Grievances are a standard mechanism for patients in a correctional facility to request changes and express discontent with a variety of conditions of confinement such as housing, officer treatment, and inadequate healthcare.  Although many in correctional health care see the grievance process as a tedious necessity, medical grievances can be a rich source of information for uncovering system flaws. This patient feedback can actually help improve the quality of your patient outcomes, reduce clinical error, and avoid legal liability. Here are three important ways to use patient grievances to help provide quality correctional health care.

Fix System Problems

“Last month when I saw Dr. Jones she said I was going for special tests on my liver. I have not been sent, and every time I ask the nurses they say they don’t know when I am going, and they couldn’t tell me if they did know. Please help!”

Grievances can sometime unearth major system troubles. A common area of deficit seen in audits of correctional healthcare programs is the process for outside diagnostic testing. It is often a complex task to get our patients scheduled for a liver biopsy and the various other arrangements necessary for a successful procedure, and to coordinate officer transport. The investigation of this grievance revealed that several patient tests had dropped off the log during an extended family leave for the medical unit clerk. Staff turnover can lead to system issues if there are no cross-trained staff to keep processes going. This issue was revealed and resolved through a patient grievance.

Resolve Staff Issues

“I keep turning in sick call slips but the nurse will not see me. They cannot keep ignoring me! I need to be seen right now!”

Sometimes grievances are the result of unreasonable expectations and, after investigation, result in educating the patient about the process of requesting and receiving health care. This request, however, resulted in the discovery that the evening shift nurse, whose post duties included rounding to collect sick call slips, was discarding some slips that she determined were unnecessary to process. Resolving the cause of this grievance may have prevented future patient harm by identifying inappropriate staff behaviors. The immediate result of the investigation was termination of the staff member and retraining the remaining staff in the sick call process.

Correct Communication Concerns

“My toe is swollen and infected. I was told I would get better shoes months ago. Where are they? I need them NOW!”

This older diabetic inmate rightly needed special foot wear and the state prison system in which he was incarcerated had a good process set up for providing them when necessary. However, the communication between medical and procurement in this particular prison was faulty. Investigation of this medical grievance revealed the disconnect and the facility was able to initiate a change in the communication process among facility departments that resulted in faster procurement of medically necessary items such as these shoes.

A System for Effective Grievance Investigation

It can be easy to discount the complaints of our patients generated through the grievance process. This is a mistake. Granted, some complaints may be unfounded, but all complaints deserve to be investigated.

To use patient grievances effectively, a system is needed for investigating grievances, answering them, and tabulating any trends. Here are some tips for an effective grievance process:

• Have a designated individual handle all medical grievances. If you are a one-person department, that would be you. However, if more options are available, pick someone who has a genuine interest in patient satisfaction or quality improvement. A single communication point for grievances means relationships can be built among individuals in the facility most likely to be regularly handling complaints; thus speeding results. This also provides a consistent contact point when addressing issues with the patient population.
• Make sure your system is set up to address grievances promptly. Consider grievances like sick call requests and turn around a first response in 48-72 hours. A complicated issue may take more time to resolve, but your patients should know they are being heard and that the wheels are in motion.
• Categorize grievances related to common quality issues once an investigation of the situation indicates a primary cause. Here are some suggested categories:
  • Capacity Issues: Staffing/Supplies
  • Communication
  • Patient Information/Understanding
  • Staff Issues: Knowledge, Accountability, Skill
  • System/Process Issues
• Tabulate grievance themes in your quality improvement program and investigate trending issues with a formal process or outcome study. Once a trend is seen, a quality improvement study will validate a quality problem and provide baseline data for tracking the outcome of any system changes implemented.

Patient grievances can be a useful source of information about your clinical program. How are you using grievances? Share your experiences in the comments section of this post.