1. Understanding and Implementing the CLAS Standards
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.”
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
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:
Suggested approaches for conflict and grievance resolution include, but are not limited to:
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
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.