Article 2

"You can please some of the people all of the time and all of the people some of the time, but you cannot please all of the people all of the time."

(A slight alteration of a quote attributed to Abraham Lincoln)

"Accidents will happen..."

(Elvis Costello)

When working with home-based healthcare organizations regarding business start-up, licensure, accreditation preparation, and other issues, I am sometimes

asked the following:

•What's the difference between a complaint and an incident?

•Why should we document them?

•How should we document them?

What?

No matter the type of organization, even the most well-managed, efficiently-operated, and client service-oriented companies will, at some time or another,

receive client complaints and have unexpected events occur.

A complaint (sometimes referred to as a grievance) is essentially the expression of dissatisfaction or protestation based on a real or imaginary wrong,

injustice, or harm. Complaints arise from a perception of being wronged, but that doesn't necessarily mean that an actual "wrong" has occurred or that it is

the fault of your organization.

An incident (includes accidents, adverse events, unusual occurrences) is an episode or circumstance that is outside of the normal organizational course of

operations and may involve actual or potential harm or risk to patients, staff, and/or company operations. Incidents are commonly thought of as involving

physical injury to persons or property, but that is not always necessarily the case. For example, an occurrence that places your organization at risk of

increased legal liability is just as legitimately an incident as a tree falling on your delivery vehicle during a storm.

The words "complaint" and "incident" often carry negative connotations. Just a glance at some of the defining words demonstrates this (i.e.,

"dissatisfaction", "wrong", "adverse", "accidents", "harm", "risk", etc.). I would like to propose an addition to the definitions of each of these:

"OPPORTUNITY"

Why?

Patient: "Do I have to floss my teeth?"

Dentist: "Not necessarily all of them; just the ones you want to keep."

If organizational efficiency, high quality customer service, and compliance with licensing and accrediting agencies are not important to you, then no, you

don't have to document complaints and incidents. Since that isn't the case with anyone currently reading this, here are the two general reasons for

documenting complaints and incidents:

1. It will benefit your patient care/service and company operations.

•Having detailed documentation of complaints and incidents will afford your organization the ability to utilize this information as part of retrospective

reviews for quality improvement activities and for strategic planning.

2. Medicare and other regulatory and accrediting agencies require that you do so.

•There are specific regulations and standards that your organization must be in compliance with in these areas.

Complaints and incidents should ultimately be looked upon as opportunities for:

•Identification of important issues related to the care/services provided;

•Demonstration to patients, staff, the community, licensors, and accreditors of a commitment to improving services;

•Education of patients and staff members, as applicable;

•Correction of any mistakes made on the part of the company;

•Improvement of company policies, procedures, and/or forms;

•Improvement of company operational efficiency and financial position;

•Avoidance of (further) harm to patients, staff, property, and/or operations;

•Avoidance of (further) risk exposures and legal liablities for the company.

How?

How well you document the specific details of complaints and incidents will affect how much potential benefit is derived from the collection of this information.

After all, aside from meeting any regulatory and accreditation requirements, the practical reasons for tracking this data are the ability to identify issues,

correct problems, and improve the way you do what you do. Organizations use a variety of forms to document complaints and incidents, ranging from a single

form for each type of event (i.e., Complaint Report Form, Incident Report Form) to separate specialized forms that address sources of complaints (e.g.,

patient,employee) and types of incidents (e.g., patient-, employee-, medication-, equipment-related, etc.) to hybrid or combined forms that are multi-purpose

in their format (e.g., Perception of Care, Customer Feedback forms, etc.). Regardless of the type or formatting of the document(s) used to record this

information, it is important that you do have standardized forms that all applicable personnel wihin your organization are trained to utilize. In addition, there are

a number of informational elements that should be included

on whatever forms you use:

Complaints:

•Date and time the complaint was received.

•Person receiving the complaint.

•Name and phone number of patient/person reporting the complaint.

•Nature of the complaint with a brief description.

•If the complaint involves an incident, accident, unusual occurence,

and/or injury, also complete an Incident Report Form.

•Any action(s) initiated by staff member at the time of receiving the

complaint (including forwarding of information to supervisory or management

personnel for further action/investigation) and any outcomes/resolution.

•Ensure that your policies and procedures are followed regarding timeframes

for notification of receipt of complaint, investigation, and reporting results.

Incidents:

•Date and time of incident.

•Date and time of incident report.

•Location of incident.

•Name(s) of person(s) involved in the incident.

•Type of incident (e.g., injury, non-injury, hospitalization, death, property

damage, equipment-related, care-related, medication-related, etc.).

•Name of employee taking/completing the report.

•Condition of the involved party at the time of the incident (e.g., awake, alert,

oriented, sedated, confused, agitated, unresponsive, unconscious, etc.).

•Notification of physician, as applicable.

•Notification of family, as applicable.

•Actions taken at the time of the incident.

•Date and time that investigation of the incident was initiated by company.

•Who is doing the investigation.

•Any other comments or follow-up activities.

•Ensure that your policies and procedures are followed regarding timeframes

for completion of the Incident Report Form, initiation of investigation, and

reporting of results.

Lemonade from Lemons

Please accept my sincerest apology for the reference to so trite a phrase as "When life gives you lemons, make lemonade". Trite yes, but also applicable in

this case. While dealing with complaints and incidents is generally not a pleasant experience, it is certainly an inevitable and important part of providing care,

services, and products.

Ultimately, these processes should be perceived and treated as opportunities for improved care, services, and operations. So remember, when life gives you

complaints, make "complaintade".......or something...