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Patient Grievance Procedure

Purpose

The purpose of this policy is to establish guidelines for the patient or caregiver of a patient to submit a formal grievance as well as educate staff on patient complaints and grievances. No patient or caregiver will be retaliated against for exercising the right to file a grievance.

Definitions

Complaint

As defined by CMS, complaints are patient issues that can be resolved promptly or within 24 hours and involve staff who are present (e.g., nursing, administration, patient advocates) at the time of the complaint. Complaints typically involve minor issues, such as room housekeeping or food preferences. (CMS). In the case of Matthew 25, clinic staff includes CMA, Staff RN, Site Director, other applicable roles involved in direct patient care.

Grievance

A formal complaint made by a patient or patient representative, regarding the patients care such as issues not resolved/able to be resolved by a staff member, abuse or neglect, issues related to care and patient rights. All grievances will be filed in the Compliatric incident module.

Procedure

I. Patient Complaints

  • See definition of complaint listed above.
  • If a patient makes a verbal complaint, clinic staff will make every effort to address and to correct the matter of the complaint and will notify their site director of the complaint. Site directors will inform the Chief Clinical Officer of the complaint.
  • If a patient makes a complaint via the Contact Us section of the Matthew 25 website, the Chief Executive Officer will forward the complaint to the applicable member of the leadership team to address the complaint.

II. Patient Grievance

  • See definition of grievance listed above.
  • If a complaint cannot be resolved by staff and further action is needed, a site director, Chief Clinical Officer, or other member of the management team can provide the guidance for filing a formal grievance.

III. Non-retaliation

  • Workforce members will not retaliate against a patient for filing a complaint or formal grievance. It is against the law.
  • If a workforce member has been found to violate this policy, progressive disciplinary action including and up to termination will be issued.

IV. Instructions to Patients for Filing a Complaint or Grievance

Complaint

Patient complaints may be filed online at Matthew25clinic.org using the Contact Us form, or see a member of your patient care team to discuss your complaint. The submitted Contact Us form is directed to the CEO.

Grievance

Filing a grievance is different than a complaint, and will take the patient directly to the incident link within Compliatric. Patient grievances may be filed using the following button:

  • For those who wish not to use the website to file the grievance, patients or caregivers can request a paper form at any of the Matthew 25 site locations found on the server on the Z drive – Community folder – Forms file – Patient Grievance form. All grievances will be routed directly to the Director of Health Information Management & Compliance for review and further investigation. Grievances should be filed within 72 hours of any specific incident/complaint. The person filing the grievance will receive a response in writing from the organization representative within seven (7) business days.
  • If a paper grievance form is filed, the Director of Health Information Management & Compliance will initiate an incident within Compliatric on behalf of the patient/caregiver for auditing and tracking purposes, and upload the paper form into the applicable incident/grievance in the system.
  • If resolution is not attained to the satisfaction of the patient/caregiver, the Director of Health Information Management & Compliance will forward the grievance and all relevant information including investigation information and written account by any staff witnesses or involved to the Chief Executive Officer (CEO) and/or Board President.
  • The Chief Executive Officer (CEO) and/or Board President will review the grievance and take any necessary action within seven (7) business days and respond to the patient/caregiver in writing of the decision regarding the grievance.
  • If resolution continues to be unmet to the patient’s/caregiver’s satisfaction, the grievance will be forwarded to the third party for Matthew 25 AIDS Services, Leslie Newman, Attorney-At-Law. Ms. Newman will request both parties any further information that she may need to help resolve the grievance. She will issue a written statement to both patient/caregiver and to the Board of Directors. The grievance and the statement from attorney will be reviewed at the next monthly board meeting and the patient/caregiver will receive their decision in writing with ten (10) days of the meeting.
  • The decision reached by the Board of Directors will be final.
  • Patients/caregivers who are not satisfied with the grievance resolution of Matthew 25 AIDS Services, Inc. have the right to inform the program funder about the circumstance surrounding the grievance. The funder, when willing, will make decisions based on their programs specific policies and procedures.