Standard 13: Complaint and Grievance Resolution (guideline)

“Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.”

Patients who bring racial, cultural, religious, or linguistic differences to the healthcare setting are more vulnerable than others to experiencing situations in which those differences may not receive appropriate respect from a healthcare institution or its staff. These situations may include such issues as different attitudes regarding informed consent or advanced directives, difficulty in accessing services or denial of services, or even outright discrimination. Healthcare organizations should ensure that all staff members receive training in how to recognize and prevent potential conflicts and that patients receive information about and have access to complaint and grievance procedures. In anticipation of patients who are not comfortable with expressing or acting on their own concerns, the organization should have informal and formal procedures such as focus groups, staff-peer observation, and medical record review to identify and address potential conflicts.

Standard 13 is linked to many existing legal requirements that are regulated at the federal or state level, eg, issues such as grievance procedures, ombudspersons, and discrimination policies and procedures. However, many of these policies are written with a broad scope, and individuals may not take advantage of such regulations due to culture and language-related concerns. Title VI requires that organizations provide notices to limited English proficiency (LEP) patients concerning their right to complain about not receiving language assistance when needed and their right to have available interpreters and translated materials related to any complaint processes.

Recognizing Misunderstanding and Bias—and Organizational Solutions
The evidence from incidents related to cultural misunderstanding can be subtle and may be reflective of potential unconscious bias. For that reason, the involvement of lawyers is important during the development of policies and procedures to define what constitutes discrimination and violation of rights. Although issues related to racism can still be concerns, racism is not as legally well defined as discrimination. In some situations, if people do not understand how to present themselves respectfully to others of diverse backgrounds, productive communication may become impossible. In healthcare settings, procedures that will result in respectful intake and other interactions need to be implemented.

Healthcare organizations should have in place the resources to help staff members recognize and act appropriately concerning emerging cultural conflicts before they rise to the level of formal complaints. For example, cultural and religious issues about discussing death and dying may mean that members of some recent immigrant communities may choose not to sign informed consent forms. To resolve such an issue, the organization’s legal staff could hold a community meeting to try to develop a compromise approach that would meet the needs of both the community and the hospital. Although this may not always achieve a perfect solution, this type of dialogue can contribute to better relationships and understanding between community members and healthcare staff. Other instances of cultural misunderstanding may require calling in a patient advocate or ombudsperson or enlisting the assistance of an ethics committee as soon as it appears that a disagreement or conflict could be emerging.

Formal institutional policies and procedures to address patient complaints about unfair or discriminatory treatment can guide staff members in their efforts to achieve cultural competence. Cultural competence training has a critical role to play in preparing staff to respond appropriately when faced with cultural differences. Procedural guidelines, courses, and analyzing case studies can educate staff in:

  • How to listen and respond respectfully when cultural differences arise
  • How to respond to patient complaints
  • Which cultural issues influence patient dissatisfaction

Suggested approaches for conflict and grievance resolution include, but are not limited to:

  • Obtain patient/client and staff input to craft grievance policy and process
  • Create a policy and process that are responsive, inclusive, and equitable and that lead to prompt resolution of grievances in a culturally and linguistically responsive manner. At a minimum, the process must address literacy, English ability, individuals with disabilities, and unfamiliarity or reluctance of some cultural groups to make formal complaints
  • Ensure that the organization’s data system has the capacity to document and track complaints, their status, and resolution for both patients/clients and staff
  • Provide training to all new staff members on the grievance policy and process. Ensure all staff members, volunteers, patients/consumers are informed of the policy and process
  • Update the grievance policy and process as appropriate

Organizations may find it useful—or they may be required—to create programs with an ombudsperson and an ethnically diverse staff to proactively address patient rights and protections. Such programs can also provide the organization with input regarding the effectiveness of its current cultural and linguistic competency efforts.

Patient Culture/Empowerment Issues
An absence of complaints from patients does not necessarily mean that issues of cross-cultural conflict or discrimination are not taking place. In fact, the absence of complaints could mean that patients may:

  • Not recognize that they are being treated inappropriately
  • Have cultural attitudes that inhibit them from complaining
  • Not know that they have the right to complain
  • Believe that a complaint will be disregarded by the institution

Healthcare organizations should communicate the concept of patient rights to the people whom they serve in a way that recognizes potential barriers and reassures patients about the safety, importance, and validity of the complaint process. That process itself should be understandable, easily accessible, confidential, and transparent. To that end, linguistic accessibility to notices, forms, and processes is crucial.






Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center