Managing Customer Complaints in Healthcare

October 14, 2015
Healthcare providers face numerous challenges in today’s environment.  One of the biggest challenges involves reducing costs without affecting quality of treatment and service. Failure to meet the patients’ demands for quality healthcare and service will threaten the financial viability of ANY hospital or physician group.  Just a few bad experiences can ruin a healthcare provider’s reputation with the assistance of social media proliferation. Thus, all providers must learn to effectively deal with patient complaints to address more than just the regulatory and legal requirements. In fact, all hospitals should include ‘complaints management’ in their overall compliance strategy. To help address the issue, let’s start with the basics…

Why do patients complain?

  • The healthcare provider did not meet the patient’s expectations with respect to medical care.
  • The staff treated the patient poorly and/or without compassion.
  • The staff didn’t notify the physician or administration of a patient’s concern/issue.
  • The patient was discharged too soon or without comprehensive evaluation.

How to keep a complaint from becoming a more serious grievance.

Minor complaints need to be addressed promptly.  More serious complaints may even require a written response and personal 1-on-1 involvement by administration. Complaints that don’t get addressed – even minor ones – often grow into a much large grievance.  Thus, it’s important to take EVERY complaint seriously. Also, never assume a complaint is groundless and be sure to give some type of empathetic and prompt response.  

Best Practices for Patient Complaint Management

  • Easy place to submit complaints: Patients should have an easy mechanism for submitting a complaint. Select a place that can be easily found and accessible.  Making the submission easy often reduces a patient’s frustration right off-the-bat and communicates your good intentions.
  • Prioritize serious complaints: Address all complaints regardless of severity, but the more serious issues need to be addressed as soon as possible.
  • Keep records: Log complaints and track the status for proper record-keeping and analysis. Create different categories and status codes to make reporting easier to analyze and review.
  • Assign responsibility: Each complaint should be assigned to one person for handling and then forwarded to another level of authority for supervision.
  • Acknowledgement of Complaints and Defining of Responsibility: Complaints are always acknowledged by talking to the customer on phone or in person. In some cases formal letters are also issued to acknowledge complaints.
  • Investigation and Analysis of Complaints: Fairness in analysis of the complaint is demonstrable and documented. Records of all meetings, conversations and findings are maintained in the complaints file.
  • Resolution Consistent with Company Policy: The complaint is forwarded to the appropriate level of authority for resolution and the consumer is kept informed about progress reports. A notification of the proposed settlement is sent to the consumer promptly.
  • Follow-up with the Customer: If the consumer is not satisfied with the resolution, the problem is addressed again. The complaint is referred to a third-party dispute-resolution mechanism, if necessary.
  • Analysis and Summary of Complaints: Complaints statistics and action proposals are circulated to appropriate departments and an action plan for complaints prevention is developed and implemented.


Some of the major drivers of complaints management are:
  • Regulatory Compliance
  • Competition
  • Costs
  • Customer Litigation
It is imperative for a complaints management system to seamlessly integrate with hospital operations and be equipped to provide adequate complaint resolutions in order to achieve the desired results.