How to Respond to Complaints

While almost anyone can take a complaint, there is much more to it than just writing down a person’s name, address, the location of the incident, and summing up the allegation in a few sentences. How you initially handle a complainant directly relates to how cooperative the complainant will be in the future and how successful your investigation will be.

Complaints can be received from any number of sources. In my experience the majority of complaints are received via telephone, however they can also be received by letter, elected officials, government Web sites, community boards, hospital staff and the media.

However the complaint is received, it is important that it be addressed in a timely, caring, professional, and fair manner. In the emergency ambulance business, almost any complaint has the potential to “blow up” if it isn’t handled properly.

The Art of Receiving the Complaint

If staffing allows, you should have a seasoned investigator receive the complaint, someone who has previously spent time on an ambulance, or in your communications center, someone who can be sympathetic, polite, and who can calm the complainant down so the dialogue is fruitful for both parties. This person must be able to obtain the necessary information from the complainant without causing agitation. You require certain information, and at the same time the complainant needs to feel satisfied that his or her complaint has been heard and that an investigation will occur. The investigator’s tone of voice needs to be reassuring while also conveying that he or she is in a position of authority. The key to the complaint-intake process is that the investigator needs to actually listen to what the complainant has to say.

There are obvious questions that routinely should be asked relative to the scenario of the complaint. This may sound elementary, but this may be the only time you are able to speak to the complainant, so you need to take investigative advantage of the situation.

Another benefit of having a seasoned investigator receive the complaint is that many times someone will be complaining about one or two things, but as the complaint scenario unfolds the seasoned investigator will realize that there are additional areas that require investigation. The seasoned investigator should note these areas but not necessarily alert the complainant that the scope of the investigation has just widened. All the issues should be investigated, and future dealings with the complainant should be limited to the issues that the complainant originally raised, unless of course the newly identified issues are so serious that your complainant will be required to be a witness at a subsequent hearing regarding the complaint.

The assigned investigator should develop good rapport with the complainant. This is important for a variety of reasons. You may require the complainant’s assistance to help locate a witness or to testify at a subsequent hearing. You want the complainant saying to others that you were a caring, compassionate professional and took his or her concerns seriously.

The investigator should never editorialize to the complainant that a particular action alleged to have been taken by the ambulance crew was incorrect. If the investigator does make such a comment, the complainant will probably quote the investigator at a later date. The proper response by the investigator would be to say something like the matter will need to be investigated and more information obtained before a comment could be made.

I can understand an investigator’s reasoning for initially wanting to explain away a particular action when receiving the complaint. He or she might feel that by explaining the action there would be no valid complaint, or there will be one fewer allegation to investigate. As well-intentioned as the investigator might be in wanting to explain away an action, it is likely that he or she would not have all of the available information at the time of the explanation, which might compromise his or her career if he or she explained an action without first investigating it.

The complainant may be complaining about one crew member but may not initially provide enough information for you to identify the crew member in question. You should work with the complainant with the objective of understanding which crew member they are referring to. If the complainant doesn’t have the crew member’s name, you can have the complainant identify the crew member either by a physical description or by comparison to the second crew member outlining any distinguishing characteristics.

If the complaint involves the recent death of a family member, I have found that it is sometimes better to make the initial complaint intake call somewhat brief. In situations like this, you should conduct a second follow-up interview (telephone or in person) a few days later. By doing so you are allowing the complainant adequate time to begin the grieving process with the reassurance that an investigation is being initiated. When the follow-up conversation is conducted, the complainant is usually calmer. In situations like this, the follow-up interview would be the time you should pursue any required details that you weren’t able to initially obtain.

After you have obtained the scenario of the complaint and have asked all the preliminary questions that you need to, this is the time to completely identify all the witnesses from the complainant’s perspective who were at the incident location. My experience has shown that if you don’t do this when the complaint is received, witnesses later tend to come out of the woodwork, usually at the most inopportune times. I call this witness growing. If the issue of identifying all the witnesses is not initially addressed, it is difficult later on to determine if this newly identified person was actually a witness. Additionally if witnesses subsequently come forward that you should have known about but didn’t, it may be suggested that the investigator did not do his or her job. By initially identifying all of the witnesses who were on the scene as far as the complainant is concerned, you basically have a controlled group of witnesses, which means that you will mitigate the possibility of a new witness appearing after your investigation has been completed.

Another important step you should take is to determine if the complainant (or any witness) would be willing to testify at a formal hearing should it be necessary. Whether or not an individual will testify, you will still process his or her complaint. However if the witness is not willing to testify, that may place limitations on the outcome of your investigation. It certainly will put limitations on any disciplinary action that might be taken as a result of your investigation.

It is also very important at the time that the complaint is received to advise the complainant about the specific type of response he or she can expect to receive at the conclusion of the investigation. I can’t emphasize enough how important this is. What you explain to the complainant will directly relate to the correspondence guidelines of your organization. Whether he or she will receive a letter detailing the results of the investigation (which I do not recommend) or just receive a letter acknowledging the complaint and indicating that an investigation has been conducted (which I do recommend), this needs to be clearly stated during the intake conversation. If you don’t initially make this perfectly clear, you can expect follow up phone calls from the complainant looking for an update or a final disposition for the complaint. With each additional phone call, the complainant will become increasingly frustrated with you while you will find it increasingly more difficult for you to appease him or her. It should be documented on your complaint form whether or not the complainant actually initially requested a response to the complaint. Not every complainant will request a response.

When you receive a new complaint you should record the telephone conversation (check your local laws before doing this). You should advise the complainant that you are recording the conversation. Most complainants will not object. If a complainant does, explain to him or her that it is part of the normal nature of your business, and that you want to make sure that you have an accurate record of the complaint. By recording these calls, you have created evidence that will be discoverable if the matter ever goes to a hearing. Once you create such a recording, you must preserve it and document its existence.

How Much Information Is Enough?

The answer to this question is directly related to the allegations that are being made, as well as the condition of the patient. If the allegation is not serious, let’s use a low-level discourtesy complaint as an example, and assuming there is no major issue with the patient, you don’t necessarily require an overabundance of information, so you don’t need to dig too deeply. If on the other hand the complainant says something that makes you uncomfortable, you should ask a few additional questions. You being uncomfortable, which is also called a gut feeling, will come from your years of investigative experience, and it may unearth more serious allegations.
The downside to asking too many questions about a less serious complaint is that once your questions are answered, your minor complaint may have just grown into a major complaint. Once you have information that makes it a major complaint, you have to investigate it that way. If you don’t pursue the matter this way, you are “failing to act.” If you fail to act, you could be in trouble both administratively and criminally.
Another issue to consider is that all the complaints that your investigative unit receives have to be managed. Internal investigations, which are investigations of the most serious allegations, should be your bread-and-butter investigations. Too many open internal investigations in the unit at one time will certainly back things up. Complaints that pertain to patient deaths and serious patient care issues should be investigated internally no matter how many additional open internal investigations you have. Less serious cases should be referred out to commands within your organization for investigation. Some months you will refer more cases, and some months you will refer fewer. Referrals are like a relief valve for case management. The more cases that you refer, the more time you will be able to dedicate to the more serious internal investigations.

You shouldn’t routinely be making major cases out of minor ones, at least not without a valid reason. As an investigator, this point may conflict with what you were taught. Certainly you were taught to be thorough, and you should be. New investigators may find this point difficult to understand. New investigators want to show their supervisors that they know what they are doing and may initially tend to dig deeper into a matter than they need to. My view is that this is a good investigative trait for a new investigator, and it shouldn’t be initially stymied. Only time and experience will teach the new investigator what the proper level of questioning or digging is. For him or her to properly learn this, you are going to have to let him or her completely conduct a few investigations concerning cases where he or she initially asks too many questions. Let the new investigator develop these cases and interview all the witnesses and employees. After investigating just a few of them, the new investigator will come to the conclusion that these cases weren’t as serious as originally thought, and in fact they could have been referred to command rather than investigated internally.

The Basics

It is just as important to accurately obtain all the information that goes on to the complaint form, as it is to be accurate in all other parts of the investigation.

NAME, ADDRESS, AND CONTACT NUMBERS

You can conduct the most in-depth investigation possible in which you substantiate all the allegations, but if the complainant receives correspondence with his or her name misspelled, it won’t matter how complete your investigation was. In the complainant’s eyes you were as incompetent as the people about whom he or she originally complained. The complainant’s address should also be recorded accurately, including the zip code.
In this day and age it’s important that you obtain all of the complainant’s contact information, including an e-mail address and cell phone number. Everyone knows he or she needs to obtain the complainant’s home and work phone numbers. I recommend that you also obtain the complainant’s cell phone number and e-mail address. The complainant may initially be reluctant to provide this information, so take the time to explain how important it could be. This extra contact information is especially important if your case will be going to a hearing that can occur many months after you have completed your investigation.

By having obtained all possible contact information, you have a decent chance of reaching the complainant if you need to do so.

INCIDENT LOCATION

When you originally receive the complaint, the complainant may or may not know the exact location of the incident or may provide an address that doesn’t match your 9-1-1 computer records. I have seen instances in which the complainant, who was the patient, had no idea where he or she was picked up. The only thing he or she knew was that on a certain date he or she wound up at a specific hospital and was told that he or she had arrived by ambulance. Researching such a scenario shouldn’t be too much of a problem if you are able conduct a computer search of your organization’s ambulance responses by hospital destination. If you can’t, then you will probably have to spend some more time on the phone with the complainant, trying to determine where he or she was coming from or going to at the time, the approximate time of day, his or her age, what he or she was wearing, and the intended description, and anything else to help you identify the call. If a copy of the Ambulance Call Report is normally placed in the patient’s hospital medical record, and you can always look there for the call location.

DATE OF THE INCIDENT

I have found that there is more of a chance of a complainant providing a wrong incident date rather than a wrong location. If the incident occurred around midnight, it is possible that the complainant inadvertently provided you with the wrong date. The reason for this is that the ambulance arrived after midnight, but because the original 9-1-1 call was made before midnight, the official date of the call will coincide with the time that the 9-1-1 call was made, not the arrival time of the ambulance.

If the alleged incident occurred weeks or months in the past, in a non-confrontational manner you should inquire why it took so long to make the complaint. There could be various reasons. Some are:
• The patient was just released from the hospital.
• He or she didn’t know how to file a complaint and just found out how to do so.
• He or she just received an ambulance bill.
• He or she simply forgot.

SCENARIO OF THE COMPLAINT

I always tried to document the scenario of the complaint using the same basic terminology that the complainant used. I would not use technical medical words if the complainant hadn’t used them. If the complainant did use technical words to describe the complaint, I documented these words using quotation marks so that the assigned investigator would have an idea of the type of complainant with whom he or she would be dealing. To me the use of technical terms was rare and suggested knowledge of or employment in the health care field. It is even more important to use the complainant’s own words if the complaint is something allegedly said. You want the exact quote. This way you will have some information to compare with when you interview other witnesses or re-interview the complainant at a later date. You don’t want to put words into the person’s mouth. If the complaint turns out to be a serious one, and the case subsequently winds up at a disciplinary hearing, your initial complaint form will certainly come into play. The complainant will be asked if he or she actually said what the complaint form documents. If you used a technical term rather than the complainant’s exact words, the complainant may indicate that he or she didn’t use that term. That type of answer could hurt your case.

LOCATION OF INCIDENT IDENTIFICATION

The next step is to identify the specific incident location. This is done by computer research of the 9-1-1 calls to which your organization’s ambulances responded. Once the particular assignment is identified, a computer printout should be obtained. These printouts display a chronological listing of events that transpired during the call. They should document: the time that the call was initially received; the time and identity of all resources that were assigned; the time of their arrival at the scene; the time that the patient was transported to the hospital; the identity of the hospital; and the time that the ambulance arrived at the hospital.

You should verify the identity of the responding ambulance crews. It is very important that the crew identification is accurate. If you don’t obtain accurate information you may end up calling in and interviewing an employee who was not on the subject call. Trust me, there is nothing more embarrassing than calling an employee into your office for a subject interview, and when he or she is sitting across the table from you with his or her union representative or attorney, you realize he or she wasn’t involved in the subject call.

Complaint Form

Once you have received all of the information about the complaint and identified the subject call, the information needs to be transferred to a complaint intake sheet (complaint form). This should be a preprinted form or computer entry mask that includes at least the following fields:
• The date and time that the complaint was received.
• How the complaint was received.
• The phone number on which the complaint was received.
• The identity of the investigator who actually received the complaint.
• The name, address, phone numbers, and e-mail address of the complainant.
• The name, address, phone number, and e-mail address of any witnesses identified by the complainant.
• The relationships, if any, between the complainant, witnesses, and the patient.
• The name, address, and contact numbers of the patient.
• The basic scenario of the complaint.
• The type of complaint (check box selection that directly mirrors your database complaint type categories).
• The location of the incident.
• The date and time of incident.
• Whether the complainant requested a response.

For more than 30 years, Steven Gilbert conducted thousands of emergency ambulance investigations for the NYC Emergency Medical Service and then for the NYC Fire Department after EMS and the fire department merged. He became director of the investigative unit in the mid-1980s and retired in 2011.