Effective Complaints Management in Healthcare

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Failing to deal effectively with complaints proves detrimental, not only from a regulatory standpoint but also in terms of avoidable litigation and attendant costs.

To stay as a provider of choice, healthcare service providers need to invest in technology solutions, including an automated complaints management system. A best-in-class solution for complaints management provides seamless handling of complaints and introduces a systematic process for improvement, thus enabling hospitals to turn weaknesses into opportunities.

A recent survey of healthcare industry chief information officers, revealed that technology to minimize medical mistakes and improve patient safety is their top spending priority for the next two years. (14th Annual HIMSS Leadership Survey)

Introduction
Healthcare providers face the formidable task of optimizing costs without lowering the quality of inputs. This at a time when maintenance cost of hospital is increasing at an estimated 7% annually. In addition, the hospital administration has to cater to the growing demand of patients for more and better healthcare services. The fact that not many people in the US have faith in their healthcare providers is evident from the report published by The Economist in 2006. This report claims that only 15% of Americans have a great deal of confidence in healthcare organizations. In this scenario, one single mistake can put the reputation and the financial health of the hospital in jeopardy.

Complaints management is a major initiative under the broader compliance management strategy. By leveraging technology, complaints management can help deliver superlative service and quality.

Need for Streamlined Complaints Handling in Healthcar
Customer complaints management has become an integral part of hospital management, both from a regulatory perspective and a customer service standpoint. Regulatory bodies have established specific guidelines for capturing, investigating, resolving and reporting customer complaints. Some of the major drivers of complaints management are:

• Regulatory Compliance: Hospitals are under the continuous watch of regulatory bodies and need to follow certain guidelines. An effective complaints management system supports compliance with these regulations by ensuring streamlined workflow and the correction of complaints.
• Competition: With an ever increasing number of healthcare service providers, patients today have a lot of options and expect the best in terms of quality and service from their hospital. An ignored complaint can hurt the image of the hospital and affect its bottom-line.
• Costs: It is estimated that the cost of replacing a current patient is ten times more than the cost of retaining an existing one. Effective handling and resolution of complaints drive continuous improvement in operations ensuring customer retention.
• Customer Litigation: Today’s informed customer expects value for every dollar spent and does not hesitate to take legal help in case of an ignored complaints or discrepancies.

In response to consumer concerns and litigation, the US healthcare industry, is concentrating on means to prevent medical mistakes and implement effective ways to manage complaints. It is imperative for a complaints management system to seamlessly integrate with hospital operations and be equipped to provide adequate complaints redressal to achieve the desired results.

• Appropriate Location to Receive Complaints: Consumers need to know where and how to file complaints. A place is selected to receive complaints, which is visible and accessible to consumers and is well-publicized to encourage consumers to voice their dissatisfaction and to make the good intentions of the company apparent.
• System for Prioritizing Complaints: Complaints are prioritized on basis of severity level. Complaints which are more important are addressed first.
• Process and Record of Complaints: Complaints are logged and categorized for resolution and record-keeping. Categories are clearly defined and are exclusive of one another. Finally, the complaint is assigned to one person for handling and then forwarded to another level of authority for supervision.
• Acknowledgement of Complaints and Defining of Responsibility: Complaints are always acknowledged by talking to the customer on phone or in person. In some cases formal letters are also issued to acknowledge complaints.
• Investigation and Analysis of Complaints: Fairness in analysis of the complaint is demonstrable and documented. Records of all meetings, conversations and findings are maintained in the complaints file.
• Resolution Consistent with Company Policy: The complaint is forwarded to the appropriate level of authority for resolution and the consumer is kept informed about progress reports. A notification of the proposed settlement is sent to the consumer promptly.
• Follow-up with the Customer: If the consumer is not satisfied with the resolution, the problem is addressed again. The complaint is referred to a third-party dispute-resolution mechanism, if necessary.
• Analysis and Summary of Complaints: Complaints statistics and action proposals are circulated to appropriate departments and an action plan for complaints prevention is developed and implemented.

An effective complaints management system must also provide visibility into the complaints database and lifecycle. This should be done with the help of comprehensive, aggregate reporting and individual case status tracking, for giving maximum benefit to the healthcare provider.

Benefits of a Software Solution for Complaints Management
Complaints are valuable sources of information that organizations can use to improve their service. A good complaints management software solution not only provides a track of complaints, but also helps imbibe remedial actions across various functions of the hospital. It leverages valuable information found in the content of complaints into opportunities for growth and development.

• Provides fast and accurate capture and classification of customer complaints.
• Automatically routes complaints cases to appropriate staff based on subject, classification, staff skill set and availability.
• Tracks each complaint in real-time from capture and initiation through investigation, reporting and closure.
• Provides a consolidated real-time view of all complaints being processed by the hospital management along with their associated data, files and correspondence using an intuitive interface.
• Ensures adherence and compliance to standard best practice processes.
• Drives work to completion and ensures meeting of milestones and performance targets using workflow, alerts and notifications.
• Provides real insight into the management process through graphical dashboards, MIS and trend analysis reports.
• Reduces end-to-end cycle times through optimized routing of work, elimination of manual handovers and reduced reliance on paper documentation.

• Automated Data Evaluation: The system assimilates, analyzes, and automatically assigns a complaint as soon as it is logged.
• Automatic Alerts: Automatic real-time alerts are generated and sent to the required personnel. It obviates the need for human interference and simplifies operations.
• In-built Reporting System: Provides reporting and analysis of the complaints data.
• Browser Based: The system is browser based enabling personnel to view dashboards of information, as per their requirement, from anywhere in the hospital or even outside.
• Secure: The system prevents unauthorized access. Automatic time-out options, appropriate password settings, intruder login detections etc., are an inherent part of its security system.
• Communication Across Channels: In order to deliver best results, the complaints management system allows data sharing both vertically and horizontally across the hospital hierarchy, while integrating with other systems and departments of the organization.
• Flexible & Scalable: The system is flexible easily grows with the needs of the organization, in a cost effective manner.

While there maybe hospital specific requirements -a best-in-class software solution provide the benefits of a reliable complaints management system.

Conclusion
The focus of a hospital is to not only to treat the patients but also to provide an environment which acts as a catalyst in their recuperation. But, unfortunately, during the work process, there occur a lot of deviations which disturb the workflow and are voiced by the patients as ‘complaints’.

Effectively addressing a complaint not only satisfies the customer but is also an opportunity to create a positive experience with customers, building a healthier foundation, stronger brand value and avoiding legal penalties. As healthcare management faces mounting regulatory and market pressures, an efficient complaints management system in place can avert a lot of problems while navigating a healthcare services organization towards a better future.

MetricStream Solutions for the Healthcare Industry
MetricStream offers an integrated regulatory compliance solution for the healthcare industry for successfully meeting compliance requirements while lowering the associated costs that can otherwise be substantial. MetricStream Enterprise Compliance Platform, a proven infrastructure for building compliance applications, provides core modules and services to automate and streamline compliance processes.

Companies can use MetricStream solution for implementing quality and compliance programs through document control, compliance training, ongoing auditing, as well as recording and reporting issues and nonconformance incidents and the resulting corrective actions. By improving operational efficiencies in quality systems, MetricStream lowers the cost of regulatory compliance and creates a transparent environment for proactively identifying, tracking and resolving quality issues.

Role-based dashboards, control diagrams and scorecards provide visibility into the ongoing compliance efforts and bring high-risk areas into focus. The solution has the ability to track process ownership, assessment plans, remediation status, etc., on graphical charts with real-time information that can be accessed globally. Ability to drill-down to deeper levels of information with a single click provides an easy way to access the data at finer levels of detail.