By Mark Meier, MSW, LISCW

As a dialysis patient, to a certain degree, you must rely on others for your well-being. You arrive to each dialysis treatment anticipating that the nurses, dialysis technicians, physicians and other clinic staff will appropriately initiate your treatment, monitor you closely during your treatment and safely discontinue your treatment at the end of your prescribed run time. You also rely on your healthcare team to provide you with current treatment and medication options, educate you about your dietary needs and provide you with resource information that pertains to your needs outside of the dialysis clinic. Along with your reliance on the healthcare professional, you also have the right to have expectations about the level of care you receive in your clinic. You should be able to expect that the care you are receiving is performed safely, within the policies and procedures established by the clinic, directed by your physician, and occurring within generally accepted medical practice. Relying on healthcare professionals and having expectations about the level of care you receive are normal aspects of the patient/provider relationship and on their own or in combination should not be problematic.   

However, challenges might arise for you as a patient when the expectations you have for your care are not being met by the very same professionals you rely on for your safety and well-being. It can be a daunting and intimidating task to question or complain to, or about, the professional who is responsible for your care in so many ways. This article will help you to identify positive, proactive steps to take when identifying, reporting, and following up on a complaint about your dialysis clinic or care. You will also be provided with outside resources to utilize if you are unable to obtain a resolution within your clinic system.  

Identifying a Complaint

What type of situation merits reporting as a complaint? The answer to this question is going to be different for each patient and there is not a specific answer about what to register as a complaint.  Generally, complaints fall into three categories: (1) Treatment-related, (2) Staff-related and (3) Dialysis-clinic related. Treatment-related complaints often reflect the perception that some aspect of the initiation, maintenance, or discontinuation of the dialysis run has been performed incorrectly.  Staff-related complaints frequently relate to patient and staff conflicts or disagreements. Dialysis-clinic related complaints focus primarily on the operation and cleanliness of the dialysis center. All three categories have merit and none should be considered more important than the other should. What is important is that once you have identified a complaint that you take the next step and report the complaint.  

Reporting a Complaint

The very nature of the word “complaint” conjures up a negative image and the clichés about “complainers” are numerous. Furthermore, it can be intimidating and stressful to raise concerns about the doctors, nurses, technicians and other healthcare providers who care for you on a daily basis. However, when you have identified an area of concern, it is important to make those aware who have the capability and authority to improve the issue. When reporting your complaint, it is important to understand the complaint or grievance process your clinic has established. The End Stage Renal Disease (ESRD) Federal Regulations, maintained by the Centers for Medicare and Medicaid Services (CMS), require that each dialysis facility have a process in place to address patient complaints. The regulations further require that each dialysis clinic provide patients with specific information that explicitly informs them of the process for filing a complaint and that the patient (or patient representative) is able to file a complaint “…without restraint or interference, and without fear of discrimination or reprisal” (Conditions of Coverage of Suppliers of End Stage Renal Disease, CFR42 405.2138 Patients’ rights and responsibilities). Despite these printed assurances in the Federal Regulations, you still might not feel comfortable reporting a complaint in your clinic. You always maintain the right to forgo the complaint policy implemented by your clinic and report the concern directly to your ESRD Network, which will be discussed later in this article.  

If you have identified a concern, which might be a single incident or a pattern of incidences that you wish to report as a complaint, it is important to be thorough and specific with all components of your complaint. For example, a general complaint about a dirty clinic is more difficult to address than a complaint about unwashed dialysis chairs or used medical supplies being disposed of inappropriately. If you have a concern with a particular staff person, it is important to report your concern in an objective, concrete manner, which describes precise behaviors or actions. The use of offensive language, name-calling or insults will likely exacerbate your concern rather than improve it. Further, it is important to know the person’s name and position when reporting your concern. Specific dates and even the time of an incident will allow those addressing the complaint to narrow down and deal with the concern.  

The method in which you report the complaint is also important. As noted above, the dialysis clinic is required to have a procedure in place for reporting complaints, and they will likely request that you follow this procedure. The procedure will probably contain provisions to put your complaint in writing and to follow a chain of command in filing the report. For example, you might be asked to speak with the social worker first and then speak with the charge nurse, clinic manager, and so forth, working your way up the levels of management in the clinic. This procedure can be useful and helpful to you as a patient for many reasons. First, it provides you the opportunity to put your complaint in writing as an official notice of your concern. Second, it gives both you and the clinic a written description of the specifics of the complaint to refer back to in the process of responding to the complaint. Third, it gives the staff that works in the clinic on a daily basis an opportunity to respond to and resolve the complaint. This method of reporting also allows a measure of confidentiality for the person reporting the complaint. 

Reporting a complaint in this written manner allows the clinic staff person who is responsible for dealing with complaints an opportunity to approach the person(s) whom the complaint is about away from the treatment floor and in private. In responding to a complaint, the primary objectives of the clinic management should be to establish the validity of the complaint, resolve the complaint in a reasonable manner and period of time and to educate and provide further training to the staff so the concern is solved for both the short-term and the long-term. In fairness to the staff person about whom the complaint is brought against, they should generally be afforded the opportunity to be made aware of the problem, educated and trained further as necessary and given an opportunity to correct the issue.    

Following Up On a Complaint

In order for a complaint policy to be effective and complete, there must be a mechanism in place for follow up. Most clinic policies state the time period in which the facility will act once receiving a complaint and what action will be taken in response to the complaint. You should receive a response to your complaint in writing with some detail of the plan of correction and future plans to prevent the problem from reoccurring. The response you receive should also contain a description of the process or the resources you can utilize to appeal the decision. If you are satisfied with the resolution, providing constructive feedback and encouragement to those who have helped to solve the issue is helpful to maintain the changes that have been implemented.  

Alternative Complaint Resources

If you have identified an area of concern and you do not feel comfortable reporting a complaint to your physician or using the grievance process put forth by your clinic, you always have the option of reporting the complaint to outside agencies. The two primary agencies are the ESRD Networks and your State Survey Agency. Both are capable of receiving and acting on your complaint either alone or with the other agency.  

The ESRD Networks, of which there are 18 throughout the country, are contracted by CMS to receive and act upon patient complaints. Your clinic should have your Network’s number posted or you can ask a staff person to provide you with the telephone number. You can also access the Forum of ESRD Networks on the Internet at www.esrdnetworks.org. This site contains a detailed map of the areas covered by each ESRD Network, as well as a link to the Web site of each individual Network.  

The other alternative is to contact your State Survey Agency directly. State Survey Agencies are responsible for the licensing and certification of outpatient dialysis clinics and handle individual patient complaints. You can access a directory containing the contact information for your State Agency on the CMS Web site at www.cms.hhs.gov.  

Conclusion

Receiving and providing quality care in an environment free of problems is the goal sought by most patients and healthcare professionals. However, like the rest of the world, problems arise which are uncomfortable to face and sometimes difficult to solve. When a problem does come up, you as a patient have the right to report this complaint, expect action to improve the situation and be informed of a plan to prevent the problem from returning. You should be able to report this complaint without the fear of reprisal or retaliation from the staff that cares for you. Along with these rights, you also have responsibilities in the clinic in relation to complaints. If you identify a problem, it is your responsibility to report the issue in a manner that the complaint can be acted upon and the problem area resolved. You are also responsible for understanding your clinic’s complaint process or to know whom else you might contact to solve the issue.  

The outpatient dialysis clinic is a fast-paced, dynamic and highly sophisticated environment. It is inevitable that certain problems or challenges will surface. However, if complaints are reported and received in a professional manner and you and your clinic staff share the same goal of resolving the complaint to improve the operations of your clinic, the identified problem can be solved in a positive manner to benefit both patients and staff.

Mark Meier, MSW, LICSW has been the Consumer Services Coordinator at Renal Network 11 since 2001. He recently served as the study coordinator for the 2002 National Involuntary Patient Discharge Survey involving 12 ESRD Networks. Mr. Meier is active with the AAKP and was recently elected to the AAKP Board of Directors. 

This article originally appeared in the November 2003 issue of aakpRENALIFE Vol. 19, No. 3.

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