Evaluate and Resolve Grievances QIA
IPRO ESRD Networks are tasked by the Centers for Medicare and Medicaid Services (CMS) to work with facilities and patients to improve the grievance process within dialysis facilities. The goal is to increase patients’ comfort level about addressing their concerns with facility staff and provide facilities with the tools and resources to identify patient concerns early, opening communicating and resolving the concern before it escalates to a grievance. As defined by CMS a grievance is a written, verbal, or electronic request for assistance initiated by or on behalf of an ESRD patient(s) regarding concern(s) about ESRD issues including, but not limited to: care, treatment, or providers. Grievances can be filed by any of the following: ESRD patients, their representative’s and other family members/caregivers, facility employees, physicians and other practitioners, federal or state agencies, quality improvement organizations (QIOs), state survey agencies, and other agencies and organizations. All grievances are private, confidential, and protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) guidelines. Patient identity is confidential and cannot be released without the express permission of the patient.
In response to a grievance submission, a formal and thorough investigation of any issues, complaints, or concerns involving a facility, physician, or other provider is conducted by the Network. As such, the Network has a responsibility to take the necessary steps to ensure that all grievances filed by, or on behalf of, one or more ESRD patient(s), are evaluated and resolved in an efficient and effective manner.
The potential for deceasing grievances focuses on:
• Increasing communication between patients and the treatment team
• Empowering patients to take a more active role in their care
• Promoting a culture of quality improvement
Decrease facility grievance scores by a relative 20% from baseline (March 2017) to re-measure (September 2017)
Secondary goals are to:
Foster patient and staff relationships to improve patient self-efficacy in handling their concerns with the facility by improving communication among the patients, the facility staff, and the Network. Providing tools to both the provider and patient will assist the facility in establishing and maintaining an effective and efficient grievance process so that patients feel capable of handling their environmental, interpersonal, and operational issues with the facility.
In addition, improved communication early in the grievance process may decrease escalation of issues that evolve into an IVT/IVD, which places the patient at risk for an access to care issue. It is anticipated that the Network and facilities will continue to work together to address QoC and access to care issues.
Facilities are selected and notified of their participation in January. The Network collects additional baseline data from facilities and selects the final participants in March. The Network will work with the facilities to implement interventions between April and September. The re-measurement will be completed in September based on monthly grievance information reported by facilities. Facilities will be notified in October if they have met the goal to graduate or will continue in the project during the next year.
12 Facilities within the ESRD Network, selection is made based on the number and type of grievances filled at the facility.
All facilities are included in the baseline data collection who had two or more of the following grievance types: Immediate Advocacy, General Grievance, or Quality of Care and/or one or more access to care issues reported to the Network reported during the year prior to the start of the project.
Data for this QIA will be submitted monthly by facilities and reviewed by the ESRD Network with final data being collected in September.
Tools and Resources
Interactive Posters have been created as a platform to help promote better communication between facility staff and patients by understanding more about the perspective of each other.
Patient Interactive Poster
Professional Interactive Poster
Educational Posters are available to provide communication strategies to consider when communicating between patients and staff
Forum of ESRD Networks Resources
Dialysis Patient Grievance Toolkit in English and Spanish is a toolkit created by the Kidney Patient Advisory Council (KPAC). This toolkit is designed BY patients FOR patients to help patients as they work through the Grievance System.
CMS provides a grievance template which can be used to track and respond to grievance information.
ESRD Grievance Template
Erin Baumann, LMSW
Patient Services Director