In May, 2004 Captain David Eddinger attended the SHCA conference to clarify the grievance guidelines. A patient grievance was described as: any written or verbal complaint by a patient, or the patient's represen­tative, regarding the patient's care, abuse or neglect, or the hospital's compliance with the CMS Hospital Conditions of Participation (COP), which was unable to be resolved by staff present. This definition has brought about much discussion over the last year, resulting in CMS allowing the 2004 SHCA President, Brenda Radford to attend a meeting at CMS in Baltimore, MD, with Captain Eddinger, his supervisor and several AHA staff.

This meeting was a success and CMS agreed to allow the SHCA Board to review edits made and to provide suggested language for the final document. When the Board met in January, a considerable amount of time was spent reviewing these changes and a few suggestions were provided to CMS. We are very happy to report that CMS has accepted these changes and a new version of the Grievance Conditions of Participation will be published very soon. Initially CMS stated it would most likely be the end of the summer before these guidelines were published, but in conversation as recent as May 12, 2005, Captain Eddinger felt that these guidelines should be ready sooner.

During the 2005 SHCA Confer­ence, held in Chicago, IL, I provided an update on the proposed changes to the guidelines.

While the definition of a patient grievance will remain the same, the definition of staff present will provide our members with some flexibility as to what has to be deemed a grievance.

Below are listed some of the changes that we should see adopted in the very near future:

*Staff present will include any hospital staff member who is immediately available to take care of the patient's complaint. If someone is available to take care of the issue, the complaint will not be considered a grievance.

 *If the concern cannot be resolved at that time, is postponed for later resolution, is referred to another staff member for later resolution, requires investigation, and/or further actions to resolve the concern - the issue becomes a grievance. (If you do not have a house-wide service recovery program in place, you may want to consider establishing one.) Billing issues are not usually considered a grievance, however, Medicare beneficiary billing complaints are considered COP issues and are therefore considered a grievance.

*Any formal written complaint is always considered a grievance (e-mails and faxes are considered formal written documents).

*If a patient attaches a letter to a patient satisfaction survey, describing complaints, this should be considered a grievance.

*If a patient writes comments on a patient satisfaction survey that your hospital would normally treat as a grievance, these are to be treated as a grievance as well. However, if the complaint would have been handled by staff present, if staff was aware of the complaint, the issue does not have to be categorized as a grievance.

*Telephone calls received from a patient or patient representative describing patient care issues are to be categorized as grievances. Post-hospital verbal communication, which would have been handled by staff present if staff was aware of the complaint, do not have to be categorized as a grievance.

*All verbal and written complaints regarding abuse, neglect, patient harm, or hospital compliance with CMS requirements are to be considered grievances.

*Any request by patient or patient representative to file a formal grievance should .be considered a grievance.

Requirements for responding to patient grievances are listed below:

*Resolution is requested to be sent in writing within 7 days (CMS will review to be sure that a response is sent on an average of 7 days.)

*If the concern cannot be resolved 'within 7 days, an acknowledgement letter will be required. You must provide the expected date of resolution in this letter to the patient. Resolution will be expected in accordance with the hospital's individual grievance policy.

*Resolution is to be communicated appropriately, in a language and manner the patient or patient's legal representative understands. If a patient has limited English, you will want to be sure the letter is in a language the patient can understand.

*The hospital may use additional tools to resolve a grievance (e.g. meetings with the family); however, in all cases a written notice must be provided.

*If a patient communicates to the hospital via e-mail or requests a resolution bye-mail, an E-mail response is acceptable (pursuant to hospital policy).

*The hospital is not required to include statements that could be used in a legal action against the hospital, but each grievance letter must obtain the name of the hospital, the contact person,

steps taken on behalf of the patient to investigate the grievance, and results of d1e grievance process.

 A grievance is considered resolved when:

*The patient is satisfied with the actions taken on their behalf; however,

 *there may be situations where the hospital has taken appropriate actions on the patient's behalf in order to resolve the grievance and the patient or patient's representative remains unsatisfied. In these situations the hospital may consider the grievance resolved for the purposes of this requirement. The hospital must maintain documentation.

 Other issues regulated by the grievance guidelines state that a hospital must have a grievance committee. This committee needs to be more than one person, but may be an ad-hoc committee (pulling in the appropriate people needed to resolve a particular grievance). Patient Advocates are not required to be involved with each and every grievance, but a mechanism does need to be in place to track all grievances in a central location. It is also very important that hospitals tie the trended complaint/ grievance documentation to their quality assurance program.

Please remember that the above changes have not yet been put into place.

SHCA will alert ALL MEMBERS immediately upon hearing that the guidelines have been posted.