Concern / Complaints

Patient Concern Form

 

Systematic Concern Procedure

1. Patient(s)/customer(s) who have a concern may document said concern on the Patient/Visitor Concern Form. Additionally, an employee or other interested party may complete the Patient/Visitor Concern Form on the patients' behalf.

2. The documented Patient Problem/Concern Form(s) should be forwarded to Customer Service Manager: Patient/Visitor Concern Forms, if completed by an employee, should be forwarded to the Customer Service Manager within 24 hours. The Customer Service Manager is responsible, within 24 business hours, to provide the department manger(s) and/or physician(s) a copy of the Patient/Customer Service Concern Form.

3. The department manager(s) and/or physician(s) are, within 72 business hours, responsible for performing a root cause analysis and, if necessary, recommend system or process changes to the Customer Service Manager. As part of a root cause analysis, the manager will receive a written response from the employee(s) whom the complaint is directed.

Additionally, the department manager and or physician, if requested by the Customer Service Manager or CEO, is responsible to provide the Customer Service Representative a written response (draft) to the Customer Service Manager. Finally, if deemed necessary by the Customer Service Representative, the Customer Service Manager has authority to extend the 72-business hour root cause analysis requirement.

4. Manager(s) and/or physician(s) in all circumstances, from the Customer Service Representative, are provided identifying information about whom, when, where, and what to perform an appropriate root cause analysis. If adequate information is not available for the manager(s) and/or physician(s) to perform a root cause analysis, the Customer Service Representative will informally discuss the concern with the manager. The manager(s) and/or physician(s) are not required to provide a formal recommendation. The concern will not be included in the quality assurance evaluation and monitoring studies.

5.  The Customer Service Manager, after reviewing the department manager(s) and/or physician(s) system or process change recommendation(s), and, if applicable, policy and procedure changes, is responsible to review the changes with the CEO.  Additionally, the Chief of Staff or physician designated by the Medical Staff will review concerns regarding a physician.  The vice-Chief of Staff or designated physician, Medical Staff Peer Review, or other designated physician by Medical Staff will review any concerns regarding the Chief of Staff.  Concerns regarding a physician's or mid-level practitioner's quality of care or premature discharge from the hospital shall be forwarded to the Medical Staff Peer Review committee, directly accountable to the Medical Staff in accordance with Medical Staff By-Laws, by the Customer Service Manager.

6.  The Customer Service Manager, after obtaining CEO approval, will determine who performs written patient follow up.  Patient follow up is required unless the patient requests the follow up not be done or follow up was done as part of a patient survey and patient did not request follow up.

7.  The Customer Service Manager, as part of an ongoing quality assurance study, is responsible to evaluate and monitor patient concern information.  If available, the Customer Service Manager is responsible to benchmark data with other hospitals.  The Customer Service Quality Assurance Report will be reviewed with the CEO each month.  Additionally, the Customer Service Manager, after reviewing the report with the CEO, is responsible to review the Customer Service Quality Assurance Report findings with appropriate department manager(s) and/or physician(s) on a monthly or next scheduled meeting basis.  Finally the Customer Service Manager is responsible to present a monthly Customer Service Quality Assurance Report to the WBRH Medical Staff and WBRH Board.  

8.  The Customer Service Manager is responsible to maintain a Patient/Visitor Concern Form to include appropriate information regarding William Bee Ririe Hospital grievance and notification requirements.  The Customer Service Manager will assure Patient/Visitor concern Forms are available for patient access in the Hospital Admissions Office, Clinic Admission's Office and Hospital Billing Office.

9.  The written notification and answer to a concern, by the Customer Service Manager, to a patient or customer, is to include the name of the hospital, the steps taken on behalf of the patient to investigate the grievance, the results, and the date of completion.  The written notice will be in a language or manner understood by the patient or legal representative.

Grievance Committee

A Grievance Committee will be responsible for reviewing and referring complaints for investigation and overseeing any changes in the policies or procedures as a result of a grievance.  This committee will consist of the Chief Executive Officer, Chief of Staff, Hospital Director of Nursing, and Quality Assurance-Performance Improvement / Risk Manager, and Customer Service Manager.  The Customer Service Manager will review complaints and investigations with the Grievance Committee, as necessary.

a. The Customer Service Manager will obtain as much information as possible from the patient.  The Grievance Committee shall conduct an initial review within three days.

b. Practitioner issues are those that involve any aspect of care provided by an individual who has been granted privileges by the hospital, including complaints about disruptive behavior.  The concern shall be investigated and corrective action determined consistent with the Medical Staff peer review process.  A written report of the actions shall be submitted to the Grievance Committee for review and recommendations, if necessary.

C. Hospital issues are those that involve any aspect of services provided by the hospital except the care provided by practitioners.  These complaints will be referred to the manager responsible for the area.  Actions shall be reported to the Grievance Committee for review and recommendations.

Confidentiality

The Customer Service Manager, in coordination with the Quality Assurance-Performance Improvement Manager, will be responsible for maintaining all minutes, reports, recommendations, communications and actions made or taken pursuant to this policy that are deemed to be covered by the provisions of N.R.S. 49.265 in accordance with Medical Staff Bylaws and Peer Review Process.

Furthermore, the department directors, committees and/or panels charged with making reports, findings, recommendations or investigations pursuant to this policy shall be considered to be acting on behalf of the Hospital Medical Staff and Hospital Board of Directors when engaged in such professional review activities and thus shall be deemed to be "professional review bodies" as that term is defined by the Healthcare Quality Improvement Act of 1986.  The Customer Service Manager, in coordination with the Quality Assurance-Performance Improvement Manager will maintain, in secured files, the root cause analysis and action plan.

 

Person submitting concern: ________________________   Date of Concern: _ __     Address: ________________________________________________ Phone Number: _______ Concern Received by WBRH Staff: __________________________ Date Received: _________ Patient/Customer/Visitor Statement of Concern: ______________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ Patient's/Customer/Visitor's Recommendation(s) for Improvement: ________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Please return to: William Bee Ririe Hospital                                                                                                                

                              Customer Service Manager (775-289-3612 ext. 130)

                              1500 Avenue H

                               Ely, Nevada   89301 

Manager(s) Physician(s) Responsibilities:

Root Cause Analysis: ____________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Action Taken (System/Process Improvements)-Attach a copy of the revised policy & procedure (if appliable): _______________________________________________________________________________ _______________________________________________________________________________ 

Department Manager or Physician signature: ____________________________  Date:_______  Patient Follow-up Date (After Manager(s)/Physician(s)/ obtain Customer Service Manager and CEO Approval for Recommendations): ____________________________________________________________________________

Customer Service Manager: ________________  Date: ________  Patient Follow-up Date: ____ Resolution (Circle): Satisfactory or if Unsatisfactory Explain: ____________________________ _____________________________________________________________________________ ______________________________________________________________________________   Chief of Staff or designated Medical Staff Member Review & Approval: _________ Date: _______  C.E.O. Approval: __________________________________________________    Date: _____  Hospital Director of Nursing: _______________ QA/Risk Manager: __________  Date: _______

                                          

                                        Thanks for Sharing Your Concern

                                        ATTACH A COPY OF REPLY TO THIS FORM 

 

Patient Notification Procedure

1.     Each patient who receives inpatient or outpatient services in the hospital and clinic shall be given the name and telephone number to file a complaint.  Patient/Visitor concerns can be forwarded to the Customer Service Manager, Georgiann Mellos, or call the William Bee Ririe Hospital/Rural Health Clinic at 775-289-3612 ext. 130 or fax to 775-289-6423.

2.     Each patient may address concerns or complaints directly to the state survey agency, whether or not a grievance is filed with the hospital, and can be directed to the state agency at the following address:

 

         State of Nevada Department of Human Resources Health Division

         Bureau of Licensure and Certification

         1550 E. College Parkway, Suite 158

         Carson City, Nevada   89706

         fax number:   775-687-6588

         phone number:  775-687-4475

 

Additionally, for complaints related to the professional competence or professional conduct of physician/surgeon or podiatrist, concerns or complaints can be directed to the following: Medical Board of Nevada, 1-888-890-8210 or Central Complaint Unit for Physicians and Podiatrists at 1-888-633-2322.

 

3.  The patient follow-up time frames include the following:

     a. Customer Service Manager is responsible within 24 business hours, to provide the department manager and/or physician a copy of the Patient/Visitor Concern form,

     b. Customer Service Manager will notify the patient in writing, within 10 business days, unless patient requests no follow-up to be done, notice of the investigation results including the name of the hospital contact person, the steps taken on behalf of the patient to investigate     the grievance, the results, findings of the Grievance Committee, and the date of completion.  If a written notification is not done within 10 business days due to extending the investigation, Customer Service Manager will contact the patient by telephone until a written letter is sent.

    c. Finally, the patient has the right to appeal the outcome of the complaint investigation.  The ptient should contact the Customer Service Manager at 775-289-3612 Extension 130 to begin the appeal process.  This is not to be interpreted to include the release of Meeical Staff peer review information.             

G. Norman Christensen, M. D.
Board Certified General Surgery