THE ROLE OF COMPLAINT MANAGEMENT IN THE SERVICE RECOVERY PROCESS | ACCREDITATION OF HEALTHCARE ORGANIZATIONS


PART 1
Service Recovery
Service recovery is an important and effective customer retention tool. One way an organization can ensure repeat business is by developing a strong customer service program that includes service recovery as an essential component. The concept of service recovery involves the service provider taking responsive action to “recover” lost or dissatisfied customers and convert them into satisfied customers.20 Service recovery has proven to be cost-effective in other service industries. A good recovery can turn angry, frustrated customers into loyal ones, result in higher satisfaction, and even create more goodwill than if things had gone smoothly in the first place.21–23


Service recovery cannot take place if the provider is unaware of dissatisfied customers. Unfortunately, when customers are dissatisfied, they are more likely to complain to friends and family than to complain to the provider.20 In the health care industry, only 5% to 10% of unhappy patients actually complain following a dissatisfying experience.24 Instead, many leave silently with the intention of never returning. 14, 25 If consumers do not complain, the organization loses the opportunity to remedy the problem and retain a customer.26 Because the potential impact of service failures on return behavior and negative word of mouth is so great, effective recovery strategies are essential to a comprehensive customer retention approach.27 Background: Patient satisfaction and retention can be influenced by the development of an effective service recovery program that can identify complaints and remedy failure points in the service system. Patient complaints provide organizations with an opportunity to resolve unsatisfactory situations and to track complaint data for quality improvement purposes.

Service recovery: Service recovery is an important and effective customer retention tool. One way an organization can ensure repeat business is by developing a strong customer service program that includes service recovery as an essential component. The concept of service recovery involves the service provider taking responsive action to “recover” lost or dissatisfied customers and convert them into satisfied customers. Service recovery has proven to be cost-effective in other service industries.

The complaint management process: The complaint management process involves six steps that organizations can use to influence effective service recovery: (1) encourage complaints as a quality improvement tool; (2) establish a team of representatives to handle complaints; (3) resolve customer problems quickly and effectively; (4) develop a complaint database; (5) commit to identifying failure points in the service system; and (6) track trends and use information to improve service processes.

Summary and conclusions: Customer retention is enhanced when an organization can reclaim disgruntled patients through the development of effective service recovery programs. Health care organizations can become more customer oriented by taking advantage of the information provided by patient complaints, increasing patient satisfaction and retention in the process.

PART 2
Given the important influence of service recovery on patient satisfaction and loyalty, health care organizations should welcome and encourage patient complaints. An effective complaint management process can be an important QI tool that allows organizations to obtain customer feedback that is useful in making process improvements that increase customer satisfaction, loyalty, and profits.28–30

Understanding Complaints
Customer loyalty can be increased by encouraging consumers to complain.31 Complaints provide organizations with an opportunity to recover from their mistakes, retain dissatisfied consumers, and influence consumers’ future attitudes and behavior.32–33 Moreover, complaints allow the organization to identify common failure points in the service that in turn enable the organization to improve the quality of health care delivery. Consumers in the health care industry are reluctant to complain because they fear that they may receive lower service quality if and when the need for future care arises.24 This is unfortunate, since complaints are important to health care providers. The majority of customers who do complain to the provider about some aspect of service actually will use the service provider again if they perceive the complaint as being resolved.11–12,34 In best-practice organizations outside health care, customer complaints are viewed as opportunities for improvement.28 However, in health care organizations, complaint data have only recently been recognized as a management tool.35 Service recovery cannot occur without a complaint, and resolution of complaints can build customer confidence in the organization. 16,20

There may be situations in which the organization realizes that the customer is not always right and customer retention may not be the appropriate goal. A customer who complains frequently or is never satisfied with recovery efforts may need to be labeled as the “wrong customer.”24 Because of the stress these customers place on the organization and its employees, some organizations may choose to avoid relationships with these customers, since they do not represent valuable long-term relationships.27 However, in instances when dissatisfied customers must return because of insurance requirements, the organization should attempt to make the customers feel that they have been heard and treated fairly but inform them that it is not possible to meet their request.16 If no compromise can be achieved, the organization should maintain a record of these specific customers so that employees will be aware of their disposition and approach the situation with caution when these customers return for future services. During the past several years, most hospitals have developed a formal complaint handling process to meet accreditation standards set by the Joint Commission on Accreditation of Healthcare Organizations

(Oakbrook Terrace, Ill). These standards require that
1. A mechanism exist for receiving complaints;
2. Patients be informed of this mechanism and their right to file a complaint;
3. Each complaint be analyzed and appropriate action be taken, if warranted;
4. Each patient or family making a significant complaint receive from the organization a response that substantively addresses the complaint; and
5. Filing a complaint will not compromise the patient’s future access to care.36

Although many hospitals have instituted procedures for handling patient complaints in response to accreditation requirements, some still do not track complaints for improvement purposes and/or do not formally capture any complaints except those accompanying the patient satisfaction survey.35,37 Complaints offer valuable insight into areas of the organization that are in need of improvement, and an organization that does not respond to customer complaints risks gaining a negative image in the eyes of the consumers who complained.17

The Complaint Management Process
Figure 1 (p 281) depicts a model that incorporates the role of complaint management in the service recovery process. Recommended actions for each step are summarized in Table 1 (p 282). The model contains six steps in the complaint management process that influence effective service recovery and in turn influence patient satisfaction and loyalty and ultimately customer retention and hospital revenues.

The six steps of the complaint management process are as follows:
1. Encourage complaints as a QI tool;
2. Establish a team of representatives to handle complaints;
3. Resolve customer problems quickly and effectively;
4. Develop a complaint database;
5. Commit to identifying failure points in the service system; and
6. Track trends and use information to improve service processes.
These six steps, and recommended actions to take during each step, are now described.

Encourage Complaints as a QI Tool
It is important for the hospital to institute a formal policy throughout the organization to provide a mechanism for patient complaints. The hospital should view complaints as a QI tool and make it easy for customers to complain.16 Inform patients and their families of the complaint process on admission to the hospital and reinforce the organization’s commitment to service excellence and the importance of complaints to both patients and staff by posting visual materials throughout hospital. Require staff to record all complaints on a formal log sheet for documentation purposes and make them aware that complaints are encouraged for quality, rather than disciplinary, purposes.29 Provide monetary and nonmonetary incentives to employees who support the complaint management process. Reward and recognize employees who comply with procedures to record patient complaints, and deny rewards and recognition to those who do not. A combination of individual and team-based compensation, rewards, and recognition will reinforce and illustrate the value of complaint management to all employees.28

There are several ways for a health care organization to encourage complaints. Patients and families can be informed of the complaint resolution process as part of the admission process. Patient handbooks can provide information on the complaint management process, with a contact number to call if conflict arises. Patients can be provided with an information flyer in their rooms that communicates the hospital’s commitment to service excellence and includes a customer service hotline number. Posters can be placed in the hallways that encourage patients to express complaints and concerns, with a contact telephone number listed. Finally, complaints can be solicited from patient satisfaction surveys that are mailed to patients after discharge.

Resolution, demonstrate the effectiveness of the complaint management program and reinforce the organization’s ongoing commitment to encouraging complaints. Fewer than half of the patients who have a negative experience with a hospital respond actively to change the dissatisfactory situation, which suggests that written complaints are just the tip of the iceberg. 12 Many times customers lodge complaints with the nearest employee they can find. Although it is certainly a challenge to ensure that complaints delivered in this manner are communicated back to the organization, it is vital for an accurate assessment of organizational performance.24 Hospitals should pay attention to oral complaints made to hospital personnel because they are an accurate reflection of the level of dissatisfaction with hospital services.12

Field reports from one hospital involve a standardized systematic approach to complaint management39; to capture the complaint as soon as possible, a physician or staff member who receives a complaint immediately refers the patient to management personnel. If a manager is not available, the complaint is recorded on a standard patient complaint form. The information recorded on the complaint form must accurately report the allegation as well as the patient’s suggestion for correcting the situation. The complaint form is then forwarded to the appropriate manager for further investigation. To gain employee buy-in for the complaint management process, it is important to make it easy for employees to track complaints. The hospital can provide employees with simple complaint forms that serve as internal documentation used to record service failures.24 It can also hire or designate certain employees to respond immediately to complaints that require prompt attention, such as complaints regarding quality or medical issues. For complaints that do not require immediate resolution, employees can log the complaint by using coded data or flagging the patient’s record until the appropriate manager can attend to the complaint. The process can be further simplified by appointing a complaint coordinator whose primary responsibility is tracking and compiling complaints soon after they are registered. Employees for whom the workload does not permit an immediate filing of the complaint could direct the patient to address the complaint to the appropriate personnel.

Summary and Conclusions
The growing importance of customer service has prompted many organizations to make customer retention a primary goal of their patient satisfaction programs. Customer retention is enhanced when an organization can reclaim disgruntled patients through the development of effective service recovery programs.
Health care organizations can become more customer oriented by taking advantage of the information provided by patient complaints, increasing patient satisfaction and retention in the process. Satisfied patients serve as referrals for a health care organization by encouraging others to use the service provider, whereas dissatisfied patients can damage
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