Have a process in place to address patient grievances

How hospitals address patient rights is a key area highlighted by both the JCAHO's standards and the Centers for Medicare & Medicaid Services' (CMS) Conditions of Participation ( CoP ). But a new area of focus for CMS in 2006 is how hospitals handle and resolve patient grievances.

Both CMS and the JCAHO require that inpatients and outpatients are informed about their rights. JCAHO standards are more specific about rights centered around care and treatment and cultural, spiritual, psychosocial, and personal dignity. The JCAHO also addresses patient responsibility information, whereas CMS does not.

Hospitals must have a formal patient grievance process and mechanism that has been approved by the organization's governing board. The CMS interpretative guidelines define a patient grievance as "a written or verbal complaint by a patient, or the patient's representative, regarding the patient's care, abuse or neglect, issues related to the hospital's compliance with CMS Hospital CoPs, or a Medicare beneficiary billing complaint related to rights and limitations."

Billing issues are not considered grievances unless the complaint also contains issues about patient service or care. The hospital must inform the patient of the grievance process and provide a written response to each patient's grievance.

If the grievance will not be resolved or the investigation has not been or will not be completed within seven days, the hospital should inform the patient or his or her representative that the hospital is still working to resolve the grievance and will follow up with a written response within a stated number of days based on the hospital's grievance policy. The hospital must attempt to resolve all grievances in a timely manner.

In the past, hospitals "didn't always tell patients that we did something negligent," says Sue Dill Calloway, RN, MSN, JD, hospital risk management director at OHIC Insurance in Columbus, OH. With the new CMS revisions, that has changed.