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Patient grievance cell yet to click with hospital management
Shardul Nautiyal - Mumbai
Amit (name changed) went to see his younger brother Siddharth, who was operated
for an ailment in a well-known Mumbai-based private hospital. Amit was denied
entry into the ward, where his brother was staying, post-operatively and was
asked to produce a consent letter duly authorised by the medical director to
enter the ward. It was near to impossible for Amit to access the medical director
at 7 in the evening, as the director was available only in the morning.
After rounds of requests and an hour of waiting, the supervisor
permitted Amit to see his brother. The case of Amit reveals the plight of many
patients and their relatives, who are denied immediate redressal of their grievances.
The case would not have been so time-consuming and frustrating, if a speedy
and efficient grievance cell would have been in place to help him.
For Dr Usha Sharma, a senior consultant, gynaecology, Royal Hospital, Muscat,
getting a knee replacement surgery in the country turned into a harrowing experience,
when she developed an infection after surgery. Narrating her experience, Dr
Sharma told Express Healthcare Management (EHM) that just a few days after her
total knee transplant surgery at one of the premier hospitals in Mumbai, she
developed the wound swab. When the surgeon didn’t act, Dr Sharma went asking
for in Delhi, where she had to undergo a repeat surgery. “I went through
unnecessary hassle, pain and agony and the doctor/hospital didn’t take
any responsibility,” says an aggrieved Dr Sharma.
There are many patients like Dr Sharma who suffer due to lack of virtually no
redressal system in place in most of the hospitals across the country. According
to Dr P M Bhujang, medical director, Sir H N Hospital, no hospital can function
effectively, unless it is sensitive to patients’ grievances.
Grievance cell is assuming importance in India, as patients have become more
conscious of their rights. Moreover, the accrediting and rating agencies insist
on documentation of patient’s feedback.
According to Dr Bidhan Das, vice president, corporate affairs, Rockland hospital,
it is important that patient is informed about his/her rights to seek justice,
which is why it is imperative that all hospitals have Citizen’s Charter,
highlighting the rights of patients vis-a-vis the hospitals.
 However,
the situation is bleak in government hospitals, private hospitals and nursing
homes, more so in the former as the concept- consumer is the king- does not
exist in government hospitals. According to Alok Mukhopadhaya, chief executive,
Voluntary Health Association of India (VHAI), “The private hospitals are
overcharging and there is no check on them. In both the situations, the loser
is the gullible patient and his relatives.” There is no system of consumer
redressal in primary and secondary healthcare institutions, he adds.
In big private hospitals in metros, the consumer redressal committees are on
paper only, laments Mukhopadhaya and adds that there’s need to initiate
a consumer movement so that patients instead of being at doctors’ mercy
are informed of their rights. Though the concept of a patient grievance cell
is gradually assuming significance in large private hospitals across the country,
the hospital management have a long way to go in putting such a system in place
as compared to the west, where the system has evolved manifold.
What is a grievance cell?
According to Dr Suganthi Iyer, assistant director, medical services, Hinduja
Hospital, and a medico-legal expert, “Grievance cell can be compared to
a quasi-judicial body and is an internal inquiry cell within the hospital set-up
in order to investigate as to what actually has transpired between the hospital
and the patient.”
In such a set up, the aggrieved patient puts up his complaint or petition before
the grievance cell. “The cell should just not be defensive on behalf of
the hospital and is supposed to give a fair hearing to both the parties concerned
on the principles of natural justice in an unbiased manner,” adds Dr Iyer.
The grievance cell has the power to investigate and make decisions. However,
some experts believe that the role of the grievance cells is to explain the
adequacy and rationale of the medical care delivered. Says Joe Curian, chief
spokesperson, Association of Hospitals (AoH), “The patient needs detailed
explanation, when the cost of the treatment exceeds the indicated cost or there
is a death due to a complication that has occurred during the course of the
treatment.”
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Grievance cell in various hospitals
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| Bombay Hospital: It has
a team of administrators or a core team to look after the patient grievances.
Says medical director Dr D P Vyas, “We are always accessible on any
eventuality of patient grievance and our core team comprises of medical
director, deputy medical director, medical superintendent, deputy medical
superintendent, deputy officer on special duty and all the respective heads
of the department.”
Jaslok Hospital:
According to medical superintendent Dr J P Sharma, “Besides feedback
form given to patients, there is a suggestion box, where the patients
can post their complaints in written format. The box is opened by the
medical superintendent under the strict supervision of a hospital staffer,
deputed by the medical superintendent for ensuring confidentiality and
security of the complaints.”
Hinduja Hospital:
The Hospital has a patient relationship department handled by a dedicated
team of customer service executives (CSEs) for the redressal of patient
grievances on a daily basis. According to Anupam Verma, director, administration,
Hinduja Hospital, “The cases are first taken up by the CSEs and then
forwarded to the management team or the respective head of the departments.”
CSEs are empowered by the core committee of the hospital to solve cases
of patient grievances on an urgent or priority basis. The core committee
of the hospital comprises of the Administrator, Director (Professional
Services), Director (Medical Quality and Ethics), CEO and the HR team.
The patient relationship department
resolves the grievances on a case-to-case basis within seven days. Generally,
three to four cases of critical nature are resolved in a month.
Sir H N Hospital:
The hospital has a floor supervisor and a public relation officer, who
visits every patient daily and receives complaints and grievances. An
officer looks after the administration of the hospital even in the night.
Hospital administrators and trustees are always accessible to patients
and relatives. When a patient is discharged from the hospital, he/she
is given a feed back form. These grievances are studied and remedial actions
are initiated.
Rockland Hospital, New
Delhi: The hospital has a five-member redressal committee for attending
to the complaints of patients. The hospital’s complaint box is opened
on a weekly basis to address the issues.
Post Graduate Institute
of Medical Education and Research (PGIMER), Chandigarh: The hospital
has a six member redressal committee under the chairmanship of a senior
professor. Other members are from the medical fraternity, except the convener.
Besides suggestion/complaint boxes, people can voice their grievances
directly to the medical superintendent or even the director. The committee
holds its meeting every month, the feasible suggestions are implemented
and issues are taken up. The Citizen’s Charter of PGIMER, Chandigarh
is currently awaiting approval.
Dharamshilla Cancer Hospital:
According to director Dr S Khanna, “We have a very strong redressal
system. There’s a central complaint register at the front desk and
satellite complaint registers at all counters.”
Complaint register is sent to the director
on a daily basis. The hospital has a Preventive Action Group (PAG) comprising
of five members, which include medical superintendent, deputy medical
superintendent. The meetings take place every day with all the concerned
departments. Patients are given customer feedback forms at the time of
admission, which they are asked to fill up upon discharge.
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Importance of grievance cell
The grievance cell helps to reduce frivolous litigation in consumer courts.
Opines Dr Lalit Kapoor, chairman, medico-legal cell, Association of Medical
Consultants (AMC), “The grievance committee ensures that any case of patient
dissatisfaction is resolved at the earliest to avoid any medico-legal implication.”
According to Dr R K Anand, medical director, Jaslok Hospital, “The number
of medico-legal cases in Consumer Courts can be reduced if patients’s complaint
is heard by the grievance cell in hospitals. During my tenure with the Association
for Consumers Action on Safety and Health (ACASH), I observed most of the cases
related to patient grievances were not due to medical negligence but were attributed
to the lack of communication between the doctor and the patient.”
Twenty five per cent of the cases taken up by the grievance cells are sorted
out by explaining to the patient, the nature of shortfall on the part of the
hospital or hospital authority, say experts. The remaining 75 per cent of cases
go to consumer courts(CCs).
Experts say that the patient should avoid approaching CCs as the judgement is
delivered only after four to five years. “The patient approach the CCs
or the so-called patient friendly courts primarily because they do not have
to hire a lawyer and pay any fees, ” informs Dr Kapoor.
The setting up of grievance cell enhances doctor-patient relationship. “The
patients and doctors are vulnerable to lawyers called as ambulance chasers,
who incite the patient to file mischievous or frivolous litigation against the
doctors. This has affected the doctor-patient relationship to a great extent,”
opines Dr Kapoor.
To enable government hospitals to constitute a grievance cell, experts suggest
decentralisation of medical services, whereby cases of patient grievance can
be referred to secondary/tertiary care hospitals.
(With inputs from Sapna Dogra, New Delhi)
shardulnautiyal@rediffmail.com
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