Patient Complaint & Grievance Policy

Policy Statement

NYU Hospitals Center, as part of its total commitment to excellence, believes in the patient's and their representative's right to a courteous, prompt and complete response to their communications with the Hospital. Information and response provided by NYU Hospitals Center should be consistent in the presentation of facts and statement of policies. When appropriate or necessary, follow-up action and/or patient contacts are to be completed.

In accordance with New York State Hospital Operating Code Section 405.7, the Hospital will investigate complaints including grievances. The Hospital will provide the patient or patient's representative with a written response if requested, or if the complaint rises to the level of a grievance, indicating the findings of the investigation. The Hospital will also inform the patient or patient's representative of their right to complain to the New York State Department of Health and/or The Joint Commission if he or she is not satisfied with the Hospital's written response.

To ensure satisfactory, appropriate and consistent patient-sensitive communication, Patient Relations shall manage all complaints and grievances directed to NYU Hospitals Center, regardless of where first contact is made.

Patient Relations serves as a central resource for responding to all grievances with the exception of the following:

  • Complaints, including grievances, citing only financial concerns will be managed by the Vice President for Medical Center Finance, Revenue Cycle Operations, for review and response to the patient. Patient Relations will document receipt of the grievance, acknowledgment, referral, and any supporting documents provided to the patient in the patient feedback system.
  • Complaints, including grievances, regarding HIPAA privacy concerns shall be referred to the VP for Audit and Compliance/Privacy Officer who will determine their involvement in the investigation.

For these exceptions, an Acknowledgment will be communicated by Patient Relations to the patient or their representative within seven days of receipt. The Acknowledgment will inform the patient or their representative of the referral to Department/Point of Contact and that they will receive a written response within 30 days.

Administration

The Chief Patient Experience Officer has oversight responsibility. The Director of Patient Relations is responsible for the daily operation and subsequent revisions to this policy and procedure.

Purpose

The purpose of this policy is to describe appropriate handling of complaints, including grievances, received from patients or patient's representatives (i.e. family members, significant others, visitors, etc.).

Policy Scope and Applicability

This policy applies to all patients receiving care provided by NYU Hospitals Center including its ambulatory sites (article 28 facilities). As part of the registration process, all patients are advised of their rights. Information on this process is available on the NYU Hospitals Center website: http://www.med.nyu.edu/patients-visitors/patient-visitor-information/patient-information/patient-services/patient-advocates

Definitions

A "complaint" is defined as an expression of dissatisfaction brought to the attention of personnel. A complaint can be resolved by the appropriate department or with the assistance of Patient Relations. A complaint is not initially considered to be a grievance.

All complaints received by Patient Relations will be documented in the patient feedback system.

A formal "grievance" is defined as a written or verbal complaint that is made to the hospital by a patient, or the patient's representative, regarding the patient's care (if not resolved at the time of the complaint by staff present), abuse or neglect, issues related to the hospital's compliance with the CMS Hospital Conditions of Participation (CoPs), or a Medicare beneficiary billing complaint related to the rights and limitations provided by 42 CFR 489.

A complaint is considered a grievance when:

  • It is received in writing (i.e., letter, email, fax, attachment to a patient survey)
  • A patient or patient's representative requests that their complaint be handled as a formal complaint or grievance
  • A patient or patient's representative requests a written response from the hospital
  • A complaint is postponed for later resolution, referred to other staff for later resolution, requires investigation, and/or requires further actions for resolution

All grievances will be received by/referred to Patient Relations for documentation in the patient feedback system, investigation and response to patient or the patient's representative.

Procedure

Verbal Communication Procedure

Internal Hospital Communication

Verbal communications (i.e., telephone calls, discharge phone call referrals, etc.) are referred to Patient Relations when resolution is not possible by the individual receiving the call. The person receiving the call should record all pertinent information and tell the caller that their concerns will be referred to the Patient Relations Department to facilitate resolution. The phone number to Patient Relations should be provided to the patient or the patient's representative. The caller's name, telephone number and information shall be provided to Patient Relations via telephone at (212) 263-6906 at NYU Hospitals Center (North Campus) or (212) 598-6336 at NYU - Hospital for Joint Diseases (South Campus) or through hospital email addressed to PatientRelations@nyumc.org

Acknowledgment

The complainant will receive a return phone call from Patient Relations. If the issue cannot be resolved prior to a patient's discharge or end of visit, and meets the criteria for a grievance, the verbal communication will be escalated to a grievance and will follow the Written Communication/Grievance Procedure (Steps 2 & 3) detailed below.

In-Person Communication Procedure

Internal Hospital Communication

Hospital personnel will collaborate as necessary to resolve inpatient concerns prior to patient discharge.

A patient or patient's representative who expresses concern to hospital administration will be referred to Patient Relations.

Acknowledgment

If the issue cannot be resolved prior to patient discharge or end of visit, the verbal communication will be escalated to a grievance and the Written Communication/Grievance Procedure (Steps 2 & 3) will be followed.

Written Communication/Grievance Procedure

Internal Hospital Communication

Written communication is always considered a grievance and will be handled by Patient Relations. Written communication will be referred to the Manager of Patient Relations, or their designee, for recording in the patient feedback system.

Acknowledgment

Within seven days of receipt, a written or verbal acknowledgment to the patient or patient's representative, will be communicated by Patient Relations. The acknowledgment will include:

  • Confirmation of receipt
  • Expected timeframe for response
  • Name and contact information for the Patient Relations Department member managing the case

The acknowledgment will be documented in the patient feedback system.

Written communication addressed to the Dean or a Vice Dean will be acknowledged by the Chief Patient Experience Officer, or designee. The acknowledgment will name Patient Relations as the point of contact for the patient or the patient's representative.

Investigation and Response

The Manager of Patient Relations, or designee, will assign each grievance to a Patient Relations Specialist. The Specialist will collaborate with the appropriate leaders of the disciplines/ departments involved to provide a formal response that complies with regulatory guidelines and this policy. The leader (i.e. nurse manager, department manager, unit medical director, etc.) assigned to provide feedback will investigate, address and return a response to the assigned Patient Relations Specialist. Feedback is requested within seven days of the referral for investigation.

Complaints, including grievances, regarding lost or stolen property will be managed by Patient Relations. Investigation for property will be conducted by Security Department and report will be provided to Patient Relations. Feedback is requested within seven days of the referral for investigation.

Patient Relations will complete a written response of the hospital's findings. The response will be provided to the patient or the patient's representative in a language and format they understand within 30 days.

Complaints, including grievances may be referred to the Department of Patient Safety and Risk Management, who will determine its involvement in the investigation. For grievances requiring involvement by Patient Safety and Risk Management, written response will be completed by, or in collaboration with, Patient Relations within 30 days.

If final response is not complete, interim contact will be made at day 15 and every 15 days thereafter with the patient or patient's representative to advise that the investigation is ongoing. Interim contact may be made in the form of a letter, e-mail or a telephone call.

Grievances filed by the patient or their representative, where the party requests financial consideration for a quality of care issue must be received in writing by Patient Relations. If received by telephone, Patient Relations will instruct caller to forward concerns in writing. The call will be documented in the patient feedback system and closed until receipt of letter.

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