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People complain when they are dissatisfied. Add the anxiety, confusion, and potential peril of an emergency and the number and seriousness of complaints increase. For example, a mother brings her tearful 3-year-old to the emergency department (ED) because of a wrist injury. After waiting 3 hours, the child is seen by a hurried nurse and then once (for 2 minutes) by a physician, who performs a limited examination, barely speaks to either mother or child, but does mention a fracture. The patient is discharged with a splint and written instructions. Two days later, the child goes to his family practitioner, who refers the family to the orthopedist. The orthopedist complains about the ED care. One month later, a very dissatisfied parent receives an ED bill for $550.00. She is angry and on the phone waiting to speak with you.

Complaint recognition and management are critical components of the successful ED. When handled properly, a dissatisfied and angry person can achieve satisfaction. Alternatively, the improper management of a complaint can lead to a disgruntled person who seeks retribution. The benefits of effective complaint management go beyond meeting the perceived needs of the individual complainant. Institutions that recognize the importance of the consumer seek opportunities to improve by taking steps to reduce the root cause of dissatisfaction.

All EDs receive complaints. Inevitably, some people will voice their dissatisfaction with the quality of care, length of stay, attitude of providers, or cost of care. The approach of the department team and the institution distinguishes the organizations seeking improvement and satisfaction from those destined to repeat mistakes. To develop an effective approach, it is necessary to first understand why people complain.

We all experience dissatisfaction with some interactions because “reasonable” expectations go unmet. The ED is particularly prone to create dissatisfaction among those who use its services. Patients, private physicians, emergency medical services (EMS) providers, and staff all enter the ED with expectations of rapid, quality care by an attentive and kind staff. Unfortunately, it is impossible to always meet these expectations.

The Complainer

Why do people complain? Generally, people are dissatisfied when their expectations go unmet. If, in addition, they perceive that they have been inconvenienced and treated rudely, they are much more likely to voice their dissatisfaction in the form of a complaint.

Brief Relationship

Although the reasons for patient dissatisfaction are myriad, certain generalizations can be made. The duration of the relationship between the healthcare provider and the patient is positively correlated to patient satisfaction.1,2 The longer the relationship, the more satisfied the patient. The relationship between an emergency care provider and the patient is measured in minutes rather than years. This brief exposure allows little opportunity to develop the bond that may exist between a patient and a private physician.

Effective Communication

Patient expectations of ...

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