UNIVERSITY OF ILLINOIS HOSPITAL AND CLINICS

MANAGEMENT POLICY AND PROCEDURE

NO.: RI 1.01

To provide and describe a uniform mechanism for managing patient complaints/grievances

regarding care and services received at University of Illinois Hospital and Clinics (Hospital). This

does not include the affiliated colleges and Mile Square Health Centers. Please refer to those

sites for complaint and grievance management information. The Hospital recognizes the rights of

each patient to express their concerns about the quality of care or service they have received, and

provides a process for prompt review and when possible resolution.

DEFINITIONS

present if the communication occurred during the stay/visit is not defined as a grievance. A

complaint is considered resolved when the patient is satisfied with the actions taken on their

behalf.

Grievance- a patient grievance is a formal or informal written or verbal complaint that is made to

the hospital by a patient, or the patient’s representative, when a patient issue cannot be

resolved promptly by the staff present. Grievances also include concerns raised regarding

the patient’s care, abuse, neglect or concerns raised regarding the hospital’s compliance

with the Centers for Medicare and Medicaid Services (CMS) Hospital Conditions of

Participation (CoP) which cannot be resolved at the time of the complaint by staff present, is

written request for resolution.

3. Billing inquiries are not considered grievances. They are referred to the Patient Accounts

Office for review and action as deemed necessary.

Resolution of a complaint or grievance- a complaint or grievance is considered resolved

when the patient is satisfied with the actions taken on his/her behalf, or the

hospital has taken appropriate and reasonable actions and the hospital considers the grievance

closed.

Staff present- includes any hospital staff present at the time of the complaint, or who can

quickly be at the patient’s location to resolve patient’s concerns, such as nursing, nursing

leaders, administration, physicians, and the patient experience navigators.

POLICY

The Hospital allows the patient to voice complaints and recommend changes freely without being

subject to coercion, discrimination, reprisal, or unreasonable interruption of care.

The Hospital provides the opportunity for all patients to express their concerns about the

quality of care or service they have received through a complaint/grievance mechanism. The

Hospital has established a process for the prompt review and resolution of patient complaints

and grievances in the language used by the patient in accordance with RI 2.02 Accommodations

for Patients with Language, Hearing and Visual Needs.

The Hospital has designated the Patient & Guest Experience Office (PGXO) to coordinate the

investigation, management, and communication of patient complaints and grievances.

Hospital Leadership requires all staff present at the time of a complaint to respond in a prompt

manner and make appropriate attempts to resolve the complaint. Patient’s complaints are

resolved by the staff present when possible. If the complaint cannot be resolved at the point of

service or by the next working day and requires additional investigation, the complaint becomes a

grievance and the Patient Experience Navigator is responsible to facilitate the process. Any staff

member who becomes aware of a patient concern or issue that cannot be resolved at the point of

care or service is required to report it to the appropriate manager/supervisor. All complaints and

grievances are entered into the Patient & Guest Experience data base.

PROCEDURE

1. Staff who is present will investigate and resolve the complaint, as well as provide

service recovery measures. Staff behavior issues may be addressed via real-time

coaching on UICARE behaviors, or other remediation as necessary. All complaints will

be entered into the MIDAS Patient & Guest Experience data base which sends an

electronic notification to the PGXO.

2. Upon receipt of the complaint, events are triaged, documented and managed by the

Addendum #1.

1. Grievances are investigated by the PGXO with the exception of the following:

a) Privacy/HIPAA complaints- referred to the Health Information Management

b) Sexual Misconduct or Abuse complaints involving employees must be

c) Allegations of a major quality of care, risk, injury from treatment, or consent-

2. Grievances are triaged as described in A.2. Patients are notified of the status of efforts

c) If an investigation is still open at 30 days or the patient is not satisfied with the

d) Once the investigation of a grievance is closed, the resolution or outcome is

resolution process, the leadership of the area where the grievance originated is

responsible to initiate an immediate review, determine appropriate actions, and

communicate findings in a timely manner.

investigation to resolve grievances, the PGXO will escalate via the administrative chain

of command (refer to LD 1.13 Resolution of Issues Related to Patient Care Standards).

University of Illinois Board of Trustees approval on file 3/29/2018

Keywords: none

References

Hospital Management Policy and Procedure

IM 4.19 Minimum Necessary Use and Disclosure of Protected Health Information

IM 4.21 Reporting Patient Privacy and Security Related Complaints

LD 4.11 Patient Abuse

Centers for Medicare and Medicaid Services

Addendum

Addendum 1 - Patient Complaint and Grievance Flowchart

Recession Date

May 2016

June 2015

April 2000

November 1996

Reviewed by:

This policy was reviewed and endorsed by the following individuals:

Chief Operating Officer