Hospitalists, as frontline healthcare providers, maintain direct contact with patients. This dynamic may encourage patients to express concerns regarding other members of the care team. To examine protocols for when that happens, Medscape Medical News consulted hospital medicine specialists for their insights.

Responding to Patient Complaints or Criticism

To begin, understand that it can be distressing for a patient to be hospitalized.

“Every patient interaction is a day at the office for us and may be the worst day of a patient’s life,” said Bartho Caponi, MD, clinical professor at University of Wisconsin (UW) School of Medicine and Public Health and a hospitalist at UW Health in Madison, Wisconsin. “Things we don’t think of at all or notice may be very impactful to a patient, including posture, tone, vocabulary, and presentation.”

So when a patient reports a concerning interaction, Caponi said he listens empathically and follows up as he feels is warranted.

“Sometimes clarification and reassurance are all that’s necessary; sometimes it may be a formal report,” he outlined. “I try to follow the concepts of ‘just culture’ and ‘safety culture’ to guide response. We all sometimes need some coaching and reminders about why we are there.”

Assessing the Severity of Complaints

Scenarios can run the gamut from a patient reporting a nurse ignored them when asking about pain medication to a situation where a physical therapist missed an appointment twice. What are the protocols for a hospitalist to respond to? Caponi said to err on the side of something that isn’t intentional.

“There’s usually no reason to not assume good will on all parts — the patient is ill and wants care, I want to provide care, the nurses and therapists and techs want to provide care, but we are all subject to stress and may not always respond in the way a patient needs at a given moment,” said Caponi.

He suggests listening, showing concern, and being empathetic.

“Again, I will apologize for dissatisfaction, provide empathic listening and reassurance, and try to objectively address the issues,” he continued.

Another step is to advise the patient there are patient advocates in place to assist. “I offer that contact information, regardless of how I feel about their report. That gives the patient an independent option and ensures I am not dismissing something more important than I identified,” Caponi said.

Should a Hospitalist Attempt to Proactively De-escalate?

Consider a patient-centric approach and be mindful of cues and actions. Consider body language that’s more relaxed and approachable and try to match eye level with a patient to have a discussion rather than to deliver a lecture, said Caponi.

“We all learn these tactics, but it took me a couple of years to realize that the effort and time investment made my patients happier — and me, too,” he said. He maintains that empathetic listening can be a game changer.

Escalating a Serious Complaint

If a patient reports demeaning language, threats by a social worker, or verbal insults from a nurse, what should the hospitalist do?

“If the issue is something that needs to be reported, then it needs to be reported,” Caponi affirmed. “Again, in a just culture, response is proportionate, and in a safety culture, safety comes first.”

To this point, if there was a reportable error or interaction, Caponi formally reports and relies on the established apparatus to address it.

“Hiding issues is never the right approach,” he said. “Every organization I am familiar with has both open and anonymous reporting options for safety, compliance, and other concerns.”

What if you deem there’s a pattern of behavior from a particular staff person? What then?

“As I’ve gained more experience, I’ve become more open to discussing such issues with leaders. That’s where formal reporting is most critical. Reporting builds a record and a list of cases. Again, hiding issues and concerns is never the right approach,” he said.

As a hospitalist, taking appropriate action is very important to maintain a culture of safety in a healthcare organization, said Tanveer Singh, MD, hospitalist and vice chair of Safety, Quality, and Patient Experience at the Cleveland Clinic in Cleveland. “Any intimidating behavior or disruptive behavior is considered unprofessional and should not be tolerated,” said Singh. “All healthcare organizations should make an effort to educate the staff to maintain an environment of professionalism that promotes high-quality care.”

If you do deem there’s a pattern of behavior from a particular staff person, taking action can also be appropriate, Singh agreed.

“It is very common that hospitalists are also leaders within the hospital, and they are leading the peer review or patient safety committees. Thus, hospitalists may review various complaints related to the behavior of any staff member,” he said.

The authors reported having no disclosures.