healthcare organization policy/procedure/guideline.Do not address or include practitionerperformance issues in the written response. This isa Professional Practice/Human Resource issue andhas no place in your response.State that the complaints are being takenseriously.Re-establish trust – offer the results of a review.Do not make promises that you may not keep.Only address actions that have already or will betaken to make improvements.When discussing corrective measures/mitigationstrategies, stay at the system level versusindividual practitioner level.Do not use policies and procedures as an excuse.Certain confidentialityprotections must berespected dependingon the type of reviewconducted. But, sharing“lessons learned” andwhat measures theorganization intends totake to prevent futureincidents is generallyacceptable.8
Sample statements for thecomplaint/concern response letter1Salutation2Thank you for your letter of regarding/concerning/in connection with We refer to your letter of about/relating to We appreciate your having taken the time to voiceyour concerns We appreciate your raising your concerns with us As a result of our review, we found that.The problem was the result of /resultedfrom The cause of/reason for the situation was As a result This led to Consequently When the review has notbeen completed:Offer an apology (if appropriate)early in the letterWe must apologize for We sincerely apologize for Please accept my/our apologies for We would like to apologize for When a loss has occurred:We would like to offer my/ourcondolences to you and/or your familyon the loss of Please accept our condolences on theloss of We appreciate that this is a difficulttime for you/your family 34Indicate what you havelearned from your reviewAccept the complaint/concernWe agree our usual high standard of servicewas not met in this instance We clearly did not meet your expectations We take these concerns very seriously We try to learn from these types of situationsand we thank you for your feedback or yourfeedback will help us improve.5We are conducting a review Our review of this matter is underway When our review is complete If you make changesbecause of the situationthat prompted thecomplaint, offer solutions6We have modified/changed our.We have implemented a system to.To prevent this from happening againwe have set up/implemented a Express regret forcomplaints expressed7We sincerely regret this happened to you We are very sorry We truly regret the unfortunatecircumstances of your stay We understand how disappointing it can bewhen your expectations are not met Conclude the letter and providefuture contact with coordinatesPlease do not hesitate to contact me/us We are available at We can be reached at Adapted from How to Reply to Complaints.9
Get feedbackExpedient complaint/concern handlingmay ultimately decrease the risk oflegal action. But before sending theresponse, ask a colleague to readyour letter and provide constructivefeedback. Engage risk management orlegal counsel in reviewing responsesto individuals, especially for sensitivecases including those that may becomea legal claim. And remember, HIROC isalways available to review and providefeedback on response letters.A second pair ofeyes on the letterwill mitigate the riskof having the rightintention but saying itthe wrong way.10
Writing the complaint/concernresponse letterSAMPLE 1 – Letter of complaint/concernRebecca White presented tothe emergency departmentof her community hospitalwith acute back pain ofunknown origin. After triageand registration, she wasdirected to sit in the waitingroom and told the doctorwas busy with a traumapatient and it would takea while for her to be seenas she was a lower prioritythan others ahead of her.On several occasions Mrs.White approached thereception desk growingincreasingly frustrated thatshe was having to wait.When she requested painmedication from the triagenurse, she was directedback to the waiting roomand told she would receivethe medication when thenurse could get to it. Fourhours had passed beforeshe was finally attended toby the doctor.11May 10, 2016Lisa McDonaldDirector, Patient/Family RelationsELPMASDear Ms. McDonald:re: recent visit to Emergency DepartmentI feel compelled to write this letter following my recentexperience as a patient in the Emergency Department onMay 7th, 2016. I have had many positive visits to the hospitalpreviously, but this time, was appalled at being made to waitfor 4 hours before being seen by a doctor. The Triage Nursewas rude to me and told me that it was a very busy night and Iwas “not the priority”. At that time, I was experiencing a lot ofdiscomfort in my back and having to sit for that length of timemade it even worse. When I approached the front desk to askabout getting something for the pain, I was told to sit down andthe nurse would “get to it” when she had time.You advertise your organization as being caring and patient/family-centred but this is obviously not the case in yourEmergency Department.I would most certainly appreciate an explanation in writing, ofwhy things went so wrong and what you plan to do about it.Thank you and I wait to hear from you.Mrs. R.W. White
SAMPLE 1 – Suggested response formatMay 20, 2016Dear Mrs. White:SAMPLE 1 – How not to respondJune 20, 2016re: recent visit to Emergency DepartmentThank you for your letter of May 10, 2016regarding your recent experience in ourEmergency Department. Clearly our care did notmeet your expectations with a prolonged wait, lackof courtesy and lack of pain control for your backpain. For all for this I do sincerely apologize.ELPEMLAPSMASDear Mrs. White:re: recent visit to Emergency DepartmentThank you for your complaints about ouremergency department. First of all, a fourhour wait in our emergency department is notunusual. As you may be aware, wait times in ourprovince are a real problem yet to be resolved.There are many hospitals that struggle with thesame issue.When I spoke to the nurse about being rudeto you, she said that she wasn’t and furtherindicated: It was a very busy night so she doesn’treally remember you that well You were over-anxious about your pain From her assessment she felt you couldwait to get your pain medicationOnce again, thank you for writing to us but weare a very caring and patient/family-centredhospital. I guess it wasn’t a good experience foryou. That is too bad.Sincerely,Lisa McDonaldDirector, Patient/Family RelationsI am very sorry to learn of your experience and canunderstand how upsetting this has been for you.I also want to assure you that we take theseconcerns very seriously and this is not the patient/family experience we strive for. We have reviewedyour concerns and have conducted interviews withthe staff who took care of you. I have been advisedthere were several patients waiting for care thatevening, some with life-threatening conditions.Your prolonged wait to see the doctor related tothat patient volume and acuity on that particularshift. Reducing wait times for all patients/familiesin our emergency department is a high priority atour hospital. We anticipate improvements in futureas we continue to address this concern.When the Emergency Department nurse managerspoke with the nurse about her response to you,the nurse indicated she was regretful of her tonewith you and extends her sincere apologies for notaddressing your pain sooner.If you have any further concerns about this andwould like to discuss this in-person with myselfor the nurse manager, please contact me at thenumber below and I will be happy to arrange ameeting for you. I am available throughout the dayand am happy to schedule a meeting with you.Sincerely,Lisa McDonaldDirector, Patient/Famil
The complaint response letter layout. 7. Keep these tips in mind. 8. Sample statements for the complaint/concern response letter. 9. Writing the complaint/concern response letter . 11. Writing the complaint/concern response letter to a challenging individual. 17. Final thoughts. 17. Additional Resources. 18
Dispute resolution: Complaints DISP INTRO Introduction INTRO 1 Introduction DISP 1 Treating complainants fairly 1.1 Purpose and application 1.1A Complaints handling requirements for MiFID complaints 1.2 Consumer awareness rules 1.3 Complaints handling rules 1.4 Complaints resolution rules 1.5 Complaints resolved by close of the third business day
5.10.2 Complaints relating to provider organisations 22 5.10.3 Process for complex complaints that span several NHS organisations 22 5.10.4 Process for handling complaints about non NHS Services 23 5.11 Complaints that cannot be dealt with under this policy 24 5.11.1 Claims and Legal Action 24 5.12 Complainants and Staff 24
G:\Member Services\General\Member Relations\ISSUES & COMPLAINTS\COMPLAINTS\Procedures-Policies-Scripts & training tools\ICHP\Internal Complaints Handling Policy ver 7.doc 1 ARSN 094 718 108 ("Club") A.P.V.C. Limited ACN 093 228 141 (“Responsible Entity”) Internal Complaints Handling Policy & Procedure Manual
Best practice for complaints management processes Best practice for complaints management processes are widely reported and include the following: acknowledging complaints promptly [4, 6-8, 10] assessing complaints and assigning them priority [4, 6-8, 11, 13] planning an investigation if one is needed [4, 6, 8]
where healthcare complaints are divided into three general domains: Clinical complaints, Relationship complaints, and Management complaints Category Categories represent the second level of the taxonomy, which clarify the types of healthcare complaints under each Domain. Sub-Category Sub-categories represent the third level of the taxonomy,
1. make a complaint to the complaints and client relations Section, or 2. have your bill taxed (see page 10) If you go to the complaints and elations Section, the usual complaints client r procedure is followed. The complaints and client elations Section will determine r whether the solicitor's fee is excessive. The bill must have issued less .
Objectives. Participants will be able to: Define and explain Guests Complaints. Identify the nature and types of complaints. Identify the skills necessary to dealing with complaints. Document the global procedures of Guests complaints handling. Identify each type of customer who complains and how to handle them. Analyze each complaint situation and determine an
Complaints as % of all attendances 0.10 0.11 0.09 0.08 Complaints as a % of Inpatient Activity 1.66 1.63 1.50 1.52 Table 2 below shows the number of complaints received and the method by which they were received. The majority of complaints were received by email.
