“Wanted: Physician Complaints” This is not a request heard very often in the corridors of most hospitals. But at St. John's Regional Medical Center and St. John's John's Pleasant Valley Hospital in Ventura County, CA, they discovered a rich lode of information about their hospitals through the Physicians' Complaint Process that was implemented in February 1996. The feedback they received from their doctors proved highly valuable to improving their satisfaction and the way they deliver health care.
A hospital's admitting, or attending, doctors are in a unique position to know how well a hospital is working. They are customers of many hospital transactions, receiving x-rays and laboratory tests, for example. They can apply professional expertise in evaluating the outputs that they receive, and they know how different activities fit in with the overall goal of delivering quality care. They are also customers of the organization as a whole, bringing patients to the hospital and retaining responsibility for patients after discharge. They see first-hand the quality of care their patients have received, and they know how to judge it.
At the same time, doctors are also suppliers / partners with a vested interest in improving performance. Both hospital and physician are in the business of delivering the highest quality of care possible. Improvements in a hospital's performance boost physician productivity, too. These were some of the reasons the St. John's Performance Improvement Council decided to establish a Manage Physicians' Complaint Process as part of our overall development effort. It was suspected that doctors were a rich, unused source of useful knowledge and that a complaint system would be the best way to tap into it.
Avoiding Complaint Pitfalls
Physician input was included from the outside by inviting two doctors to join the design team. One of the first questions put to them was: How should complaints be entered into the process?
The doctors were quick to reject a paper system. Filling out a complaint form was the kind of task likely to be postponed and forgotten, they said. After some discussion, the team came up with the idea of a hotline, a voice mailbox where doctors could phone in a complaint and be done with it.
The “no paper” requirement was confirmed when collections were contacted who had tried physician complaint systems and failed. Just as their own doctors predicted, filling out complaint forms had proved to be a major stumbling block.
We also learned a second reason for failure. Hospital colleges reported that complaints were not always resolved in a timely or satisfactory manner, which under the effort and hampered success. Answering complaints was frequently low on the priority list of busy staff. Often doctors did not bother to document complaints, considering that it would do no good.
These preliminary findings provided the hospitals with two key goals as they prepared to design the system. They decided:
- to implement an easy-to-use input device available 24 hours a day, 7 days a week, 365 days a year-the hotline our improvement team doctors had suggested.
- to build accountability into the process to insure timely and satisfactory responses to complaints.
Our next article will discuss development of the “Complaint Blueprint.” Stay tuned!