Complaints and Grievances, A Different View

Author: Mark Parkinson BsPharm:  President  AFC-CE

Credit Hours 2 - Approximate time required: 120 min. 

Educational Goal

Provide a new perspective on the complaints and grievances process.

Educational Objectives

  • Review the negative paradigm of the Complaint Process.
  • Explain how to turn the complaint process into a positive experience.
  • Teach good customer service principles.
  • Suggest a plan of action for complaint filing and resolution.

Procedure:

Read the course materials.  2. Click on exam portal [Take Exam].  3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate).  4. Log in  5. Take exam.  6. Click on [Show Results] when done and follow the instructions that appear.  7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records.

Disclaimer

   The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.

 

Complaints and Grievances, A Different View

 

I have had several requests for Complaints and Grievances training from Mental Health homes. It is a requirement that they have to fulfill once a year. For those who work in Geriatric and DD homes, hang in there with me. I will make it worth your while. You will see that this course is going to really help you out. It’s all about caregiving customer service principles.  Or how to turn grouchy clients into happy customers. If you want more content residents and improved reputations with the State, then take this course. 

In researching this topic, I met with a Quality Improvement Specialist of the OHA/AMH Division. He described for me what the complaints and grievances process was. As he explained what the State wanted care providers to do and why, I had an insightful revelation. This was not another burdensome program of documenting complaints to get people in trouble. This was a systematic way of identifying the root causes of troubling issues and resolving them. For heaven’s sake, what Sam was talking about was just good customer service techniques. The complaints and grievances requirement was really a caregiver tool that could be used to make their residents content with their life. As an added benefit this was also a way to prove to the state inspector that you do care about the people in your charge, and you have some serious problem-solving skills. 

 

The Requirement

I am not going to quote what the administrative rule is concerning complaints. My goal is to get you to look beyond the wording. I want to inspire you to look at this requirement from a different angle all together. First, let’s change your current thinking. The complaint and grievance process is not a negative, we just make it that way. 

Ways to overcome Negative thinking | MedicalGyan.in

 

I found the following at https://www.oregon.gov/oha/HSD/AMH/Pages/AMH-Complaint.aspx

The Health Systems Division is responsible for investigating complaints about mental health treatment facilities/homes and outpatient behavioral health services, as outlined in Oregon Administrative Rules 309-035 and 309-019. Please submit a complaint when you:

  • Are not satisfied with your experience with a behavioral health care provider, and
  • Have filed a complaint with your provider, but the provider did not resolve your complaint, or
  • Could not file a complaint with your provider because the provider does not have an accessible complaint process.

Questions? Contact the Health Systems Division.

How to submit a complaint

Fill out the Official Complaint Form and click the "Submit" button at the end of the form. A staff member will contact you.

Other ways to submit a complaint

For complaints involving:

I have to admit, on the surface, this looks scary for care providers. The information on this page was confusing to me though. In my interview with Mr. Dickson, he told me there was no form that was required. I came to the conclusion that what the above was in essence saying is if the caregiver/facility is not taking your complaint seriously the state will. Just notify us and we’ll look into it. For your convenience, you can use this online form to contact us, or you can just give us a call. 

 

The Response

After the complaint is received what is the first thing the state is going to do? They will come to visit your home and ask, “What is going on?” Unfortunately, it is just human nature to unthinkingly respond with, Oh, it’s nothing for you to be concerned over. It was just so and so being grouchy, and I took care of it.” Oh Boy, that certainly makes you look like you’re hiding something. Naturally, the county inspector will start to think, “Oh really! Well, just see about that.” I’ve spouted this bonehead response myself when I operated homes. It is little wonder that an Us versus Them paradigm starts to develop.

Understanding the 'Us Vs Them' Division Through the Notion of ResponsibilityAFH and DD homes are also all too familiar with how this unspoken conversation plays out. Everyone puts up their dukes and is ready to fight. As a result, it is so much harder to get anything done and everyone thinks the other side are twits. Good luck with getting a positive outcome on the next complaint that is investigated. Under this way of thinking, each successive problem that arises gets harder and harder to resolve. There has got to be a better way.

 

A Better Way

Here is the new angle I suggest you look at the complaints and grievances process from. Think of them as a positive opportunity. Yes, complaints are opportunities dressed in work clothes. With every issue solved your reputation increases. Residents start to look at you as some kind of superhero that they can count on. They love living at your home because they feel safer and protected from problems. The county inspectors, home health nurses, and other professionals think, “finally, here is someone who knows what they are doing. They are more willing to lean into any future problems with you and help you out. Friends and family members see the positive outcomes and they start spreading the word about this caregiver they know who is a good, really good. This frame of mind makes you go from zero to hero every single time, but only if you are prepared and take the right steps to resolve the issue. 

 

The Caregiver Tool  

There have been thousands of books written about issue resolution. What I am going to tell you is not the only way to solve problems. But, after 40 plus customer service awards in two different industries, I think I’ve got a pretty good method developed. It starts by viewing problem solving as a series of steps, not as a single event. Once you got the system perfected you now have a potent caregiver tool that you can use over and over again. It works in any circumstance, on any issue. 

 

Step 1. It’s not about you, it’s about them. 

As we discussed earlier, in a conflict it’s normal for an Us versus Them mentality to arise. You perceive that you are being attacked. But as a professional caregiver, it’s not about you. It’s about using your caregiving skills and role as a patient advocate to help a needy person in your care who has a problem. Let’s resolve right now that you are going to resist the “Us versus Them” mentality and replace it with a “We against the problem” mindset. No matter what is said, you will not take it personally and start to defend yourself. Instead, you are going to roll up your sleeves and get to work finding solutions to the problem. That’s what good professionals do. 

Understand why people complain. 

Life Coach Insights: Is Complaining Healthy or Harmful? — Blog | Jody Michael AssociatesTo help get into the “We against them problem” mindset let us contemplate complaining itself. Let’s start with something you know a lot about- YOU. Why do You complain? What are You trying to get by stating an issue out loud? According to psychologists, there are several reasons why people complain.

The three reasons I want to concentrate on are:

  1. You need to Vent. Problems lead to frustration. Frustration leads to emotions. Over time, excessive buildup of emotions needs to be vented. So, we vent to feel better and get our emotions back under control.             
  2. You are seeking validation of your self-worth. Having troubles is a blow to your ego. We think less of ourselves for having problems that we think others don’t have. Also, we see others getting help and think, “I am just as important as they are. Why am I not getting help?” So, we complain to placate our bruised pride. 
  3. You are trying to recruit help. It’s the old “a squeaking wheel gets the grease” thing. You complain to make sure you get the attention of those who you think can help make the problem go away. 

If those are the reasons why You complain, don’t you think that the person complaining to you is trying to do the same things? I hope you are having a big “Wow, now I understand” moment that will lead to the “We against the problem” mindset. Let the complainer vent completely. They’ll feel better afterward. Build up their depleted ego after the venting by paying attention to them with respect. By listening to the whole complaint and all they have to say about the matter shows them respect. Most importantly, start to work on resolving the problem. 

Tips to use that will get you on their side of the issue

I am going to let you in on some of my “secret sauce’ tricks that have made me so successful in the past.

A. Match communication style.

People communicate in different ways. By mirroring their communication style, it will make it feel like you are one of them. Self-defense barriers will come down and you will communicate more deeply and effectively. I have noticed 4 general styles of communication. 

 

  1. The Alpha- they are direct and to the point. No long explanations and little emotions unless they have to. It feels like they have no time for excuses or emotions. They just want the facts and a quick resolution. Be direct right back. Don’t waste time trying to make them feel anything. If you try they will most likely not be interested in participation. After the complaint they will leave it up to you to handle the details. They are prone to like step-by-step approaches and promised times of resolution. Make them feel like they are in control. 
  2. The Thinker- they like a lot of explanation and time to think before responding. Be prepared to hash over details. Readily talk about the whys and hows. Include them in all procedure development and idea generation. 
  3. The emotional- They think with their feelings and want to express their emotions a lot. Apply large amounts of empathy and show your feelings as well. Take the time for long discussions about the emotional results of actions. They will be worried about how their complaining will make you feel. Thank them for their consideration before proceeding.  
  4. The socializer- They are the talkers. It will feel like they take forever to get to the point. They like storytelling and lots of examples. They develop thoughts on the fly during the conversation and are easily distracted. Have patience and be very flexible. Give them stories about how you solved similar problems. It’s okay to interrupt them with stories to show you understand.

Teamwork: Active Listening - The Conover CompanyB. Listen Actively

Anyone can listen but what I call active listening is a skill that has to be developed. Active listening is paying attention to all the verbal and non-verbal clues the help you understand what the intention is behind the words being said. Complainers are trying to get you to do something which may or may not be in harmony with what they just said. For example, angry complainers sounds like they are trying to pick a fight. But their intent is to get your attention. They feel that they will not get your help without yelling. Another example is quite complainers that look everywhere but in your face are actually telling you they are unsure of your reaction. There actions are saying, “I’m afraid that you are judging me for needing help”. 

Here are three important techniques that will help you develop your active listening skills.  

  1. Non-defensive listening. It’s all about what you do with your brain as you listen. Use your brain to determine what is being requested not for defending yourself against a complaint. Be thick-skinned. Resist the urge to think of a rebuttal as you listen to a complaint. Professionals focus on the needs of their patients, not their own personal egos. Do not take the bait.Often when a person complains their emotions are very high and they want to fight someone. They dangle baiting phrases designed to draw you into a “me against you” fight. Some examples are: You’re just like all the other idiots I’ve had to suffer with. Are you paid to be that dumb? I’ve heard all the bad stories about you, I guess they’re true. Do not fall for such traps. Do not respond in kind. Blast right past the negativity and get to the real heart of the issue. 
  1. Be the Sherlock Holmes. As you listen to the words, you are using all the clues they are sending out to determine what they actually want you to do. Watch their body language. Listen to the tone of their voice, and how it changes at the end of a sentence. Keep in mind the context and the environment they are coming from. What are they not saying that normally would be said? Always, always ask yourself, what do they really want, as you listen to the words of complaint. 
  1. Rephrase to ensure meaning.After they are done talking, rephrase or paraphrase what they said and include what you think they want you to do. Then ask them if that was right. Using different words and adding perceived intentions forces the complainer into a different mindset. They are now working with you instead of against you to ensure the correct interpretation of what they just complained about. If it takes more than one go-around, apologize for the failure to understand. Then try again until you get it right. 

The Problem – Economic InequalityC. Do not claim the problem. 

The most direct path to “Us versus them” is to start with excuses worded as if you caused the problem. As an example, pharmacy techs will often say. I can’t fill your prescription. It’s too early to refill it. You’ll have to come back later. 

If there is an angry response coming, there is only one target. The tech who just claimed they are the cause of the issue. In truth, none of us go out of our way to make things difficult for others on purpose. So why make it sound like we did? If you are going to state the reasons why things happened, then be more specific about the causes. Find a way to lay the blame on the person who is not there to argue with. Make it look like you were just the messenger. Once the complainer understands that you were not out to get them, step in with some possible solutions. People tend not to argue with some who understands the root cause of an issue and is trying to find a solution. To continue the pharmacy tech example, they should have said, “I see that the insurance company you chose will not pay for the prescription so soon. Did you lose the medication? Going on a trip? Did the doctor change the dose? Let me call the insurance company to see if I can get an override.” Who’s going to yell at a tech who said that? (From zero to hero in one easy step). 

If you are the root cause of the problem, then quickly apologize and mention that it was never your intention to harm. Show that you mean it by starting right away to find the proper resolution of the issue. 

D. Tell them that you believe them and you are on their side.

I think it is important that you verbalize that you believe what they are telling you is the truth. Tell them you think the problem is important enough to you that you are going to start to do something about it right now. If it is a clear-cut us versus them case, as with an outside party, then tell them that you’re on their side. That is one of the strengths of being an In-Home caregiver. You are small enough to get very focused on one person and be their advocate with everyone else. 

 

Man, Elder, Senior, Old Man, White Hair, SmileE. Get the complainer to laugh. 

Humor is a tool that can be used to dissipate tension. Laughing or even just smirking is an entirely different mindset from complaining. It can divert emotions away from the negative so a complainer can start to think clearly. Also, try to leave with a laugh. It establishes a positive backdrop for future interactions. Jokes that work can be reworded and used over and over again. For example- Well that certainly was a bonehead thing to do, no wonder you’re complaining. I guess I will have to cancel my polka dancing lesson (insert any over-the-top silly thing) because now I have some serious work to do. Well, that (insert core complaint) certainly will not ensure any popularity awards, maybe the stupidity (foot in mouth, etc…) award though. Make fun of yourself a lot. 

 

 

Lead Follow Up Archives – Lead LiaisonF. Promise to follow up.

Saying that you are on their side is not good enough. You have to show them you are on their side by following up with them. Tell them “I believe you. That is a real problem, so here is what I am going to do for you. Then lay out the overall general plan of action. Set some general time frame expectations for when you will follow up. If you set a time frame, then stick to it. I personally used the following verbiage when I am contacting them later, “I promised I would follow up with you, this is what I have done so far…”. 

That sentence is “I’m on your side” gold. It worked every single time that I used it with any communication style. Even when I had nothing to report. Good follow-up communication happens so rarely in our lives that when it happens it really sticks out and puts you squarely on the zero hero path. 

These secret sauce tips require some practice to get really good at using. Not all of them are required in every situation. You will probably only have to use all of them at once on just the toughest of cases. Once you have established a “We against the problem” mindset it’s time to stop placating the complainer. Over-kill will only make you look disingenuous. Once everyone is on the same page, it’s time to work on the problem. 

 

Step 2. The plan of action. 

A. Write it down. 

Complaints and Grievances are different from Incident reports. In general incidents are the big significant events that need to be reported on. Complaints and Grievances are everything else. They cover not only complaints against you but with other residents, family, jobs, hospitals, and doctors. Literally everything else. When you hear of any complaint from one of your residents, write it down. 

My thoughts for Mental Health homes.  

You know the state and county inspectors are going to come to your home and ask if your residents had any complaints or grievances in this year. They are not asking the questions to dig up dirt on you, even though it feels like it. Their job is to watch over mental health patients to ensure they are well taken care of. Remember, this is the group of patients that were hidden away in institutions, drugged into submission, electrocuted, and or had portions of their brains cut out as “therapy”. The administrative law and your very In Home care industry were developed to not let that happen again. So stop sweeping problems under the rug or saying there were no problems. 

You got to start acting like care professionals and not expensive room and board motels. Just because there were complaints does not mean you are a bad caregiver. Every government inspector knows there will be issues. Complaints are just part of your industry. They know that complaints and grievances are just as likely to be manifestations of the symptoms of mental health diseases as complaints about bad care. 

That is a lesson that AFH and DD homes should also take to heart. 

When (not IF but When) complaints happen, handle them openly. Treat them like symptoms of bigger or hidden issues, because they probably are. Record everything like they were therapy case notes. That is how Mental Health Hospitals operate and so should you. Recordkeeping also has the added benefit of documenting just how effective a caregiver you are. They prove to everyone that the reason why your house has no problems now is because you’re just that good of a care provider. I have to ask, why would any serious care home operator act in any other way? 

Regarding the business side of your home, it’s stupid of you not to advertise your skills in this fashion. If your residents do have legitimate grievances with the way you run your home, take advantage of these complaints to improve your business methods. Happy customers are the only thing keeping you in business. 

B. Determine what is really wanted.

 What is the outcome the complainer is actually looking for? It may be different than what was first complained about. Write it down as a separate note in the report. 

C. Pass the complaint along when needed. 

Not every complaint needs to be passed on to the state. If it is significant, report it. If it involves a third party out of your direct control, report it. When the resident wants others to know, report it. When in doubt, report it. If the complaint would trigger an investigation you might want to use the more formal incident report instead. Serious issues should be reported within 24-48 hours. 

  • The resident may be shy or afraid to complain in an official way. You can write the report yourself as a witness or the resident can report the complaint anonymously, but the report must have the resident’s name in the subject matter field. 
  • Reporting to the state is a way to get help from the calvary on tough cases. Sometimes you got to call in the big guns. 
  • The complaint does not have to go to the county inspector. See the above page I quoted for other agencies. The complaint may have to be formatted in a certain way for that agency. (bureaucracies… go figure) Help the resident file the paperwork in the proper fashion.

D. Take time to think about the why's and how comes. 

Get to the rotting root of the matter. Do not find yourself just concentrating on the dead leaves caused by the rotten root. It may take some guesswork and investigation to find the heart of the matter. Write down your theories and discoveries. 

E. Act.

It’s time to do your caregiver magic to make the problem disappear. It may require you to put on your patient advocate super suit and do battle with the powers that are causing the issue. If the problem is a tough one or is long and complicated, find something to measure. Measuring outcomes will help you determine if there is improvement happening. Naturally, keep a record of your activities. 

F. Follow through to resolution and beyond

Check in with the complainant to see how things are going. Question them to see if they are satisfied or if any other issues have cropped up. Keep your records in the patient files for possible use in the future. Review them periodically to see if a pattern is emerging. Notify other involved parties as a courtesy and as often as needed. 

The Secret Sauce to Success- The Entrepreneurial Mindset | SCORE

Here is another secrete sauce tip

Politely suggest to the satisfied resident, their friends, and family that they tell others of your success. Discretely spread the word yourself by sending thank you notes to third parties that helped or gave information. Definitely keep the county inspector or other involved government agency informed. They are expecting a follow-up report from you anyway. This is business advertising gold people, use it often.

AFH and DD Homes, are you paying attention to all the methods and principles that you could use in your homes and care practice? 

 

Final Note

If you have been paying attention, the following concern will be of no concern to you. To be complete in this training though I have to say it. The fastest way to lose your license to operate a care home is in finding a way to punish a complainer for complaining. If that scares you--- good, don’t do it. 

 

Conclusion

This was probably not the nut and bolts type of CE that you were expecting. I wanted to change the popular opinion of the complaints and grievances requirement. I wanted you to view it as a means to improve your professional status. So many things we see as a negative in this industry could actually be utilized as a positive instead by savvy caregivers. The one hard fact that I want you to take away from this CE is- The only thing keeping you in business is happy customers, so utilize everything you can to keep them that way. 

As always Good Luck in your caregiving efforts. 

Mark Parkinson BsPharm

 

References

https://www.psychologytoday.com/us/blog/significant-results/201706/the-three-types-complaining

https://www.oregon.gov/oha/HSD/AMH/Pages/AMH-Complaint.aspx

 

 

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