Guidance: Drafting a Written Response to a Patient Complaint or Grievance

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Unfortunately, not all patients are satisfied with their care. How should you respond to an unsatisfied patient? If you are part of an acute care hospital and you receive a written complaint or a patient file an official grievance, CMS clearly outlines that you must send a written response to the patient. On average, a time frame of seven days to send a response letter is considered common practice, unless the investigation is extensive and requires more time.

Physician offices and critical access hospitals are not required by CMS regulations to respond to patient complaints in writing, but your state may have rules that direct you to do so. Although this may not be a requirement, effective risk management, process improvement, quality of care and effective customer/patient satisfaction practices are to quickly and thoroughly respond to patient complaints and grievances. This involves investigating the complaint, providing a response in a timely manner, and carefully choosing appropriate language in your response knowing that your response letter could be used in future litigation. A complaint or grievance that goes without a formal response may increase the likelihood of reputational damage, erode patient trust, or lead to legal action.

The objectives for your written response include compliance with all regulatory requirements and organizational policy, preservation of patient confidence and satisfaction, and provision of a clear and concise response to the patient complaint or grievance. We would recommend that your risk manager or administrator review and approve the response letter prior to sending it to the patient.

To assist you in drafting a grievance response letter, please see the document, Patient Complaint or Grievance Letter. This sample letter contains the four key elements as required by Centers for Medicare & Medicaid Services.

Element 1: Name of the hospital or practice contact person

This could be any individual who would be able to speak to the grievance investigation and outcome, including a Risk Manager, Medical Director, or Quality Improvement Director.

Element 2: The steps taken on behalf of the patient to investigate the grievance

Cite the steps taken which could include, but are not limited to:
•    Staff involved in your care were interviewed
•    Your medical record was reviewed
•    An inspection of the area of concern (exam room, office area, etc.) was completed
•    Protecting, defending, and supporting our Members.

Element 3: The results of the grievance process

Examples of grievance process results may include, but are not limited to:
•    We have deemed Care was appropriate
•    We have developed process improvements in response to your concern
•    We are providing training/education to our staff in response to your concern

Element 4: The date of completion of the investigation

Include the date that the investigation was complete in the letter’s heading.

For more information on responding to patient complaints, visit our risk management Resource Library and search “complaint” to obtain:

•    Complaint / Grievance Resolution Letter – An example letter to get you started with a prompt response, to be customized by the provider to specifically address the unique nature of individual provider-patient relationships.

•    Complaints and Grievances Relating to the Use or Disclosure of Protected Health Information – An example of a policies and procedures document that can be customized to specifically address the circumstances and practices of your organization. 

This information should be modified based on individual circumstances, professional judgment, and local resources. This document is provided for educational purposes and is not intended to establish guidelines or standards of care. Any recommendations contained within the document is not intended to be followed in all cases and does not provide any medical or legal advice.

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