Grievances or Complaints: What’s the difference?

Happy patients contribute to a thriving practice by referring other patients. Yet, despite the best efforts to provide outstanding customer service and patient care, occasionally something goes awry: patients complain about fees, excessive wait times, unexpected changes in treatment or perceived staff rudeness.

How complaints are initially, and subsequently, handled is critical. Among other things, unhappy patients post negative reviews on social media or complain to the licensing board, insurance company or federal government.  

An important aspect of managing complaints and grievances is to recognize the difference between the two. The Centers for Medicare and Medicaid (CMS) defines both terms. It’s important to be very familiar with these terms because if your office participates in any government funded dental programs you could be dropped from the program due to patient complaints or grievances. This may in turn impact your future credentialing with other insurers. 

CMS defines a complaint as a patient issue that can be resolved promptly—right away or within 24 hours. Solutions can be as simple as offering the patient a blanket if they complain about the temperature or explaining why the doctor is running behind. Complaints typically do not require an investigation or peer-review process.

CMS defines a grievance as a patient issue that concerns unresolved issues, cannot be addressed immediately, may concern an alleged violation of patient rights, or may involve a patient’s request for response. Grievances tend to be ongoing and most often are finance- or care-related.  They may also involve patient non-compliance, such as not following treatment recommendations or missing scheduled appointments.

Proactively managing complaints is a key strategy to prevent escalation into grievances. So design a plan for handling complaints before they escalate. 

Start with these simple strategies for minimizing unhappy patients in your practice:

  • Attend customer service training workshops. This training adds tremendously to patient satisfaction and retention. 
  • Role play scenarios so everyone is comfortable responding to complaints. Remember that even though the office manager or doctor may ultimately handle the issue, the patient will complain to whomever is the closest at the time.
  • When issues arise and you are not sure how to proceed, seek legal advice from your malpractice carrier or a healthcare attorney before it escalates. They can also assist with questions such as whether to dismiss the patient.

Ultimately, staying patient-centered will minimize complaints and grievances and maximize long-term patient relationships.