Successful Handling of Patient Complaints Requires Effective Training of Specialists: A Description of the CODE Training Model for Patient Complaint Excellence

Abstract

Patient complaints are valuable sources of information for quality improvement and provide an avenue for patient self-advocacy. This paper outlines the development and implementation of a novel training program, termed CODE (Compassion, Operational Support, De-escalation, Empowerment), for patient experience complaint management staff. The program consists of 2 core tracks: procedural training on operational systems and resources, and interpersonal communication training. A dual-track framework ensures practical knowledge to access resources to assist complainants is paired with communication for empathy and human connection. The CODE program's dual-track structure is a key strength, bridging the gap between operational efficiency and compassionate communication. By emphasizing both procedural knowledge and interpersonal skills, it equips healthcare professionals to manage patient complaints successfully. The CODE program represents a novel approach for healthcare institutions seeking to optimize patient experience and complaint-handling performance.

Introduction

Healthcare institutions receive large numbers of complaints from patients and their families. ¹ Evidence suggests that patient complaints and grievances (hereafter “complaints”) are a useful source of information to guide quality improvement and mitigate risks.^2,3 Patterns of complaints can identify recurring problems in departments or with processes, including problems related to patient safety.^4–6

The Centers for Medicare and Medicaid Services in the United States outline broad requirements for the establishment and maintenance of a complaint process. ⁷ The Agency for Healthcare Research and Quality provides guidance on the elements of effective service recovery. ⁸ Standardized workflows, centralized data management, and leadership accountability are key process tools to improve responses to patients and meet regulatory and accreditation requirements. ⁹

Effective handling of a patient complaint is a critical task that impacts the complainant and the institution. Personal, accountable, and empathetic responses to patient complaints remain the cornerstone of effective complaint management and service recovery.^10,11 There are limited published data on training staff to handle patient complaints.

Office of Patient Experience Structure

The Office of Patient Experience (OPX) mission is to bridge communication between patients and their advocates (hereafter “patients”) and the clinical practice, through relationships and human connection. OPX handles complaints, compliments, and suggestions, across a multisite, multistate enterprise. OPX's vision is that patients are heard, trust and confidence in the institution are restored, and positive change is created across the organization.

Actionable Insights

Experience Onboarding Project

Project Goals

Maintaining service excellence is the key impetus for a consistent approach to managing patient complaints. Historically, the institution did not have a defined framework for service recovery other than being attentive and considerate to complainants.

The goal was to develop an effective onboarding plan to improve and standardize OPX communication with patients and the clinical practice. The key was to instill a foundational understanding, at the time of hiring, of the standards of communication. Compassion and de-escalation are critical when engaging with exceedingly high emotions from patients, so it is crucial that staff have the necessary skills to effectively hear, validate, deescalate, and resolve.

Another goal was to ensure that specialists had confidence in their understanding of processes, familiarity finding and using practical resources, and superior operational knowledge.

Conceptual Foundation

Respect, Integrity, Compassion, Healing, Teamwork, Innovation, Excellence, and Stewardship values

Mayo Clinic, as a values-driven organization, prioritizes the integration of core institutional values into education and practices. These values—Respect, Integrity, Compassion, Healing, Teamwork, Innovation, Excellence, and Stewardship (RICH TIES)—are communicated to new hires and specifically emphasized within work units.

The Mayo Model of Communication

The Mayo Model of Communication (MMOC, previously XMOC) is the key resource used for teaching communication skills. This framework integrates best practices and RICH TIES values (Figure 1). The evidence supporting MMOC includes the significance of empathy, validation, and legitimization—essential components for effective service recovery.

Figure 1.

Experience Model of Communication (XMOC) schematic.

Compassion, Operational Support, De-escalation, Empowerment framework

Compassion, Operational Support, De-escalation, Empowerment (CODE) not only encompasses core elements of complaint management but also conveys additional concepts to new staff. Beyond being an acronym, “CODE” signifies adherence to values and ethical practices and serves as a unique combination for unlocking service excellence. The framework's elements are the CODE.

CODE Development Process

Among the skills identified as valued by staff were communicating effectively with members of the clinical practice, empathic redirection, and escalation management.

The program's authors have expertise in interpersonal communication and conducted a literature review on service recovery and healthcare-specific customer satisfaction. They compiled essential knowledge addressing the psychology of complaints, elements of service recovery, and trust restoration after perceived failures.

CODE Dual Track Framework

The program was divided into 2 core tracks: (1) procedures and resources, and (2) interpersonal communication skills training. The process track focused on key operational systems and resources. Developing the process track included creating support resources such as standard operating procedures and compiling them into a cohesive, accessible package. The interpersonal track was focused on communication skills. A complementary communication mini-curriculum was developed for leaders, with a focus on team communication skills. Notably, while telephone and in-person communication received significant focus, a proportion of complaint closure is written. A recognized limitation was a paucity of literature on writing appropriate, compassionate, and risk-minded letters. Thus, a component of the program is writing education.

CODE Program Overview

The process track includes information on regulatory environment and a department-specific focus emphasizing the OPX mission and organizational structure. In addition, technology training, system navigation, resolution resources, and quality assurance of training are critical components. The communication track consists of training on interpersonal skills, MMOC principles, and recognizing distress. Establishing trust, escalation prevention, addressing ruminative behaviors, and the role of self-care were critical components. Additionally, the training plan includes role articulation during the complaint reception process, in which Patient Service Specialists are trained to describe their role as a neutral facilitator or liaison, rather than an advocate. Program elements included multimedia content, flexible learning, and customer relationship management software familiarization. Leaders undergo the same program as frontline staff, with an additional module tailored for leadership on skill mastery, role modeling, and managing team conflict.

Consolidation and Sustainment Phase

After the initial program, employees enter a 6-to-8-week consolidation phase paired with a senior specialist for mentoring. An important aspect of the second phase is familiarizing new staff with the organizational structure. See Appendix A for a consolidation schedule.

The employees maintain competencies through mechanisms for skills sustainment including monitoring compliance with a scorecard which outlines essential elements for quality interactions, and a robust tracking system that drives continuous improvement.

Practical Recommendations

Build Confidence Through Training

Develop a training program that focuses on both procedural knowledge and interpersonal communication skills. This dual-track approach ensures that staff are well-equipped to handle patient complaints effectively and builds staff confidence in handling difficult interactions.

Gather Feedback for Continuous Improvement

Use post-training surveys and listening sessions to gather feedback from staff. This feedback can identify areas for improvement and ensure that the training program remains effective and relevant.

Provide Flexible Learning Options

Offer training modules through various modes of delivery and allow staff to complete them at their own pace. This flexibility can help accommodate different learning styles and schedules.

Recognize and Motivate Staff

Use achievement badges and other forms of recognition to motivate staff and acknowledge their accomplishments during the training program.

Plan for Advanced Training

Develop advanced training programs that combine different modes of learning, such as instructor-led training, self-paced learning, and role-play exercises. This can help reinforce the skills taught in the initial training program.

Focus on Writing Skills

Include education on writing appropriate, compassionate, and risk-minded letters in the training program. This can help address the limitation of the paucity of literature on this topic.

Establish Mechanisms for Content Updates

Create mechanisms to regularly update the training content, as best-practice data can change rapidly.

Facilitators of Program Success

The production team found that the engagement of managers at the group level was vital. Staff valued receiving updates and providing input throughout the development process. Providing dedicated work time to complete modules and presenting content via mixed modes of delivery were identified as important as was the flexibility to pace curriculum completion on an individualized basis. Finally, recognition of task accomplishment using achievement badges was identified as motivating.

Practical Considerations for Improvement

Several areas for improvement were identified related to technical aspects of the online curriculum user interface, such as adding functionality for pausing and bookmarking within a module for subsequent return. Staff identified the learning of many grammar and punctuation rules in the writing modules as cumbersome. The curriculum development team identified that best-practice data can change rapidly and consequently mechanisms to update content would be of value. Nomenclature can be a source of confusion. At our institution, “complaint” is a term that delineates concern unrelated to patient care or, if related to patient care, handled at the unit level, in the moment, with real-time service recovery. A “grievance” is a concern brought directly by a patient to OPX related to patient care, which triggers the opening of a case for OPX to manage to resolution.

Some aspects of the CODE content are institution-specific; however, all healthcare institutions should benefit from training that emphasizes processes for locating and using systems, operating procedures, workflows, supporting documents, and regulatory compliance resources.

At Mayo Clinic, the guiding principle is the relentless pursuit of category-of-one performance. To deliver care that is both highest quality and human-centered, it is essential that the people responsible for maintaining human relationships are skilled to operate at a highly proficient level.

Conclusion

The CODE onboarding program stands as a novel effort in enhancing patient experience complaint management. By integrating principles of CODE, this initiative equips staff with the essential skills and knowledge to effectively address patient complaints while upholding service excellence. The dual-track framework ensures a comprehensive approach, emphasizing both process fluency and empathetic communication. As healthcare organizations strive for continuous improvement and excellence, initiatives like CODE serve as crucial tools in ensuring that patients’ voices are heard, their concerns are addressed, and trust in an institution is restored.

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