Managing Complaints and Grievances
September 22, 2016 | Aging Services Risk, Quality, & Safety Guidance
Although it is important to address both complaints and grievances in a timely and effective manner, recognizing the difference between the two is a critical foundation for any grievance resolution process.
Complaints are issues that can be quickly resolved. Complaints, as defined by CMS regulations for acute care hospitals (the most detailed guidance provided by the agency), are patient issues that can be resolved promptly or within 24 hours and involve staff who are present (e.g., nursing, administration, patient advocates) at the time of the complaint. Complaints typically involve minor issues, such as food preferences or dissatisfaction with housekeeping. (CMS "Hospitals")
Most complaints will not require that the organization send a written response to the complainant. However, even if a complaint is addressed quickly and informally, the organization should document the complaint and the actions taken to resolve it and maintain the records for quality improvement activities. (CMS "Hospitals")
Organizations should always try to resolve complaints or concerns immediately and informally whenever possible. However, small issues can escalate, and individuals served (clients, residents, patients, or their families) who feel that their complaints have not been resolved or who have a more in-depth concern may file a formal grievance.
CMS interpretive guidance for long-term care facilities defines "grievances" as issues that involve treatment, care, management of funds, lost clothing, or violation of rights. Grievances are not limited to written complaints and formalized processes, but may also include a resident's complaint verbalized to facility staff. (CMS "Long...